The fact that facilities are short staffed when it comes to nurses is not surprising. We have been hearing about a nursing shortage for years now, but the situation in nursing facilities is approaching dangerous levels. Researchers from Harvard and Vanderbilt medical schools examined records from 15,399 nursing homes covering April 2017 through March 2018 and concluded that three-fourths of the nation’s nursing homes never meet federal staffing expectations for registered nurse staffing.
Study co-author David Grabowski, a professor in the Department of Health Care Policy at Harvard, said he found the RN data “‘staggering,” commenting that 75% of SNFs were almost never in compliance with the Centers for Medicare & Medicaid Services’ expectations for staffing given their residents’ acuity levels. Weekends are a particularly challenging time for staffing in these facilities, with lower levels of all nursing care reduced on Saturdays and Sundays. One time when staffing levels spikes is in the two weeks around a survey team’s visit.
Part of the issue is that nursing homes are no longer just for geriatric residents. Residents enter facilities sicker, the acuity level has increased, and the role of the facilities has expanded. LTC and SNF care for patients with higher-level nursing and rehabilitation needs. These more medically involved residents need more care and attention to be safe. Understaffing is often the root cause of abuse and neglect in nursing homes. Nursing staff are unable to give each resident adequate attention, and overworked and stressed staff increases the risk of mistakes and committing abuse.
A focus on just numbers however ignores training, experience and management of a facility. All factors need to be addressed to improve the safety of nursing homes for both the resident and the nurses.