Having enough nursing staff at a nursing home is crucial to ensuring that the home’s residents get the care and treatment they need. Fortunately, Pennsylvania has enacted a state minimum for nursing home staff levels, and that minimum just increased beginning July 1, 2024. Now, Pennsylvania nursing homes are required to have enough nursing staff to provide 3.2 hours PPD, or “per patient day. ” This is up from 2.87 PPD as of July 1, 2023, which was an increase from 2.7 PPD before that. Federal law only vaguely requires all nursing homes to provide enough staff to safely care for residents, so it is only this Pennsylvania state minimum that provides a specific minimum for PA nursing homes.
This increase is an “important step in the right direction,” and a win for nursing home residents across the state, as higher staffing levels result in more hands-on care for the residents. However, the National Academies of Sciences, Engineering, and Medicine (NASEM) have recommended as much as 4.1 hours PPD. Even the Centers for Medicare and Medicaid Services recognize the importance of staffing levels, finding a direct correlation between nurse staffing ratios and nursing home quality of care in a CMS staffing study. This study also recommended 4.1 hours PPD. So, while we can be grateful that Pennsylvania has raised the minimum PPD for our nursing homes, it likely is still not high enough.
The connection between staffing and providing care to the residents is obvious. Without proper staffing, even the best-intentioned nurse or aid would be unable to properly care for all of their residents. These caregivers are only human, and when they are tasked with caring for too many residents during their shift, they simply won’t have time to provide meals, toileting, medication, and bathing for all of them while also dealing with any new conditions or emergencies that may arise during their shift.
Numerous studies have confirmed this link between staffing and the care received by residents of nursing homes. Inadequate staffing can lead to the nursing staff not being able to provide all the care necessary to all the residents, and then not being able to document the care that they are able to provide. This problem snowballs when the next shift comes in and is still understaffed, and now doesn’t even know what care has already been provided.
Understaffing at nursing homes also contributes to residents’ incontinence as nursing staff consistently have to deal with more “urgent” issues rather than assisting the residents with proper toileting. When nurses and aids simply don’t have the time to assist every resident with going to the bathroom every shift, this too can lead to further issues, such as UTIs and fecal
impaction. In an effort to save time, some staff may attempt to rely on absorbent pads or special undergarments, allowing residents to go without assistance. However, these still need to be changed and cleaned, and residents are often left sitting in their own waste, sometimes for hours, before staff has a chance to clean them up.
While nursing staff do what they can during their shift, it must be noted that the nursing staff themselves are rarely the cause of these understaffing issues. In fact, in October 2023 the SEIU Healthcare Pennsylvania (PA’s caregivers’ union) marched in support of proper staffing and owner accountability. A speaker at that march explained succinctly: “The problem is that [the corporate owner] doesn’t want to pay for more staff. They would rather you work short.” Ultimately, the nurses can only work as long as they are being paid, and if the owners refuse to pay for enough staff, all they can do is make their voices heard.
More recently, in May 2024, SEIU Healthcare again spoke out about the staffing crisis for caregivers. Speaking at that event, a 16-year RN confirmed what the above studies showed as she stressed the need for higher standards for staffing: “giving patients more time and attention would lead to better outcomes and help retain nurses in our hospitals.” Having stricter staffing standards, and enforcing those standards, emphasizes the true purpose of nursing homes: caring for the residents who cannot care for themselves, rather than profit for the corporate owners of those nursing homes.
Despite these increases in mandatory staffing minimums at nursing homes, the actual performance of these nursing homes has not kept up. Across the United States, nursing homes are providing fewer hours of care to residents each year, while simultaneously racking up increasing amounts of more serious deficiencies, per an analysis by KFF Health News.
This is not behavior that should be rewarded with ever-increasing profits. Pennsylvania courts have repeatedly recognized that this understaffing at nursing homes, while its residents are suffering, can support a claim for punitive damages. This means that the nursing home and its owners could be liable not just for the damages they caused, but also potentially additional damages designed to dissuade them from continuing to prioritize profits over their residents.
Unfortunately, nursing homes rarely give up the reports showing their staffing levels easily, and it normally takes court intervention to force them to turn over the documents. At Anapol Weiss, our attorneys routinely fight to obtain staffing records from nursing homes so we can show that they were dangerously understaffed when our clients suffered injuries. While Pennsylvania has recently heightened its nursing home staffing requirements, every state has its own requirements that nursing homes are required to abide by and understaffing is not limited to Pennsylvania.
It takes an experienced professional to obtain and evaluate the necessary staffing records to determine whether a nursing home was understaffed, what days they lacked proper staffing, and how below the minimums they were. If you or a loved one has suffered injuries at a care facility, please contact us today at (215) 929-8822 for a free consultation. Our attorneys have extensive experience in nursing home, assisted living facility, and personal care facility litigation. Understaffing may have played a part in the injury.
1) 42 CFR Part 483, Subpart B, § 211.12 (i)(2).
2) ldi.upenn.edu/our-work/research-updates/pa-set-new-standards-on-nursing-home-staffing-are-they-sufficient/
3) Kramer AM, Fish R. “The Relationship Between Nurse Staffing Levels and the Quality of Nursing Home Care.” Chapter 2 in Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes: Phase II Final Report. Abt Associates, Inc., Winter 2001.
4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614622/
5) https://seiuhcpa.org/nursing-home-workers-march-for-national-safe-staffing-and-owner-accountability/
6) https://seiuhcpa.org/speak-out-during-nurses-week-about-the-staffing-crisis/
7) https://www.kff.org/medicaid/issue-brief/a-look-at-nursing-facility-characteristics/
8) Scampone I, 11 A.3d at 991 Scampone v. Grane Healthcare Co., 11 A.3d 967, 987 (Pa. Super. 2010)
