Under-staffing in nursing homes is an ongoing problem that stems from the fact that staffing a facility is usually considered the largest overhead component. By reducing staffing levels or hiring staff with less experience– and hence a lower salary– nursing home operators can extract more revenue from each facility. When cost cutting methods are applied to a nursing home operator who may control many facilities and hundreds, if not thousands of beds, the increased revenue can be substantial.
Less Staff, Less Care to Patients
The downside to the issue of reduced staffing in a nursing home setting is that when staffing levels are reduced, patients tend to receive a diminished level of care. The insufficient care tends to bring about complications that arise when patients’ needs go unmet over extended periods. Basic things such as ensuring that each patient receives adequate hydration may seem like an easy task, but when a significant percentage of the residents require assistance to access the fluids, such a basic task turns into a great deal of work which requires the patience of skilled workers.
Similarly, even for patients who are physically able, an inadequately staffed facility may result in situations where staff are forced to fend for themselves in a manner that may endanger themselves. A patient needing to use the toilet– may be forced to navigate their way to the toilet which can easily result in a fall or injury when then get out of their bed or onto the commode.
Getting Caught in the Act
Despite the inherent dangers to patients that result from a skilled nursing home operation that is insufficiently staffed, operators regularly find ways around to skirt around a growing body of regulations put in place by state departments of health to deter the practice. Perhaps the best known example of a nursing home literally getting caught ‘not doing their job’ was when a class action lawsuit was filed against Skilled Healthcare on behalf of 32,000 past and current patients at the facility. The case went before a California jury in 2010 and a $677M verdict was rendered against the operator for its systemic under-staffing. While the matter was resolved for substantially less during the appeal process (approximately $50M) the case was quite significant as it was really the first time an operator had been taken to task for intentionally under-staffing their facilities.
Times must be quite good at Skilled Healthcare, because apparently a $50 million payout wasn’t sufficient enough to get the operator to begin to change their ways in terms of staffing their facilities. According to a recent Los Angeles Times article, a settlement agreement was recently reached between Skilled Healthcare and the California Attorney General– relating to– yes, you guessed it– under-staffing at their facilities. In the wake of the settlement, Skilled Healthcare promises to hire more staff at their facilities and will pay for an independent group to monitor the implementation.
$50 Million & Years Later- Not Much Change
Citing on-gong problems at the chains facilities between 2008 and 2012, the California Department of Public Health issued 76 citations to the companies various operations for problems such as: dehydration, malnutrition, bed sores and over-medication. According to Attorney General Kamala Harris, “[a]t a time when California’s elderly population is growing twice as fast as the general population, family and friends should have peace of mind that their loved ones are being well cared for when they are in a nursing home setting.”
As a nursing home neglect attorney, I most definitely agree. However, when operators provide inferior care and are allowed to remain in operation, I question how effective the A.G’s words may be. Until, operators truly understand that they must comply with the law– or leave the business entirely– chronic staffing problems in nursing homes with remain a significant threat to the safety of our elders.