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Nursing home staff under stress

As Nursing Homes Fail to Evolve with Resident Needs, the Staff Takes the Blame

Numerous studies have shown that the key indicator of quality in a nursing home is the ratio of nurses to patients. Today’s nursing home resident has a complex and time-consuming set of needs to ensure their health and overall well being. Despite the increasing demands being placed on nursing home staff, the for-profit nursing home industry continues to keep staffing levels dangerously low in order to push for higher profits. The pressure of understaffing creates a situation where there is not enough time in the day to meet the needs of residents. That means dangerous and miserable conditions for residents and high turnover and low morale among nursing home staff.

“It might be easy to blame the staff member when you have a situation of nursing home abuse or neglect. The reality is usually that the nursing home has created an unsafe workload that cannot be managed properly with the staff they have, and they know it.” said Leah Barron, a founding partner at Brown & Barron, a law firm specializing in nursing home cases.

When nursing homes were first envisioned, it was a place where elderly residents could get assistance with a number of daily activities, such as getting dressed, bathing, and eating. That is still the case. However, as medical science has progressed, people are living longer in nursing homes, but that often requires a complex regimen of medicines and care. That responsibility has fallen upon the staff of nursing homes. Although the nursing home worker is picking up the slack, the nursing home industry has not adapted to that challenge.

Asking Fewer Nurses to Do Much More

The vast majority of nursing home health care workers are certified nursing assistants (CNAs). These are the people with the lowest amount of training, and they are also the lowest-paid workers in health care. Yet these are the people tasked with the health needs of some of the most elderly and sick people in our society. The complex needs of residents can include such tasks as:

  • Tracheostomies
  • Complex wound care
  • Surgical site drains
  • Total parenteral nutrition (feeding tubes)
  • Assisted ventilation
  • IV medications

You might expect a doctor to handle this sort of work, but in a nursing home, this work is divided among the CNAs with a certified nurse on duty to manage the CNAs. Most certified nursing assistants care for about 15 patients per shift, but that number can get much higher. In a Nurse.org article, Portia Wofford reported the results of a survey of CNAs in a private Facebook group, and she found the following patient-to nurse and patient to CNA ratios:

  • 32:1 nurse and 16:1 CNA- Ohio
  • 44:1 nurse and 44:2 CNA- Tennessee
  • 50:2 nurse and 15:3 CNA- New York
  • 66:2 nurse and 66:4 CNA- Illinois
  • 50:1 nurse and 30:1 CNA- Georgia
  • 60:1 nurse and 60:3-4 CNA- Nebraska

The main problem is that there are no federally mandated staffing ratios for nursing homes. The COVID disaster in nursing homes, in which some 40% of all COVID deaths occurred in the U.S., created renewed political pressure, and a few states have begun introducing legislation to set standards.

Systemic Failure

The for-profit nursing home industry in America is aware that it is endangering the lives of residents with low staffing levels. In a for-profit business model, the key to higher profits is to raise revenue to what the market can bear and to keep costs as low as possible. In the for-profit world of nursing homes, the revenues are fixed because most of the funding comes from the government through the Centers for Medicaid and Medicare (CMS). So with prices basically set in stone, the way that nursing homes drive higher profits is by skimping on the cost of delivery, namely by slashing staffing costs to the bare minimum. Aside from the threat of fines and lawsuits, they have no financial incentive to make their nursing homes safer with more and better trained staff. In California, they tried paying nursing homes more in 2006, and the money did not make it to the staff, so while the nursing homes became more profitable, there was no increase in quality.

“The for-profit health care model is an inherent failure, and the dismal history of the for-profit nursing home industry is proof,” said Brian Brown, a founding partner with Brown & Barron.

To learn more about your legal rights and options, contact Brown & Barron’s Baltimore attorneys online or at (410) 698-1717 for a free consultation.

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