Short Staffing in Long-Term Care Is Having an Impact on Resident and Financial Outcomes

April 1, 2021
April 1, 2021

Healthcare is an industry in the midst of transformation driven by demographic change, financial instability, and technological advance, not to mention the immediate issue and yet to be determined ramifications of the COVID-19 pandemic. Many non-hospital organizations across the care continuum are reeling from challenges to how they have long operated. Not only is it becoming harder and harder to retain employees, but everyone in healthcare needs more staff to care for our aging population. At the same time, government oversight and the wide range of measures aimed at improving the quality of care are not likely to go away anytime soon.

Short Staffing in Long-Term Care Is Having an Impact on Resident and Financial Outcomes

Staffing levels are one of the most important determinants of whether a long-term care facility is providing adequate care. However, many nursing homes have employee coverage issues and are failing the meet the CMS requirement “that a registered nurse be on-site at least eight hours every day” (Rau & Lucas, 2019). To verify staffing levels as part of the ratings effort for the Nursing Home Compare Website, CMS now requires facilities to submit their payroll records. A Kaiser investigation found that “nursing homes had fewer nurses and caretaking staff than they had reported to the government, according to new federal data, bolstering the long-held suspicions of many families that staffing levels were often inadequate” (Rau, 2018).

Understaffing is extremely important, as it “can indirectly cause nursing home abuse because overwhelmed and underpaid nursing home staff members and caregivers are more likely to be abusive to a nursing home resident” (Nursing Home Abuse Center, 2019). Inadvertent neglect is a natural product of understaffing—residents are dependent on caregivers who are stretched too thin. Increased psychological problems may result, as well as physiological conditions. The reasons for understaffing  are varied—it may be intentional on the part of some organizations as a strategy to reduce labor costs. Nursing facilities also may have a serious problem finding and retaining adequately trained nurses. High turnover among staff results in a greater burden on those who stay, leading to stress and burnout. Payroll records submitted to Nursing Home Compare “reveal frequent and significant fluctuations in day-to-day staffing, with particularly large shortfalls on weekends” (Rau, 2018).


Nursing Home Abuse Center, “Understaffing in the Nursing Home,” November 14, 2019, Retrieved at https://www.nursinghomeabusecenter.com/ nursing-home-neglect/understaffing/.

Rau, J., “Most nursing homes are not adequately staffed, new federal data says,” PBS Newshour, July 13, 2018, Retrieved at https://www.pbs.org/news­hour/health/most-nursing-homes-are-not-adequately-staffed-new-federal-data-says.

Rau, J., and Lucas, E., “Short-Staffed Nursing Homes See Drop In Medicare Ratings,” Kaiser Health News, May 3, 2019, Retrieved at https://khn.org/ news/short-staffed-nursing-homes-see-drop-in-medicare-ratings/.

This blog post begins a series based on our article, Top Issues Across the Care Continuum, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. Subsequent challenges to be examined include:

  • The Patient-Driven Payment Model (PDPM) Has Changed Reimbursement for Physical Therapy in Skilled Nursing Facilities
  • Low Rates for Medicaid Reimbursement, Coupled with Additional Recent State Funding Cuts, May Be Precipitating Skilled Nursing and Long-Term Care Facility Closures.
  • Long-Term Care Continues to Feel the Financial Impact of Civil Money Penalties and Civil Money Penalty Reimbursement Programs.
  • Efforts to Decrease Widespread Antipsychotic Drugs in Long-Term Care Facilities Require Individualized Care Plans.
  • Focused Dementia Care Surveys Are Reducing the Use of Antipsychotic Medication, with Unintended Consequences
  • Infection Control Surveys Reveal a Widespread Problem Across Long-Term Care.

There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about Healthstream solutions for non-acute care organizations.