Texas Staffing Problems

The Investigation

Nursing homes are required to have sufficient staff to meet the needs of the residents or prevent neglect. It has always been a problem in the industry. Nursing homes need different levels of care depending on acuity or needs of residents. CMS adjusts the staffing expected based on assessments showing the needs of each facility’s residents. Unsafe staffing is a problem particularly at for-profit nursing homes operated by national chains.

The Texas Observer had an article about how short-staffing negatively impacts the care provided to Texas nursing home residents. Over the past year, the Texas Observer and Type Investigations analyzed federal inspection reports and staffing information. They reviewed four years of records for more than 1,200 facilities in Texas.

The evidence discovered that almost all of the for-profit corporations operate nursing homes well below safe thresholds for adequate staffing. Health experts and consumer advocates around the country have repeatedly found that corporate owners cut staff hours to increase profits. This is unsafe for the residents and the staff. Texas, on average, allows the lowest staff-to-patient ratio in the country.

Neglect caused by short-staffing accounts for the vast majority of deaths in nursing homes. A review of reports shows that many deaths and serious injuries are related to low staffing levels.


Neglect is the failure to provide care and services necessary to meet the needs of the resident. This includes medication errors and staff failures to offload pressure, provide oxygen, prevent falls, monitor lab results, or communicate acute changes in a patient’s condition to physicians. Neglect can cause physical or emotional harm or pain.

The article quotes J.T. Borah, a Texas lawyer: “Abuse has more headlines, but neglect has more victims. What you end up with is too few people spending their whole shift putting fires out, as opposed to actually managing the care they’re supposed to be giving to the residents.”

There is virtually no downside to them drastically cutting back on staffing and killing people because they will be making money,” said Ernest Tosh, a Texas nursing home neglect lawyer. “The state isn’t going to fine them very much, if at all. So why wouldn’t you do that if you’re a nursing home?”

Well said. I could not agree more. We need to mandate safe staffing of 4.1 hours per patient per day. We need to increase staffing for registered nurses.