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11 Common Warning Signs Of Nursing Home Understaffing

By: staff.writer January 25, 2023 no comments

11 Common Warning Signs Of Nursing Home Understaffing

Ensuring nursing homes are adequately staffed is essential for providing quality care to residents, and preventing nursing home neglect. Unfortunately, nursing homes across the country suffer from understaffing and neglect that can lead to serious consequences. To protect nursing home residents from inadequate care, the federal government has established specific staffing requirements nursing homes must adhere to in order to receive Medicare or Medicaid funding.

Many states have no minimum required staffing ratios (i.e. the number of staff required per patient). However, federal law currently requires all nursing facilities that receive Medicare or Medicaid funding to provide 24-hour licensed nursing services, which are “sufficient to meet nursing needs of [their] residents” — in addition to using the services of a registered professional nurse at least eight (8) consecutive hours a day, seven (7) days a week. Federal law does not require a set number of nurses in a facility, because the nursing needs of the facility depend upon both: (1) the number of patients in the facility, and (2) the acuity level of those patients (i.e., their level of dependence or need).

The vast majority of all nursing homes in the United States are owned or operated by for-profit companies. For-profit corporations are in the business of generating profits and making money for their shareholders. Thus, it should not be surprising that all too often nursing home corporations impose arbitrary and inadequate staffing levels upon the facilities they own and/or operate that will help them maximize their profits by improving their bottom line. The largest expense in a nursing home is typically staffing, so the easiest way for a nursing home to improve its profit margin is to cut corners with staffing, relying instead on an inadequate number of caregivers.

Assisted living facilities must now report their staffing levels so that they can be reported on Medicare’s Nursing Home Compare website. On this website, one can research how the reported staffing levels of a nursing home compare with the reported staffing levels of other nursing homes. You can find information about the reported average number of hours of care per day each patient receives from licensed nurses, nurse aides, and therapists. You can also find some information about the level of staff turnover the facility has and how that compares with the state and national average.

While the information provided on this website can be helpful, it may not tell the whole story. First, the information is derived from what the nursing home self-reports. Over-reporting is all too common, making it difficult to know if the information for any one facility is accurate and can be trusted or not. In addition, the staffing numbers alone do not tell whether the facility had sufficient staff to meet all of the particular needs of their patients at the time of reporting, taking into account the number and acuity of their residents. The staffing numbers simply tell how much staff there was per patient on average, without specifying how much staffing was needed by the patient population at the time.

Because these numbers do not tell the entire story, it is important to learn what you can do to be on the lookout for an understaffed nursing home. Fortunately, there are often warning signs that a nursing home is understaffed. Below are some things to look for as indicators of a nursing home lacking adequate staff.

1. Do Patient Call Lights Go Unanswered?

Nursing home resident call lights going unanswered is a sure sign of understaffing. When nursing homes are understaffed, nurses may not have the time or resources necessary to promptly answer patients’ call lights when they need assistance. In nursing homes that are adequately staffed, nursing staff should be able to respond to patient call lights within a reasonable amount of time. When nursing homes are understaffed, nursing staff can become overwhelmed with the number of call lights they must answer, resulting in delays or missed calls. This can significantly impede a patient’s ability to receive assistance when they need it most. If you see patient call lights going unanswered for extended periods of time, beware.

2. Is It Hard To Find Staff When You Walk Through the Facility?

One of the most telling signs that a nursing home is understaffed is when it’s hard to locate staff members while walking through the facility. If patients, their families, or visitors notice that they often have difficulty finding nursing staff when they need assistance or have questions, this can be especially worrisome. When nursing staff are not readily available, patients may not receive the help they need in a timely manner – or worse, not receive any help at all and is strong evidence of understaffing.

3. Do Patients Have Fresh Water Readily Accessible?

Adequate hydration is important for all of us, and in particular for many nursing home residents; It is one of the basic needs for every resident. Dehydration can negatively impact the elderly in many ways. Many nursing home patients cannot easily obtain water or other beverages for themselves. Accordingly, the nursing staff has a responsibility to keep fresh water within reach of patients who cannot easily obtain it for themselves. If patients are left with stale or no water at their bedsides, that is an indication that the nursing staff is insufficient to meet their care responsibilities.

4. Are Food Trays Often Left Mostly Uneaten?

In addition to proper hydration, nursing home patients like everyone else require adequate nutrition in order to attain and maintain their highest practical well-being. But, many patients require assistance with eating in order to consume their meals. In an understaffed facility, patients often do not receive the assistance they need for them to consume their meals. Food trays left uneaten can be a warning sign that patients are not receiving the assistance they need due to understaffing.

