Prior to the Coronavirus crisis, long-term care facilities were already struggling to maintain adequate staffing levels. Now, statistics indicating that over half of the deaths from COVID-19 in some states involved both residents and staff make recruiting and keeping enough nursing staff almost impossible.
One long-term care ombudsman pointed out that not having enough staff increases risks. She put it this way, “When you’re working short-staffed, you make decisions you may not make on a good day.”
According to Charlene Harrington, an emeritus professor of nursing and sociology at the University of California, San Francisco, most U.S. nursing homes do not have enough staff to provide the 4.1 hours of daily nursing care experts recommend.
There is no standard federal ratio of staff to residents, although many states do set minimum requirements.
Often, when a shortage of nurses and nurse aides occurs, corners may get cut, e.g., failing to wash hands often enough or trying to provide care alone (lifting) when the resident requires two-person care. In such instances, both the resident and the caregiver may be harmed.
Due to the COVID-19 crisis, the federal government temporarily suspended Payroll Based Journal (PBJ) staffing reporting requirements; consequently, there is no national data on nursing home staffing during the pandemic to review or evaluate. But numerous workers, union leaders, and industry groups are reporting that many nursing home staff are not working because they have contracted the virus, have personal at-home caregiving responsibilities, or they are afraid to bring the virus into their homes due to having family members who are considered most vulnerable to the disease.
Healthcare worker advocates say direct care workers need better pay to fix staffing problems over the long term which will require designating more state and federal dollars for long-term care.
Compliance Perspective
Failure to provide sufficient nursing staff to meet the needs of the residents, particularly during a healthcare crisis like COVID-19, may infringe on the rights of residents to be free from neglect, could result in an increased risk for infection to both residents and staff, and be considered provision of substandard quality of care, in violation of state and federal regulations.
Discussion Points:
- Review policies and procedures regarding staffing levels sufficient to meet the needs of residents, including federal requirements for cohorting of both residents with COVID-19 and their caregivers.
- Train staff regarding infection control protocols for handwashing and wearing of PPE, and following care plan requirements for assistance levels of residents.
- Periodically audit to determine if sufficient numbers of competent staff are available, and if they are diligent in observing care plan instructions regarding the number of staff needed to provide resident care and safe transfers.
