Long-term care costs may be rising, but the same isn't necessarily true of profits. Some long-term care facilities have experienced a decline in census along with the poor economy, resulting in tighter budgets. Administrators must find ways to accomodate for a decrease in revenue, and staffing is often an area where cutbacks are made. Each state has its own regulations regarding the staff-to-resident ratio, but cutbacks can typically be made while remaining within these guidelines.
However, in a few cases, staffing cuts put facilities under the minimum staffing requirements. For example, the Los Angeles Times reports that Skilled Healthcare Group, Inc., recently lost a class-action lawsuit for understaffing its 22 California assisted living facilities. California's law states that there must be 3.2 nursing hours per resident per day.
Cutbacks aren't solely to blame for understaffing, however. Nursing shortages are a real issue across the country. The long and odd hours often associated with working in a nursing home make those jobs less appealing to nurses than, say, a medical office position with a regular 8-5, Monday through Friday schedule. Finally, frequent call-offs leave directors of nursing (DONs) in tough positions -- if no one else can be found to take the shift, the DON has to fill in, but one DON can't replace more than one shift at a time. The other option is to utilize outside PRN (as needed) agency staffing, but this is less desirable, because PRN staff aren't as familiar with residents and facility procedures.
Understaffing creates a number of issues of serious concern. The overall quality of care declines with every staffing cut. More specifically, it takes a smaller number of staff much longer to meet residents' needs. Call bells may take longer to answer, medications may not be dispensed at appropriate times, and serious hygiene issues can occur, especially among patients who are bed-bound or incontinent.
Significant understaffing resulting in resident neglect is rare, but caregivers should be aware of potential problems. If you have a loved one in a long-term care setting, check on your state's staffing requirements. Note that the guidelines may differ between assisted living and skilled nursing facilities, and in some cases, licensing boards are different. Ask your loved one's facility what their typical staffing ratios are. Many keep current staff numbers visibly posted in the lobby -- for example, 2 RNs, 4 LPNs, and 6 nurse aids. Finally, if you ever feel as though your loved one's needs have not been met in an appropriate timeframe, make the administrator aware.