5. Are Bed Bound Patients Being Turned and Repositioned Frequently?

Nursing home patients who are primarily bed bound are at high risk for developing pressure sores if they are not assisted routinely with turning and repositioning. Turning and repositioning should occur at least every two (2) hours for patients in bed (and at least every hour while in a wheelchair). Some patients require more frequent turning depending upon the patient’s individual needs and circumstances. When nursing homes lack sufficient nursing staff, this vital preventative measure is often overlooked and patients are left in the same position. If you see that nursing staff are not regularly performing turning and repositioning of patients in bed and in wheelchairs, that should be seen as a strong indicator of understaffing.

6. Does the Facility Have a High Staff Turnover?

When nursing homes are understaffed, it places a great burden upon the nursing staff trying to take care of the facility’s patients.  This burden can lead to nursing staff exhaustion, burnout, and high staff member turnover.  If nursing homes have a higher-than-average rate of nursing staff turnover, that is yet another indication that the nursing home may be understaffed.

7. Does the Facility Have a Bad Odor?

Finally, nursing home facilities that lack sufficient nursing staff often have rooms and hallways with a bad odor — often recognized as the smell of urine or feces. This malodor can be an indication of patient neglect with respect to toileting and hygiene. Nursing homes should have sufficient staff to attend to patients in a timely fashion when they are in need of assistance with toileting or incontinent care. If you notice a strong or unpleasant odor upon entering or walking through the nursing home, it could be another sign that the nursing home employees are unable to provide the necessary and timely medical treatment for the number of patients under their care.

8. Are Patients Left In Their Beds Late Into the Morning?

Nursing home patients should have their nursing care needs attended to in a timely fashion each morning as part of the nursing care plan. Be aware of nursing homes where patients spend late mornings in their beds or in wheelchairs, unassisted with the daily duties of grooming and dressing. If patients are left in their night clothes and not assisted with their morning grooming and dressing until mid-morning or later, the nursing facility may have inadequate staffing. 

9. Are Patients Awakened and Dressed Very Early In the Morning Against Their Preference?

In contrast, some facilities deal with their understaffing by forcing patients to awaken and get up very early because they do not have enough staff to care for patients during the hours when patients want to get up for the day. Patients should be allowed to determine when they prefer to awaken and get up in order to receive their morning nursing care. If nursing staff members are forcing certain nursing home patients to get up before sunrise or at unreasonable hours, this is another sign that the nursing home may be understaffed.

10. Are Patients Receiving Their Medications Late?

Nursing home patients should be receiving their medications on a consistent schedule as prescribed by their doctors.  For some medications, the failure to ensure that they are administered at the appropriate time can risk significant or even life-threatening adverse effects for the patient.  If the nursing staff is often late in delivering medications to nursing home residents, this could indicate understaffing and that nursing staff are not able to get all of their duties completed in a timely fashion.

11. Do Phones Go Unanswered?

Lastly, nursing homes should have sufficient staff to answer the telephone when a call is made by family members, prospective nursing home patients, or other members of the community. If nursing homes have difficulty answering the phone in a timely manner due to understaffing, it can be an indication that they are having difficulty responding to nursing care needs as well.


There is nothing more critical to a nursing home providing adequate care, than ensuring that there is a sufficient number of properly trained and adequately supervised nursing staff members. It is important to be aware of the warning signs that nursing homes may be understaffed. Keep in mind that the foregoing are examples only, and are by no means an exhaustive checklist. But, if you notice any of the forgoing issues at a nursing home you are visiting, it could indicate a problem with staffing levels which can have serious consequences for patient safety and well-being.

Frequently Asked Questions:

Q: What are the warning signs of nursing home understaffing?

A: Warning signs of nursing home understaffing can include high staff turnover, a bad odor in the facility, patients left in their beds late into the morning, patients awakened and dressed early against their preference, patients not being regularly turned and repositioned, food trays left uneaten, lack of fresh water, and call lights and phones going unanswered. All of these can indicate that nursing homes may be having difficulty providing nursing care needs due to inadequate staffing levels.

Q: What should I do if I notice warning signs of nursing home understaffing?

A: If you notice any of the warning signs mentioned above at a nursing home facility, it is important that you alert the nursing staff or administrators to your concerns. It can also be helpful to report nursing homes that you believe may be understaffed to the appropriate state oversight agency.

Q: What are the consequences of nursing home understaffing?

A: Nursing home understaffing can have serious consequences for patient safety and well-being. It can lead to delays in providing nursing and medical treatments and care, heightened risk of errors, increased risk of falls and other injuries, decreased quality of life due to lack of social interaction, malnutrition due to inadequate nutritional assistance, and neglect of personal hygiene needs.

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To learn more about how patients, families, and healthcare providers can hold nursing homes accountable, read “Abuses and Excuses: How To Hold Bad Nursing Homes Accountable.”  This valuable resource can be found on sale at here at Amazon.com.

Find additional information on nursing home abuse in our nursing home information section.

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