Unsafe Staffing


The Journal of the American Geriatrics Society (AGS) published a systematic review of studies concerning how certain factors–private equity, type of ownership, staffing, etc.–determine outcomes for the residents. Characteristics with no consistent correlations with outcomes included Nursing Home Compare 5-star ratings, ownership, and prior infection control citations. Staffing was the key factor.

“A large literature links the levels of direct-care staffing to nursing home quality, especially in the case of registered nurse (RN) staffing. Staffing may have taken on even greater importance under pandemic conditions, as having adequate staff is a prerequisite for implementing the measures now considered best practices in trying to control an outbreak.”

These findings place the industry on notice. Unstable staffing impedes management’s ability to create a high-reliability organization with consistent and safe workflows. Advocates have long identified staffing shortages as a major cause of inappropriate and inadequate nursing home care.


According to Consumer Voice:

“Studies have repeatedly shown that significant numbers of our nation’s nursing homes fail to adequately staff their facilities. Nursing homes with higher levels of staffing, however, provide better care to residents. A review of 87 research articles and reports from 1975-2003 found that nursing homes with higher staffing levels had residents with better health outcomes, including in the areas of functional ability, pressure ulcers, and weight loss.”

Variations in daily staffing levels at nursing homes were connected to higher quality and survey rankings. See new study published in JAMA Network Open. Investigators found that facilities with significant daily variations among both RNs and CNAs had lower quality and more neglect and abuse. A significant association exists between nursing home ownership and high staffing variability. For-profit facilities have less stable staffing and less quality of care.

This makes sense. You need caregivers to provide care. It is simple. Hire more. Train better. Express respect.