“As long as drive the speed limit, I can’t be negligent.” Wrong! Driving 70 mph during a blizzard isn't reasonable regardless of the speed limit. Nursing home owners and operators often argue that as long as they have met the state/federal staffing-to-patient ratios, they have complied with the standard of care relating to nursing home staffing. The problem with this “logic” is that the standard of care requires nursing home facilities to have enough staff to meet the needs of the residents. See 42 CFR § 483.30 ("The facility must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessment and individuals' plans of care.") As Janet Feldkamp, JD, RN explained in her article, Light Staffing Can Mean Heavy Liability, “ a nursing facility must have personnel in excess of applicable state requirements if the facility's residents require more care or supervision than can be met by the state standard.”
This means that the number of staff needed is not based on some arbitrary number (like a speed limit) but is based on a variety of factors, including the physical layout of the nursing home, but, most importantly, the actual condition of the residents (sometimes referred to as resident acuity). Resident acuity changes often and therefore requires frequent assessments. Rarely, however, do nursing homes assess residents before making staffing decisions. More often than not, nursing homes use a mathematical formula to determine staffing without ever considering the condition or needs of its residents on a given day. In other words, nursing homes will take the default position of driving 70 mph every day without considering the weather, or, in this case, the condition of its residents. This practice is not only contrary to state and federal law, it’s dangerous and the cause for many avoidable nursing home resident injuries and deaths.
Nursing homes are paid good money to provide sufficient staff to meet the needs of the residents each and every day. That is their job. If a nursing home is unable to adequately assess its residents’ acuity prior to making staffing determinations, the nursing home needs to determine why it is unable to make such assessments and make the necessary changes. Notably, the need for continual assessment to adjust staffing levels in order to ensure sufficient staff to meet residents’ needs is becoming more and more important as nursing homes are taking on sicker and sicker residents whose conditions are likely to change more often and require more one on one supervision.
-Tom
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