Understand the Risk of Understaffing in Nursing Homes and Staffing Requirements

By BKS Commercial Risk Advisors

Doctor holding a senior patiens 's hand on a walking stick - special medical care concept for Alzheimer 's syndrome.

Understaffing is one of the most significant predictors of inadequate care in Senior Living communities across the nation. Skilled Nursing Facilities (SNFs) that lack adequate staff compromise the quality of care of a resident as well as the quality of work environment for employee caregivers. Resulting consequences can include lawsuits against the operator for negligence and/or abuse as well as trouble recruiting, managing and retaining caregivers. 

Determine SNF Staffing Requirements

Determining minimal staffing requirements to maintain an optimal level of quality care is difficult. Federal regulations contained in the Nursing Home Reform Act (NHRA) require minimum staffing levels for registered nurses (RNs) and licensed practical nurses (LPNs) and minimum educational training for nurse’s aides (NAs).

The NHRA requires a Medicare or Medicaid certified nursing home to have: 

  • An RN on staff for at least eight consecutive hours on the day shift, seven days a week
  • Licensed nurses 24 hours a day
  • “Sufficient staff” to meet resident’s needs
  • Nurse’s Aids must have 75 hours of training at a minimum

Under Federal Law, the requirements for “sufficient staff” are virtually the same for a 25 resident facility as a 200 resident facility.

While the Federal Law requires SNFs “to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental and psychosocial well-being of each resident” – this requirement does not provide specific nurse-to-resident staffing ratios for RNs, LPNs or NAs (and further requires no minimum level of staffing for NAs).

SNF staffing ratios are regulated at the State level and vary greatly. This becomes the burden of the operator, especially if their portfolio spans multi-state geography.

In addition to compliance, SNF operators should be primarily concerned about adequate staffing as it relates to their overall ability to recruit and retain caregivers. The turnover rate in long-term care ranges from 55% to 75% for nurses and aides and sometimes over 100% for aides alone. What is the cost of turnover for your SNF(s)? The 2007 Donoghue and Castle study found that increasing the number of aides per resident from 33 per 100 to 41 per 100 reduced CNA turnover from 65% to 41%.

The Impact of Adequate Staffing at SNFs

Adequate staffing in an SNF will have a direct and positive effect on workplace safety and workers comp and liability loss control.

With more caregivers to share the duties of care, the operator should see a noticeable reduction in workers comp related claims. Caregivers routinely perform physical tasks through the course of employment, such as lifting residents. An adequate team of staff members spreads the physical duties which drive down the frequency and possibly the severity of workers comp claims. Additionally, a more robust staff means an optimal level of care which reduces the operator’s exposure to insurance claim costs or litigation by the negligence of a resident.

For more insight on managing risks at senior living facilities, please contact a BKS Commercial Risk Advisor.  

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