The L.A. Times had an article on the problems with short-staffing in California’s nursing homes.  Quality-of-care concerns have long plagued nursing homes and are well documented, most recently in a May report by California State Auditor Elaine Howle.

A new law, championed by consumer groups and patient advocates, that went into effect July 1 is increasing staffing to increase the quality of care.  The law tightened staffing requirements for direct caregivers and added new ones specifically for certified nursing assistants.  The new law requires facilities to provide 3.5 hours of direct patient care each day, up from 3.2 hours. But the primary worry for nursing home operators is a first-ever requirement that 2.4 of those hours must be filled by CNAs.

“There must be enough direct care staff to meet the quality care needs of nursing home residents and ensure a healthy workload for every caregiver,” said an SEIU local representative.

Wisconsin Public Radio had an article on short-staffing in Wisconsin’s nursing homes. Federal data shows staffing at the majority of nursing home facilities across the country is low and was systematically inflated in Wisconsin and other states for years.  An interactive map produced by Kaiser Health News shows staffing levels vary widely in Wisconsin and across the country.  Low staffing levels are not only potentially dangerous, but take a toll on staff morale and can lead many to high turnover. One of the reasons people leave the profession is they feel they can’t provide the level of care they feel they need to provide.

Nursing homes self-report staffing levels to the Centers for Medicare and Medicaid Services, but now the federal agency is finally verifying the staffing through payroll records. Barbara Bowers, associate dean for research at the University of Wisconsin-Madison’s School of Nursing, supports the new method to assess the number of employees providing care because it’s more accurate.  It’s also important, she said, to have the right mix of staffing including registered nurses, licensed practical nurses and nursing assistants.

You might be able to achieve good outcomes (if you are lucky) in some cases with less staff but it affects quality of life. Outcomes are tied to staffing,” said Bowers, who has studied nursing homes. “You might be able to achieve good outcomes in some cases with less staff but it affects quality of life.

On weekends employee workloads can double, according to records analyzed by Kaiser Health News and reported by The New York Times.  Often the lack of adequate staff means food arrives cold, personal hygiene is left undone, residents may have to wait to get out of bed, or even use the bathroom.  Bowers says she has talked to elderly nursing home residents who have fallen because they tried to climb over bed rails.

A lot of older adults have challenges with continence. It’s an incredible indignity to wet yourself when the only reason you’re doing that is because you can’t get help,”  Bowers said.

In studying why people quit nursing home jobs, Bowers recalled a certified nursing assistant who was distraught because she had forgotten about an elderly woman on the toilet. The caregiver had left momentarily to do another task and only remembered after she had left work.

Short staffing also can inhibit continuing education if there’s no one to fill in for you when you’re gone. Bowers said the nursing school has done workshops for certified nursing assistants around Wisconsin and a lot of them who had been working 10 or more years had never been to an education program before.