Nursing Home Patients Suffer From Staff Shortages

The abuse of nursing home and assisted living facility patients has hit an all-time high in the United States. This is partly related to the number of such patients and nursing home owners’ efforts to increase profits. One of the biggest problems is preventing falls and subsequent injuries, including traumatic brain injury and pelvic fractures. Preventing such outcomes relies on adequate staffing to provide patients with the level of care each requires.

High need or acuity patients are those who require higher levels of intervention and observation. To meet their needs, the facility must provide adequate skilled nursing, which has been shown to increase care quality. Without this, the facility residents are at higher risk of injury and, in some cases, death. 

The standard for the number of nursing staff per patient is regulated in California. The total number of nursing staff who provide patient care compared to the number of patients was increased on January 1, 2020, under AB 2079. This bill, which amended Health and Safety Code 1276.65, changed the ratio from 3.2 to 4.1 for skilled nursing facilities.  

There is a trend among many nursing care facilities to accept as many high-needs patients as possible. The reimbursement rate for these patients is high. Some nursing homes fail to abide by the ratio of skilled nursing caregivers per patient to increase the overall profit of the facility. This leaves the resident in a dangerous and sometimes deadly situation. Beyond state regulation, the federal government also has legal mandates in place to protect patients. Some California nursing home owners try to sidestep the rules using waivers and outright disregard for the number of hours their residents require.

Ambulatory patients in skilled nursing facilities present a problem if the number of available nurses is inadequate. Some nursing homes use alarms that alert nurses when a patient leaves a chair or bed if they are required to be supervised at all times to prevent falls. However, the alarms may go unanswered or ignored or be dismantled, allowing the patient to roam without needed supervision. 

Some nursing home owners report they dismantled the alarms because they were upsetting to the patients and interfered with routine. In reality, the alarms are only upsetting to other patients if they continue to ring. Having an adequate number of nursing staff easily solves this problem as each nurse attends to their charges. 

Other ways of discouraging patients from walking without supervision are often lost on patients with dementia. These include instructions to call the nursing desk to ask for help.

One of the biggest problems in investigating inadequate care is access to pertinent information. Nursing home owners and staff may try to hide or destroy incriminating proof of lack of care. Video cameras are often used in nursing care facilities, and altering the footage to disprove a claim against the owner after a serious injury or fatality occurred is problematic. Likewise, charts can be altered to change the sequence of events, or notes can be added or removed. 

Prior employees are a source that gives the investigator a glimpse into the way the facility is run. The previous employees will provide information about nursing shortages and complaints by families and other staff in some cases. The staff’s competency relies on sufficient training, and in some instances, the level of training may be inadequate. This can be easily evaluated. Another way to prove the lack of care is to evaluate the facility’s own investigation after a serious injury or fatality. Many owners fail to institute a proper investigation to make changes to correct the issues involved.

Roughly 300,000 Californians live in assisted living facilities. The facilities range from large to small multi-person or private rooms and suites. More people are entering residential care facilities for several reasons. The main reason is the greater freedom they provide over other restricted facilities. However, as the number of higher needs patients remain in residential care facilities rather than moving up to skilled nursing, the greater the level of care that is needed. 

An issue here is that the number of nurses employed has not kept up with the need. The risk of falls and traumatic head injuries is increased due to problems with ambulation. Some residents require assistance for all tasks of daily life, further complicating the level of care. The California Code of Regulations 87615 Title 22 limits admission to a residential facility based on physical condition. Yet, this rule is often disregarded. 

Our firm takes elder neglect seriously, and our hearts go out to families who have lost a loved one due to this outrageous situation. Our investigators tackle every case of abuse with a rigorous protocol to discover evidence. We look into ways that the nursing facility failed to provide comprehensive care for its residents. We search for different ways the facility monitors patients to avoid falls and TBIs. Since traumatic brain injury is a common aftermath of a severe fall, the nursing home must prevent them.

Our investigators interview both current and previous staff to ascertain how residents are monitored for changes in their physical capabilities and emotional status. We also look for changes in staffing as more residents with higher needs are added. Our investigative experts review charts to see if they were altered or do not show appropriate care in response to a fall or head injury. For example, hiding an acute injury by saying it happened in the past is a common ploy. In addition, we check out and obtain videos that might show injuries as they happened.

I am Ed Smith, a Sacramento nursing home abuse lawyer. The abuse of our older generation should not be tolerated. Families are often faced with taking the nursing home to task for their actions. This is where I can help. Call me at (916) 921-6400 or (800) 404-5400 for free and friendly advice. I can also be reached online if this is more convenient for you.

I’ve helped Sacramentans and Northern California residents with traumatic injuries for most of my 38 years as a personal injury lawyer. I’ve also assisted them when they faced the death of a family member.

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Editor's Note: This page has been updated for accuracy and relevancy. [cha 11.16.20]

Image by Sabine van Erp from Pixabay 

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