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7 Questions To Ask About Nursing Home Staffing

By: Jeff Powless May 17, 2023 no comments

7 Questions To Ask About Nursing Home Staffing

The staffing levels and practices in a nursing home are intrinsically linked to the overall quality of care provided to residents. The expertise, availability, and attentiveness of the staff directly impact residents’ well-being, safety, and satisfaction. Sufficient nursing home staffing ensures that residents receive prompt assistance, proper medical attention, and emotional support. It enables staff members to develop strong relationships with residents, understand their individual needs, and provide personalized care. On the other hand, inadequate staffing levels can lead to neglect, delayed responses to emergencies, increased incidents of preventable medical errors, and decreased resident satisfaction.

Nursing home staffing levels are closely tied to resident outcomes. Research has consistently shown that higher staff-to-resident ratios are associated with improved clinical outcomes, such as reduced rates of falls, pressure ulcers, and medication errors. Adequate nursing home staffing also contributes to enhanced resident engagement, socialization, and mental well-being. Continuity of care, which relies on consistent staffing, fosters a sense of familiarity and trust between staff and residents, which is especially crucial for individuals with dementia or other cognitive impairments.

When evaluating a nursing home, you may consider asking one or more of the following questions:

1. What is the staff-to-resident ration in the nursing home?

The staff-to-resident ratio is a critical factor to consider when evaluating the quality of care provided in a nursing home. A lower staff-to-resident ratio generally means that each staff member has to attend to a larger number of residents, which can result in reduced individualized attention, delayed responses to requests for assistance, and increased stress levels for both staff and residents. On the other hand, a higher staff-to-resident ratio indicates that there are more caregivers available to meet the needs of the residents, which can lead to better quality of care, improved safety, and enhanced overall resident satisfaction.

2. What is the turnover rate for staff members, particularly for nursing and caregiving positions?

Staff turnover rate provides insight into the stability and continuity of care within a nursing home. A high turnover rate suggests that staff members are leaving their positions frequently, which can be indicative of various issues such as poor work environment, lack of job satisfaction, inadequate support, or insufficient compensation. High turnover can disrupt the caregiver-resident relationship, as residents may have to frequently adjust to new caregivers, resulting in inconsistent care. Conversely, a lower turnover rate generally indicates a more stable workforce, potentially fostering better continuity of care, stronger bonds between staff and residents, and a more positive care environment.

3. How are the staffing schedules structured to ensure adequate coverage throughout the day and night?

Understanding the structure of staffing schedules is crucial to determine whether there is sufficient coverage to meet the needs of residents at all times. Nursing homes must have a well-designed schedule that ensures there are enough staff members on duty during the day and night shifts, including weekends and holidays. Inadequate staffing during certain periods can lead to delays in responding to emergencies, increased waiting times for assistance, compromised resident safety, and a decreased quality of care. Adequate staffing coverage is essential for maintaining a safe and supportive environment for residents and ensuring their needs are promptly attended to.

4. Are staff members trained and certified in providing specialized care for specific conditions or needs, such as dementia care or rehabilitation services?

Specialized training and certifications are vital for staff members to effectively address the unique needs of residents with specific conditions or care requirements. Nursing homes that invest in ongoing training and professional development for their staff demonstrate a commitment to providing high-quality care. Specialized training can include dementia care techniques, rehabilitation therapies, wound care, palliative care, and other specialized areas. Staff members with relevant certifications and training are better equipped to handle the complexities associated with specific conditions, resulting in improved resident outcomes, enhanced safety, and an overall higher standard of care.

5. How does the nursing home address staff shortages or absences to ensure continuity of care for residents?

Staff shortages or absences can have a significant impact on the quality and consistency of care provided in a nursing home. It is essential to understand how the nursing home addresses these situations to ensure the continuity of care for residents. Adequate measures should be in place to manage unexpected staffing gaps, such as maintaining a pool of on-call staff, utilizing agency or temporary staff, or implementing contingency plans. By having strategies in place to address staff shortages, nursing homes can minimize disruptions in care, maintain appropriate staff-to-resident ratios, and ensure that residents’ needs are consistently met, even during challenging situations.

6. Has the nursing home been cited for any staffing issues or deficiencies in the past?

Inquiring about any past citations related to staffing issues provides crucial information about the nursing home’s track record and regulatory compliance. Government regulatory agencies, such as state health departments or Centers for Medicare and Medicaid Services (CMS), conduct inspections and investigations to ensure nursing homes meet staffing requirements and maintain appropriate levels of care. By asking this question, you can learn if the nursing home has faced any penalties or citations related to understaffing, inadequate training, or other staffing-related deficiencies. Understanding the nursing home’s compliance history helps evaluate its commitment to maintaining high staffing standards and providing quality care to residents.

7. What is the nursing home’s policy regarding the employment of individuals with a criminal past?

Inquiring about the nursing home’s policy on hiring individuals with a criminal background is important for assessing the safety and security measures in place within the facility. It is crucial to understand if the nursing home conducts comprehensive background checks on potential employees and whether they have strict guidelines for hiring individuals with criminal records. This question helps ascertain whether the nursing home prioritizes resident safety and takes proactive measures to prevent any potential risks associated with employing individuals with a criminal past. A clear policy that includes thorough background screenings and appropriate risk assessment procedures demonstrates the nursing home’s commitment to maintaining a safe and secure environment for its residents.

How to conduct your own research regarding nursing home staffing

One valuable resource for researching nursing homes, including their staffing and quality of care, is the Nursing Home Compare website provided by the Centers for Medicare and Medicaid Services (CMS). This user-friendly website allows individuals to search for nursing homes based on location and provides comprehensive information on each facility. By visiting the Nursing Home Compare website (https://www.medicare.gov/nursinghomecompare), users can access detailed data on various aspects, including staffing levels, health inspections, and quality measures.

To explore staffing-related information, users can examine the “Staffing” section, which provides details on the average number of hours worked by nursing staff per resident per day, as well as the staff-to-resident ratios. This information offers insights into the staffing levels within a specific nursing home. Additionally, the website displays data on health inspections and quality measures, which encompass various aspects of resident care, such as safety, cleanliness, and resident well-being.

The Nursing Home Compare website also offers a five-star rating system, with ratings based on health inspections, staffing, and quality measures. These ratings can serve as a useful starting point for evaluating the overall performance and quality of care provided by nursing homes; however, some of the data is self-reported by nursing homes and must be considered with caution.

In summary, nursing home staffing plays a pivotal role in determining the overall quality of care provided to residents. Sufficient staffing levels, appropriate training, low turnover rates, and well-structured schedules are fundamental to maintaining a safe, supportive, and thriving environment for elderly individuals who depend on these facilities for their physical, emotional, and medical needs. By asking pertinent questions about staffing, one can gain valuable insights into the nursing home’s commitment to delivering high-quality care and ensuring the well-being of its residents.


Jeff Powless is an attorney and the author of the 2017 book, Abuses and Excuses: How To Hold Bad Nursing Homes Accountable.  Abuses and Excuses breaks new ground in helping patients and families hold bad nursing homes accountable, sharing a wealth of insider strategies and insights. It’s an eye-opening account of corporate greed, acts of neglect and abuse, an insidious industry culture of cover-up, and the actual harm that inevitably befalls vulnerable nursing home patients all across the country with shocking frequency.


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