Abuse of Nursing Home Management Regulations through Under Staffing
Nursing home regulations require management to keep a certain level of staffing to ensure sufficient care. In this section of the nursing home care guide, our South Carolina nursing home neglect lawyer discusses how under staffing at nursing home can be a form of nursing home negligence.
Under Staffing
An underlying and prevalent cause of many injuries, such as the dehydration, bedsores, and weight loss, sustained by residents of nursing homes is understaffing. This simply means there are not enough qualified personnel in a nursing home to properly care for all the residents.
The primary caregiver of residents at nursing homes, meaning the one who performs most of if not all the tasks needed to take proper care of the resident, is a certified nursing assistant ("CNA"). To understand how understaffing occurs consider that a CNA typically works an 7.5-hour shift, but with two 15 minute breaks and a 30-minute meal, the CNA only has 6.5 hours of actual time to care for the residents. This allows for 390 minutes for resident care in each shift. Now consider the minutes required for a CNA to complete the responsibilities and tasks that he or she may have on a single shift when responsible for 9 residents (unfortunately CNAs are commonly responsible for 12 to 15 residents on a shift):
- 4 showers to give (60 min.)
- 5 baths (75 min.)
- 5 incontinent residents to clean/change (25 min.)
- One catheter to empty (5 min.)
- Document on the resident care charts throughout shift (25 min.)
- Change 9 bed sheets and make up beds (40 min.)
- Turn/reposition 4 bed-ridden residents every 2 hours (60 min.)
- Set up 6 meals (25 min.)
- Toilet 4 to 6 residents 2 times a shift (60 min.)
- Shave/groom/hygiene all residents (135 min.)
TOTAL MINUTES TO PROVIDE CARE: 510 MIN.
Therefore, a CNA with only 9 residents would need approximately 510 minutes to complete these tasks to adequately care for the residents. Yet, the CNA only works for a total of 390 minutes. Thus, the CNA would need 120 more minutes, or two additional hours of non-stop work, to perform the resident care responsibilities. This is if the CNA works diligently during the 390 minutes. However, many CNAs work a double shift at the facility or have another job at another nursing home, hold down two jobs due to low wages- resulting in many days of sixteen-hour workdays, and often work six or seven days per week. Meaning these 390 minutes are likely to be less than productive.
Thus, when pushed for time, a CNA will shave some time off feedings. Those who do not eat quickly will miss some calories. Over a period of time, the calories add up and an elderly person in need of all of their calories to fight off infections and to heal will begin to lose weight, develop infections, and pressure sores.
Also, instead of checking, changing, turning, and repositioning residents, they skip a turn or two. This leads to the deterioration of the skin and the development of rashes (fungal and bacteria infections) and bedsores. Fungal and bacterial infections can get into the blood stream and cause serious illness, even death. Bedsores are painful and just as dangerous.
Simply put: much of the care needed to ensure the residents are safe and healthy is neglected because the CNA cannot perform the work by her or himself.
An accurate calculation of a facility's staffing needs can be complex. It requires an assessment of the specific needs of that facility's residents (for example the more residents who are incontinent and suffer from dementia the greater number of staff needed to provide adequate care). But there are a few good rules of thumbs: there should be a minimum of 1 nurse per shift per 20 residents and the "average" resident needs at least 3 hours of CNA care per day. To calculate hours of CNA care per day, take the number of CNAs that work on that day, multiply by 7 (hours) and divide by the number of residents. This is the hours per patient day of care for each resident. It should be at least equal to 3 hours.
At the back of this book we have staffing information for most upstate nursing homes. This information is available at www.medicare.gov. Click on "Nursing Home Compare." Use the information about a nursing home's residents (such as number with incontinence) to see if the resident mix is one that will stretch the demands of the staff compared with other nursing homes under consideration.
Contact South Carolina Attorney Andy Arnold for Your Nursing Home Negligence Case
Under staffing by nursing home management violates regulations in place to protect the residents of long-term care facilities. Violating these regulations is a form of nursing home neglect. The management of nursing homes should be held responsible for negatively affecting their patients' health and care. Contact South Carolina neglect attorney Andy Arnold in Greenville, SC to set up a free consultation.
