Understaffing and Bedsores

Reports estimate that up to 91% of nursing homes in America are not sufficiently staffed to accomplish all caretaking tasks required by their elderly patients. Elderly patients frequently have mobility problems and require assistance for all forms of activity. Nursing homes may classify patients with mobility issues as needing a one-person assist or a two-person assist, depending on the exact size and medical condition of the elderly patient. Helping elderly patients with mobility assistance is a very time-consuming activity.

In addition to mobility concerns, bedsores are a common result of understaffed nursing homes. Medical recommendations state that elderly patients should be repositioned every two hours to prevent the development of bedsores. “Repositioning” means that the elderly patient must be moved from his or her current sitting or laying position into a new position. This is necessary part of bedsore prevention, regardless of whether or not the patient is in bed, a wheelchair, or a standard armchair.

Assistance for Elderly Patients

Elderly patients in a nursing home may see a variety of nursing home workers, including volunteers, janitorial staff, secretaries, certified nurse assistants, nurses, and doctors. However, only certain members of the nursing home staff are legally allowed to assist a nursing home patient with mobility or medical concerns. Furthermore, there are classification systems in place that identify patients who may need the most assistance. The parameters of those classification systems, including one- and two-person mobility assists, must be abided by law. Mobility assistance is one of the most time-consuming needs of nursing home patients.

Mobility Assistance

While nurses and doctors may certainly help an elderly patient get out of bed to use the restroom or take a shower, these medically-trained staff members are typically busy managing the major medical needs of the nursing home patients. As a result, most mobility concerns fall upon the certified nurse assistants (CNAs). In many nursing homes, CNAs are so understaffed that they feel overworked, stressed out, or they simply quit. Many CNAs fear that they may lose their CNA license if they continue to work in these understaffed nursing home environments.

Examples of Mobility Assistance

The argument of understaffed nursing homes from a CNA’s perspective is as follows:

An average-size nursing home might have 35 nursing home patients. For any single shift, there are 4 CNAs scheduled at a time.
Most nursing homes have at least one elderly patient who is classified as needing a two-person assist for all mobility needs. Mechanical devices, such as a Hoyer Lift or a Vander Lift, are typically used to assist these patients with high mobility risks. These major mechanical devices can be dangerous, and by law they require a minimum of two CNAs to assist every time they are in use. This is where the mobility classification term “two-person assist” comes from.
Most nursing homes have at least 20 patients requiring a one-person assist for all mobility needs. A “one-person assist” refers to any patient who needs a little extra assistance, from just one CNA at a time, to conduct simple tasks such as using the restroom.
The average nursing home patient may need to use the restroom roughly 5 times over the course of a CNA’s 8 hour shift. To help a patient with a one-person assist mobility classification level use the restroom, it may take 3 minutes. To help a patient with a two-person assist mobility classification level use the restroom, it may take roughly 10 minutes.
On top of needing to use the restroom regularly, nursing home patients will also need help with reaching items that may be too far away from their beds, feeding themselves, drinking enough water, repositioning, showers, and other hygiene necessities. In addition, patients require simple and caring human interaction to prevent mental illnesses, such as depression.
If there are 35 patients and 4 CNAs, with numerous patients classified as one-person and two-person assists, there is a very high risk that all CNAs will already be busy when an elderly patient rings a call bell. This means that the elderly patients in the average American nursing home facility could easily be forced to wait 15 minutes, or longer, to get enough assistance to use the restroom. When elderly patients are placed in this position, their two basic options include wetting themselves or walking to the toilet on their own. If the patient chooses to wet him or herself, there is a large risk of bedsore development and infection, in addition to the emotional grief and embarrassment. If the patient chooses to walk to the toilet alone, he or she may fall.

In recent years, it has become apparent that many cases of death after a bedsore could have been prevent with sufficient staffing of the nursing home. There are countless reports from CNAs and nursing home staff members that end-of-shift care reports are repeatedly falsified. This has prompted many nursing home staff members to leave the industry altogether. Learn more about nursing home employee background checks.

In understaffed nursing homes, the nursing home staff will not have adequate time to handle the following bedsore prevention techniques:

Repositioning all patients every two hours
Assisting patients with mobility concerns to use the bathroom
Ensuring the cleanest possible facilities, including safe, dry bedding and effective patient hygiene
Ensuring all patients are properly nourished and active in any way possible
Ensuring all patients are getting the mental and emotional support that they need
Making use of skin mapping for bedsore prevention, by filling out documents such as a CNA skin sheet to notate marks and changes in appearance of an elder patient’s skin
Identifying and treating bedsore development early-on

Understaffed Nursing Home Lawsuit

In NYC during December of 2009, one family of a nursing home resident located in a Brooklyn-Queens nursing home facility was awarded $19 million for the development of 20 bedsores on the elderly patient. The 20 bedsores developed over the course of nine months, while the director of the nursing home claimed that she was performing the tasks of five positions including assistant director, admission personnel, end-care plan reviewer, wound care nurse, and Medicare data analyst.

Sources:

“Interview With Becky Kurtz, Jeanne Sher.” CNN Transcripts. (2002): n. page. Print. <http://transcripts.cnn.com/TRANSCRIPTS/0202/23/cst.09.html>.

“Report: Understaffed Nursing Homes Endanger Patients.” ABC News. (2013): n. page. Print. <http://abcnews.go.com/US/story?id=96416&page=1>.