This work was originally completed as an entry for the Cogan & Power 2019 Scholarship.
The decision to put a loved one into a nursing home is never an easy one. Those who have such a decision thrust upon them often take solace hoping that they have chosen the best possible facility to care for their relatives. Turning this hope into reality is an unspoken oath taken by all workers and caretakers within the Adult Healthcare industry. Unfortunately, however, The Adult Healthcare industry is also dominated by large, for-profit organizations, some of whom inevitably decide to pursue the interests of their owners and shareholders (ie, turning a profit) not through maximizing the quality of resident care and service, but by cutting corners where possible. This cutting of corners often manifests through staffing shortages in care facilities, which may well pose the greatest threat to resident safety and wellbeing given the myriad of consequences it can have on a facility.
As this case study conducted by the University of California and the Center for Medicare Advocacy details, there is strong evidence of a relationship between staffing levels and the measured quality of care in long-term Adult Healthcare facilities. To ensure the upholding of residents’ rights and well-being, it is critical that a sufficient number of caregivers are present to administer care, and when such numbers are not maintained by a facility, the resulting extra responsibilities are inevitably thrust upon however few caretakers are present. This increased workload and the stress it causes stretches nursing staff thin, reducing productivity and the overall quality of care they are able to provide to each individual resident. Such a situation can be so severe that, in some cases, even basic care tasks may be omitted, resulting in outright neglect of a resident.
The effects of staff shortages have consequences for caregivers themselves as well. And these consequences can inadvertently double back onto residents in turn. The longer the shortage persists, the greater the risk for Burnout becomes among staff, caused by the cumulative stress the situation brings. Caretakers stricken with Burnout pose even more of a detriment to patient care than those suffering from staff shortage alone. In the latter case, neglect is likely to occur as a side effect of overwhelmed caretakers struggling to provide care to all residents. The former case however, in which a Caretaker is stressed far enough to begin mentally breaking down, there opens a possibility for abuse to occur. Staff pushed to the brink may be liable to take out their frustrations on certain residents in one form or another, resulting in situations which may pose immediate threats to a resident’s well-being. A facility which endures a staff shortage for a long enough period of time to have multiple staff members succumb to burnout could well become a repeat offender for elder abuse and neglect, as this article from Coganpower describes in detail.
One might ask, if staff shortages pose such a risk, how can they be curtailed? The most effective way would likely be through pushing for federal legislation to impose stricter regulations on nursing homes and long-term care facilities. Currently, there are regulations in place for the staff levels of licensed nurses, but not for aides. This is, interestingly, despite the latter being the staff members who are often providing the day to day care to residents, and are thus more susceptible to the consequences of staff shortages. Pushing for regulations to be placed at a federal level regarding the minimum staff level for nurse aides would likely help to discourage for profit organizations intentionally cutting costs by limiting staff rosters.
Another method which may work well in tandem with such legislation is to introduce compounding fines on organizations operating facilities that are chronically understaffed. A facility could be warned after being found in violation of minimum aide levels, and given one month to rectify the issue. Should it fail to do so, at the end of that month a fine would be issued, starting relatively (to a corporate entity at least) small. Every month that they continue to be in violation after the first however, the fine would be issued again, becoming greater depending on how long the issue has persisted, or however much the fined amount previously was, depending on whether the organization paid the previous month’s fine or not.
This may strike some as a rather draconian measure, yes, but the purpose of the entire fine would be to discourage organizations employing intentional staff shortages as a method to reduce costs. And in the end, the life of an elder is never worth whatever the organization might have saved by denying them the proper care they needed.
Sources:
“Burnout or Compassion Fatigue?” I Advance Senior Care, www.iadvanceseniorcare.com/burnout-or-compassion-fatigue/.
“Special Focus Status: Nursing Home Abuse Lawyer.” Cogan & Power, 14 Mar. 2019. coganpower.com/blog/repeat-offenders/.
“What Nursing Home Staff Levels Are Required?” ElderLawAnswers, 19 Sept. 2007, www.elderlawanswers.com/what-nursing-home-staff-levels-are-required-6496.
Harrington, Charlene, and Toby S Edelman. “Failure to Meet Nurse Staffing Standards: A Litigation Case Study of a Large US Nursing Home Chain.” Inquiry : a journal of medical care organization, provision and financing vol. 55 (2018): 46958018788686. doi:10.1177/0046958018788686
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