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Nursing Home Staffing Regulations: A Necessity that Sometimes Gets Overlooked

Published on Jul 20, 2015 at 11:52 pm in Nursing Home Abuse.

Last week we talked about Hurstbourne Care Centre at Stony Brook, a Louisville adult care facility which will be forced to have its Medicare agreement terminated due to poor conditions that were negatively affecting both the health and safety of its residents. Situations like this happen all too often and are extremely painful for both the residents and their family members. In a second blog posted earlier this week, we shared advice for family members who might one day find themselves in a similar situation.

Why are such conditions allowed to happen, though? Nursing homes and adult care facilities are heavily regulated and inspected by agencies like Centers for Medicare & Medicaid Services (CMS) and Adult Protective Services, but issues still sometimes fall through the cracks. In most cases, poor conditions can be linked back to one thing that is often overlooked—improper facility staffing regulations.

To understand why facility staffing regulations sometimes falter, first we must understand the other systems of regulations that are in place. There are separate federal and statewide staffing standards that nursing homes and adult care facilities are expected to uphold. In most states, each day and night shift must have a registered nurse (RN) or licensed practical nurse (LPN) who is available at all times. In addition, nurse’s aides (NAs) are also present at all times.

According to federal regulations, a facility’s expected number of staff members is proportionally based off the number of beds in the facility. Unfortunately, that number dictates the amount of hours nurses work instead of the amount of nurses present. This often results in fewer nurses working longer shifts instead of more nurses working shorter shifts. Both types of shifts can result in sufficient levels of care, but gaps and oversights in nursing and care duties tend to increase during long shifts which can be especially taxing.

It’s in a facility’s best interest, naturally, to create facility regulations which require its nursing staff to work shifts that result in the best care possible. If a facility fails to keep the correct nursing staff ratios or forces its staff members to work extra-long shifts, poor conditions like those found at Hurstbourne Care Centre at Stony Brook may easily result. Improper scheduling or charting can also be at fault.

One other possible issue could be the fact that the federal regulations aren’t as useful as they could be for larger facilities. A facility with 150 beds might require the exact same amount of nurses that a facility with 200 beds requires, for instance, simply due to the way in which the hours-per-bed ratio is calculated. The number of required RNs and LPNs on duty also does not change no matter the amount of beds a facility has. This potentially means that the larger facilities have residents that rarely—if at all—get to see the RN or LPN on duty. In extremely large care centers, this can lead to poor care.

Larger facilities have a few options to deal with this predicament. They can hire additional nurses or organize the nursing shifts to best utilize the time of each staff member. Given the fact that Hurstbourne Care Centre at Stony Brook is a facility which houses 125 residents, it seems extremely likely that the facility failed to do one or more option. It’s also possible that the nurses themselves were not being properly supervised or that staffing regulations weren’t being enforced at all.

Adult care facilities not only have a responsibility to uphold federal regulations, but they also have a responsibility to create and enforce facility regulations that help ensure their nurses and staff members issue the best care they can. Without proper staffing regulations, even the best of nurses can falter and overlook a resident’s care sheet. It’s uncertain for now what exactly was at fault at Hurstbourne Care Center at Stony Brook, but with proper facility regulations in place, those poor conditions may have been completely prevented.

For family members of residents staying at the facility where this unfortunate tragedy occurred, there is legal help available. Requesting legal aid can potentially help keep Hurstbourne Care Center or any other facility from making mistakes that endanger the lives of others. Legal aid can also help you get your loved one into a new, safe facility and help your entire family get through this troubled time.

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Tad Thomas

Managing Partner

Tad Thomas has dedicated his practice to representing plaintiffs in various types of civil litigation, including personal injury, business litigation, class actions, and multi-district litigation.

After graduating with his law degree in 2000 from Salmon P. Chase College of Law at Northern Kentucky University, Mr. Thomas immediately opened his own private practice and began representing injury victims.

In 2011, Thomas Law Offices was established in Louisville, Kentucky. Over the past decade, Mr. Thomas has expanded his firm and now has offices in three additional locations: Cincinnati, Ohio, Columbia, Missouri, and Chicago, Illinois. He is also a frequent lecturer on topics like trial skills and ethics and technology.

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