Do Nursing Homes Understaff to Increase Profits?

According to PA nursing home lawyers, Pennsylvania’s long history of substandard nursing home care has often been blamed on for-profit facilities that consistently place profits ahead of resident care and safety. The Centers for Medicare and Medicaid Services (CMS) continue to delve into nursing home ownership models, specifically scrutinizing understaffing at for-profit nursing homes. This article will explore nursing home understaffing, discuss injuries related to understaffing, and educate consumers how take action if their loved one was injured due to understaffing at a nursing home.

Acuity Rises; Staffing Levels Not Keeping Pace

Over the past 10 years, nursing home residents have been arriving at nursing homes “quicker and sicker.” This means that nursing homes are admitting residents after shorter hospital stays and with higher clinical needs. Unfortunately, nursing home staffing levels not kept pace with the increasing clinical needs of the nursing home resident population.

In July 2022 Governor Wolf signed legislation to increase Pennsylvania nursing home staffing from 2.7 hours per patient day to 2.87 hours per patient day and set minimum shift ratios for nurses and certified nursing assistants. However, resident advocates and PA nursing home lawyers say that this change is not significant enough for the safety of clinically fragile and functionally impaired residents living in many of the state’s nursing homes. Industry experts recommend nursing homes provide a total of least 4.1 hours of care.

While federal regulations require nursing homes to staff based on acuity to assure that resident needs are met, this requirement can be obscure and difficult to enumerate. Sadly, a nation-wide standard for staffing minimums does not yet exist, but CMS has hinted at implementation of federal nursing home staffing regulations in 2023.

Expectedly, the nursing home industry is pushing back against staffing mandates, claiming that industry-wide staffing challenges and limited federal and state funding will limit their ability to comply with staffing mandates. While nursing homes “cry poor” against the staffing mandates, PA nursing home lawyers suggest that nursing homes are adept at hiding profits, and many for-profit providers, including REIT-owned facilities, make financial decisions to limit labor to induce higher profit margins.

REIT-Owned and For-Profit Facilities Scrutinized for Understaffing

According to a Kaiser Family Foundation (KFF) report, nearly 71% of nursing homes are operated for-profit. Real Estate Investment Trusts (REITs) account for approximately 12% of all nursing home ownership and have come under criticism by the federal government and PA nursing home lawyers for their profiteering approach to nursing home ownership.

Charlene Harrington, a professor emeritus at the University of California San Francisco’s School of Nursing, specializes in nursing home staffing and scheduling. She states that for-profit nursing homes earn “excessive” profits by intentionally limiting their staffing.

Nursing homes understaffing results employees who are unable to complete their work to meet the standard of care. The most common problems found in nursing homes – pressure ulcer, weight loss, falls, excessive use of antipsychotics – are directly related to understaffing.

“Recklessly Understaffed”

Sadly, there have been multiple examples throughout Pennsylvania in which nursing home understaffing has resulted in serious resident injuries and deaths. In 2021, the nursing home manager of St. Francis Center for Rehabilitation and Healthcare pled guilty to three counts of reckless endangerments after he “disregarded resident care by routinely and recklessly understaffing his nursing home.” The residents suffered conditions including, pressure wounds, sepsis, dehydration, and bowel obstructions as the result of systemic failures in St. Francis primarily driven by inadequate staffing practices. According to the state Attorney General, this routine understaffing resulted in three residents to sustain severe bodily injuries that ultimately led to their deaths.

In August 2022, two for-profit skilled nursing facilities in southwestern Pennsylvania were indicted on charges related to health care fraud. Inspectors allege “alarming low” staffing levels of 2.4 hours per patient day on multiple days at the Lancaster Nursing and Rehabilitation. Part of the allegations against these communities include falsification of staffing levels on reports to CMS.

Injuries and Illnesses Correlate to Nursing Home Understaffing

Patient care is fundamentally impacted by understaffing. To put it another way, when nursing home owners choose to understaff a building, they are choosing to put patients at risk in order to prioritize profits.

Studies looking at thousands of nursing homes nationwide have linked for-profit ownership with low staffing levels and increase COVID-19 infections. In addition, PA nursing home lawyers report that residents at understaffed buildings are more likely to suffer preventable illnesses and injuries such as:

Pressure ulcers or bed sores

Nursing home understaffing lawyers have witnessed many cases in which a resident is not turned and repositioned and develop preventable pressure ulcers. Some nursing homes then fail to follow the standard of care for treating pressure ulcers, and the pressure wound worsens, often down to the resident’s muscle or bone.

Preventable falls with injury, such as fractures

Nursing homes that understaff often do not provide residents with adequate supervision to meet their safety needs. Many residents who live at nursing homes are at risk for falls. Additionally, they may have physical limitations or cognitive deficits that impede their ability to move around safely. PA nursing home lawyers insist that adequate nursing home staffing is necessary to keep residents safe and prevent falls in vulnerable residents.

Weight loss / Malnutrition / Dehydration

Many nursing home residents require assistance with eating and drinking. Some residents need reminders and encouragement to eat. Others need physical assistance at meal time. Residents also depend on staff to obtain snacks and drinks throughout the day. Nursing home understaffing lawyers understand that these tasks often fall through the cracks when a nursing home is understaffed. As a result, residents can lose a significant amount of weight, or suffer from malnutrition or dehydration.

Resident Abuse and Neglect

Resident abuse and neglect are closely linked to understaffing. PA nursing home lawyers cite that workers who don’t have enough staffing are likely to become frustrated or angry, sparking physical abuse against residents. Understaffing can lead to resident’s suffering neglect, meaning that the facility fails to provide the resident with the care or services needed to maintain their health and safety.

Actions to Take When Understaffing Results in Resident Injury or Death

PA nursing home lawyers advocate that immediate action is needed if nursing home understaffing has resulted in resident injury or death. The following are steps that you can take to fight back and make sure your loved one receives the appropriate standard of care.

  1. Contact the Pennsylvania Department of Health and file a nursing home complaint
    1. Call 1-888-254-5164
    2. Email
    3. Mail: Division of Nursing Care Facilities Director, Pennsylvania Department of Health, Division of Nursing Care Facilities, 625 Forster St, Room 526, Health and Welfare Building, Harrisburg, PA 17120
    4. Fax: 717-772-2163
  2. Contact the PA Elder Abuse Hotline at 1-800-490-8505
  3. Contact the PA Department of Aging Ombudsman Office for help resolving nursing home complaints by calling 717-783-8975 or email
  4. Call PA nursing home lawyers at the Wieand Law Firm LLC at 215-666-7777 to learn about your legal rights to file a civil lawsuit.

Contact The Wieand Law Firm, LLC

It’s time that nursing home residents and their families stand up against poor care and understaffing at Pennsylvania nursing homes. The Wieand Law Firm represents injured victims who have suffered abuse and neglect at nursing homes, assisted living facilities, and group homes. Learn more about your legal rights through a free case review and evaluation from our PA nursing home lawyers. Call 215-666-7777 or send a message via the online form to speak directly with an attorney.

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