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The Link Between Nursing Home Understaffing and Patient Abuse

By: Jeff Powless June 9, 2023 no comments

The Link Between Nursing Home Understaffing and Patient Abuse


Nursing homes should be safe havens for our elderly loved ones, providing them with the care, compassion, and support they need in their later years. However, patient abuse remains a dark and disturbing reality within too many nursing homes. One significant factor contributing to this tragic reality is understaffing of the nursing home by nursing homes that choose profits over patients.

A recent news report discussed the rape and suffocation of an 80-year old patient by another resident at a facility that had been found understaffed. The patient was nonverbal and unable to move on her own. The autopsy revealed that the patient died of asphyxiation due to smothering. The facility had a history of having some of the lowest staffing levels in the nation, many thefts, assaults and rampant illegal drug use.

Below we explain the link between understaffing and patient abuse.

The Importance of Sufficient Staffing

In nursing homes, staffing plays a vital role in ensuring the well-being and quality of care provided to residents. A properly staffed facility ensures that residents receive attention, assistance, and supervision for their daily activities, medical needs, and overall safety. Not only does a lack of staffing result in a lack of supervision and monitoring of patients. It also leads to staff burnout and more understaffing. Facilities that choose not to employ sufficient staff place too much burden upon the staff members they do have, resulting in a poor working environment and inevitable turnover. Turnover often leads to delayed hiring and the hiring of inadequately trained staff members who are thrust upon the job with inadequate support.

Why Nursing Homes Choose To Understaff

Labor costs are one of the most significant expenses for nursing homes. The nature of the industry requires a skilled workforce, including registered nurses, licensed practical nurses, certified nursing assistants, and other support staff. These professionals provide around-the-clock care to residents, ensuring their health, safety, and overall well-being. Salaries, benefits, training, and recruitment expenses contribute to the labor costs that nursing homes face.
To maximize profitability, too many nursing homes choose to prioritize profits over patients by deliberately understaffing their facilities. By reducing the number of staff members, nursing homes can cut labor costs significantly. However, this cost-saving approach often leads to compromised care quality, as caregivers are overwhelmed with heavy workloads and unable to meet the needs of residents adequately. Understaffing can result in a lack of supervision and monitoring, missed or delayed care, increased risks of accidents or incidents, and a lack of personalized attention and emotional support for residents. While labor is indeed a substantial expense for nursing homes, prioritizing profits over patients through understaffing can lead directly to patient abuse and neglect.

Types of Nursing Home Abuse and Neglect

When nursing homes are understaffed, the risk of patient abuse increases significantly. Patient abuse can take various forms, including physical, emotional, sexual, and financial abuse, as well as neglect.

Physical abuse involves the intentional use of force that results in bodily harm or pain. Understaffing can contribute to physical abuse by leaving residents unattended, which may lead to accidents or incidents of violence by frustrated caregivers.

Emotional abuse, such as verbal insults, humiliation, or isolation, is more likely to occur when staff members are overworked and lack the time and patience to properly address residents’ emotional needs.

Sexual abuse is a horrifying violation of personal boundaries and can occur when insufficient staff allows perpetrators to exploit vulnerable residents. Additionally, financial abuse can take place when caregivers, aware of the lack of supervision, exploit residents’ financial resources for personal gain.

Neglect is another severe consequence of understaffing. Residents may suffer from inadequate nutrition, poor personal hygiene, untreated medical conditions, and lack of supervision, all of which can have devastating effects on their physical and mental well-being.

Impact on Patients

The repercussions of nursing home understaffing and resulting abuse on patients are profound and deeply distressing. Physically abused residents may experience injuries, fractures, bedsores, or infections, leading to pain, discomfort, and potential complications. Emotionally abused individuals may develop anxiety, depression, or post-traumatic stress disorder (PTSD), leading to a deterioration in their overall mental health.

Sexual abuse victims may experience long-lasting psychological trauma, affecting their ability to trust others and form healthy relationships. Financial exploitation can leave residents impoverished, stripped of their independence and dignity, and vulnerable to further harm.

Neglect resulting from understaffing can have devastating consequences. Malnutrition and dehydration can lead to weight loss, weakened immune systems, and increased susceptibility to infections. Poor personal hygiene may result in infections, skin conditions, and a decline in overall health. Untreated medical conditions due to lack of attention can worsen and cause unnecessary suffering or even lead to premature death.

Moreover, the psychological impact of neglect should not be underestimated. Residents may feel ignored, abandoned, and stripped of their dignity, eroding their self-worth and overall quality of life. The lack of social interaction and stimulation due to understaffing can also contribute to feelings of loneliness and isolation.

What You Can Do

First, you can look for warning signs of nursing home understaffing. Those signs include:

  • Do patient call lights go unanswered?
  • Is it hard to find staff when you walk through the facility?
  • Do patients have fresh water readily available?
  • Are food trays often left mostly uneaten?
  • Are bed bound patients being turned and repositioned frequently?
  • Does the facility have a high staff turnover?
  • Doe the facility have a bad odor?
  • Are patients left in their beds late into the morning?
  • Are patients awakened and dressed very early in the morning against their preference?
  • Are patients receiving their medications late?
  • Do phones go unanswered?

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.

If you are concerned about understaffing, or any other issue at the nursing home, you can contact the facility’s ombudsman. Having an ombudsman working on your behalf is invaluable when dealing with a difficult nursing home situation. Ombudsmen can offer guidance, resources, and support to help you and your loved one navigate any issues that may arise. Ombudsmen are knowledgeable about patient rights and can help ensure that your loved one is receiving the best care possible. Additionally, they can provide a calming presence in stressful situations, offering an objective perspective on what could be done to improve the situation.

You can also file a complaint with the state licensing agency. Unfortunately, nursing home abuse and neglect is all too common. One remedy to help combat the epidemic of substandard care in U.S. nursing homes is the right to file a complaint with the state’s regulatory body. Anyone with knowledge or concerns about the care of a nursing home patient has the right to file a complaint with their state’s regulatory agency, including the patient herself/himself, family members, guardians or other patient representatives, persons who are simply visiting the nursing home, and even the nursing home facility staff. Complaints can be filed anonymously and the complainant’s name and any specific medical information is confidential.

Finally, if you or a loved one are injured, you should strongly consider contacting an attorney experienced in handling nursing home abuse and neglect issues. It is important that you properly select a nursing home abuse and neglect attorney with experience and a record of success in handling such cases. It is also important that you act in a prompt manner as there are deadlines for filing a lawsuit against a nursing home.


Nursing home understaffing is a critical issue that poses a significant threat to the well-being of vulnerable elderly residents. Insufficient staffing levels create an environment conducive to patient abuse, including physical, emotional, sexual, and financial abuse, as well as neglect. The consequences of such abuse can be devastating, resulting in physical injuries, emotional trauma, loss of trust, and a decline in overall health and well-being. It is essential for society, policymakers, and nursing home operators to address this issue promptly, implementing measures to ensure sufficient staffing levels and providing the necessary resources and support to safeguard the elderly population in nursing homes.

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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