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Nursing Home Negligence - Understaffed

Understaffed Nursing Homes

Nursing homes are notoriously understaffed. Studies have shown that residents who live in understaffed nursing homes are at a greater risk of malnutrition, weight loss, bedsores, dehydration, infections, and pneumonia. Furthermore, as the patient to staff ratio increases, neglect and abuse occur more frequently. The neglect and abuse suffered by patients can cause physical ailments, psychological disorders, and even death. (nursinghomeabuseguide)

The are several reasons why nursing homes are understaffed. One of those reasons—not surprisingly—is the cost. Labor costs are very high, and consequently, some nursing homes cannot afford as many registered nurses and certified nursing assistants as they need to adequately care for their residents. Some nursing homes struggle to find, and to retain, qualified medical professionals, causing the facility to be understaffed. Some nursing homes experience a high turnover rate because they over-work their employees. (nursinghomeabuseguide)

Minimum Staffing Requirements

Federal law requires Medicare and Medicaid certified nursing homes to have a registered nurse (RN) on duty at least 8 hours a day, 7 days a week, and a licensed nurse (RN or LPN) on duty 24 hours a day. However, there are no minimum staffing requirements for nurse's aides, who provide most of the day-to-day care. Additionally, nursing homes must provide a minimum of 75 hours of training for the aides. (
Many states have standards which are higher than the federal requirements; however, those standards are still below the levels recommended by the CMS. According to a study by Charlene Harrington, a UCSF School of Nursing professor, “the key to improving nursing home staffing levels is increasing state standards. The study revealed that states with the highest standards for nursing staff levels are the only states where nursing homes have enough staff to prevent serious safety violations. According to the study, the act of raising the state minimum staffing ratio has a direct impact on the quality of care nursing home residents receive. (
north carolina Nursing Homes

North Carolina has over 400 nursing homes with over 36,000 residents. ( All long-term facilities must be licensed through the NC Division of Health Service Regulation. The type of licensing required depends on the number of residents. All staff must undergo training which covers, but is not limited to, medication training, infection control, abuse, neglect, and exploitation.

North Carolina is also required to follow all federal laws pertaining to elderly care, including the Elder Justice Act (EJA). The EJA was the first piece of federal legislation passed which authorized federal funds to address elderly abuse, neglect, and exploitation. In part, the EJA provides:

• Authorizes grants to support improvements to Adult Protective Services (APS) and Long-Term Care Ombudsman programs and state survey agencies for Medicare and Medicaid certified long-term care facilities;
• Authorizes grants for the training for APS, Ombudsman, federal and state surveyors of nursing facilities;
• Authorizes grants for forensic centers to develop expertise on elder abuse, neglect, and exploitation; and
• Enhances long-term care staffing, data exchange in facilities, mandatory reporting of crimes against residents in federally-funded facilities, promulgation of guidelines to assist researchers, and authorizes a study on a national nurse aide registry.

Nurse Staffing Requirements In North Carolina, 10A NCAC 13D .2303

(a) A facility shall provide licensed nursing staff sufficient to accomplish the following:
(1) patient needs assessment;
(2) patient care planning; and
(3) supervisory functions in accordance with the levels of patient care advertised or offered by the facility.
(b) A facility must have sufficient nursing staff to provide nursing and related services to attain or maintain the physical, mental, and psychosocial well-being of each patient, as determined by patient assessments and individual plans of care.
(c) A multi-storied facility shall have at least one nurse aide on duty on each patient care floor at all times.
(d) Except for designated units with higher staffing requirements noted elsewhere in this Subchapter, daily direct patient care nursing staff, licensed and unlicensed, shall include:
(1) at least one licensed nurse on duty for direct patient care at all times; and
(2) a registered nurse for at least eight consecutive hours a day, seven days a week.
This coverage may be spread over more than one shift if such a need exists. The director of nursing may be counted as meeting the requirements for both the director of nursing and patient staffing for facilities with a total census of 60 nursing beds or less.

The requirements for nursing aides can be found in N.C.G.S. 131E, Article 15.

North Carolina Penalties

A Type A violation means that a condition(s) has resulted in death or serious physical injury to a resident. The penalty for a Type A violation is between $1,000 and $20,000. Revocation of license and/or jail time may be imposed depending on the severity of the violation.

A Type B violation occurs when an identified condition impacts the quality of care of the residents in the facility but has not been corrected by the facility after the state has notified them of this violation. A Type B violation offender can incur a fine of $400 per day for each day the facility fails to correct the issue.

There is no excuse for the abuse of a vulnerable adult. If you suspect your loved one is suffering from nursing home abuse, please call (704) 714-1450 today to make an appointment to speak with a Charlotte Nursing Home Abuse Attorney, or stop by the office during regular business hours. There is no fee for the initial consultation.

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