USA Today Investigation Finds Thousands of Nursing Homes Routinely Violate Staffing Rules

An investigation by USA Today has revealed the scope of the problem of understaffing at U.S. nursing homes – in 2021, more than 75 percent of these facilities had fewer aides and nurses than they should have. Despite this, just 589 (four percent) of these facilities were cited by regulators for being understaffed.

Understaffing is worse if you factor in the absence of nursing home caregivers – one-third of nursing homes were not compliant with multiple benchmarks for staffing of nurses and aides.

Some may think this is a problem that emerged because of COVID-19. However, COVID-19 exposed what had already been going on for decades. Most of the nursing homes that did not have a registered nurse for at least eight hours a day had failed to do this three years before the pandemic.

Unfortunately, understaffing is often worse for low-income residents and people of color. Their facilities often report the lowest staffing levels. For example, just seven percent of the Virginia nursing homes with more residents of color were in compliance with staffing requirements.

The problem is also particularly bad in certain states. For example, for the past five years, Texas facilities have continued to report the nation’s second-lowest staffing levels. Despite this, only 16 of the 950 facilities that reported low staffing levels were cited.

Understaffing is extremely dangerous and is often the reason why residents suffer severe or even fatal injuries. If there are not enough staff to care for residents, their essential medical needs can go unfulfilled. Residents miss appointments and do not get the help they often need with personal hygiene, including showering and wound care. Even if residents call for help, their calls may go unanswered. In some cases, residents suffer severe injuries and die alone as no one notices or comes to help them.

USA Today’s investigation was comprehensive, as they reviewed millions of timesheets and thousands of inspection reports. This data was compared with the staffing requirements set by federal rules.

Despite how alarming these findings are, these findings may still underestimate the problem. Facilities are not even doing the bare minimum, according to Charlene Harrington, a leading researcher on nursing home quality and staffing levels.

Over the summer, the American Health Care Association discovered that 94 percent of nursing homes did not fulfill minimum staffing guidelines that were more stringent than those in the USA Today investigation.

President Biden Promised Sweeping Reforms of Nursing Homes

In January during his State of the Union address, President Biden vowed to reform the nursing home industry. The plan would involve paying states more money to hire more inspectors and increase their pay. The plan calls for a 25 percent increase in the budget for nursing home enforcement.

This might help with understaffing at inspection agencies, as a report from the Department of Health and Human Services Inspector General earlier this year found many inspection agencies are understaffed. Understaffing often results in delays in inspecting nursing homes after receiving safety complaints.

However, increasing the number of staff and increasing their pay may not be enough. There was a survey in 2013 in which hundreds of nursing home inspectors said they were pressured by elected officials and people in the industry to change inspection results.

Even when inspectors recommend fines or other penalties for nursing homes, their supervisors would change their reports. This can be discouraging to inspectors who want to cite facilities for being understaffed.

Another problem for many years was the guidance from the Centers for Medicare and Medicaid Services on inspecting staffing levels. The guidance used to say this issue should not be investigated unless care standards were not met. This would be like deciding to only give speeding tickets to drivers who crashed.

The guidance was updated in 2016, but it seems like inspectors still think they need to find care violations to inspect understaffing. That may be why there is such a small number of citations.

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