When Nursing Homes Say Staffing Isn’t Possible: What Families Should Know
Families across Ohio are hearing a familiar explanation when something goes wrong in a nursing home: we don’t have enough staff.
Unanswered call lights. Rushed meals. Falls. Choking incidents. Pressure injuries that seem to appear overnight. These are not abstract policy debates. They are lived experiences for residents and their families.
Recent national reporting has renewed attention on nursing home staffing rules and the industry’s efforts to challenge them. What that reporting also highlights, and what families are rarely told, is an important missing piece of the conversation: staffing decisions are often financial decisions. Where the money goes matters.
Families I work with in Cleveland, Cincinnati, and Dayton often describe the same concerns when staffing falls short in nursing homes.
As a former registered nurse and an Ohio nursing home neglect lawyer, I want to explain why “we can’t hire enough staff” is not always the full story, how staffing choices show up in real cases, and what families should be documenting right now when care falls short.
Why are so many nursing homes understaffed?
Nursing homes are often understaffed not only because of workforce challenges, but because staffing levels are shaped by financial and management decisions. When facilities limit staffing to control costs or shift profits through related companies, too few caregivers may be responsible for too many residents, increasing the risk of delayed care, neglect, and preventable injuries.
This is not a new concern. For decades, chronic understaffing has been linked to poor outcomes in nursing homes. What is new is increased scrutiny of how profits are structured and reported.
A recent New York Times investigation into nursing home staffing and industry lobbying reported that patients’ rights groups shared research that more than 60 percent of nursing home profits were hidden through transactions among related corporations. That same research found that if those funds were spent on staffing, many facilities could meet higher staffing standards, including around-the-clock registered nurse coverage.
Earlier this year, the federal government also repealed minimum staffing requirements for nursing homes, a move with significant implications for Ohio residents and their families. I discussed those changes in more detail in a prior post on the repeal of federal nursing home staffing requirements and what it means for Ohio residents.
Facilities frequently describe staffing shortages as unavoidable. When residents are being harmed, that explanation deserves closer examination.
Why does nursing home understaffing matter for residents?
Insufficient staffing directly affects safety and care. When too few staff members are responsible for residents’ daily needs, essential tasks such as monitoring, repositioning, and safe feeding may be delayed or missed, leading to falls, pressure injuries, choking incidents, and other preventable harm.
Federal oversight data reinforces this connection. The Centers for Medicare & Medicaid Services’ nursing home staffing and quality measures consistently show relationships between staffing levels and resident safety outcomes.
What staffing failures look like on the ground
In real cases, staffing decisions do not appear on a spreadsheet. They show up in residents’ bodies and daily lives.
In my practice, I repeatedly see the same patterns when staffing is inadequate.
Common signs of nursing home understaffing include:
- Missed repositioning, leading to pressure ulcers or rapidly worsening bedsores
- Inadequate supervision, resulting in falls, fractures, or unsafe wandering
- Rushed or improper feeding, increasing the risk of choking
- Overuse of medications when staff are stretched too thin
- Delayed responses to medical changes because staff cannot keep up
These outcomes are not random. They often reflect staffing choices made over time, across specific shifts, weekends, or overnight hours.
Families frequently sense that something is wrong long before they receive a clear explanation. Staffing failures rarely happen all at once. They unfold gradually.
What families can do if they suspect understaffing
This is the most important part of the conversation.
When families suspect understaffing, there are practical steps they can take to protect a loved one and preserve important information:
- Document patterns, not just isolated incidents. Dates, times, and repeated issues matter.
- Ask specific questions during care conferences about staffing levels on different shifts.
- Request records showing staffing assignments on the days incidents or injuries occurred.
- File complaints when appropriate, but understand their limits.
- Trust your instincts when a mom or dad declines without a clear medical explanation.
Families can learn more about baseline care standards by reviewing Ohio nursing home resident rights, which outline what facilities are required to provide under state and federal law.
If you are considering a complaint, our guide on how to file an Ohio Department of Health complaint explains the process and what families should realistically expect.
What attorneys should be watching for
For attorneys representing families or considering referrals, staffing explanations should be a starting point, not the end of the inquiry.
Key issues to examine include:
- Ownership and management structures, including related-party transactions
- Staffing records tied to specific dates, shifts, and incidents
- Discrepancies between reported staffing levels and actual care delivered
- Patterns of harm that cluster around certain times or staffing configurations
When staffing failures consistently align with resident injuries, accountability questions follow naturally.
Frequently asked questions about nursing home understaffing
Can understaffing cause nursing home neglect?
Yes. Chronic understaffing has been repeatedly linked to neglect, including missed care, inadequate supervision, pressure injuries, falls, and unsafe feeding practices.
Is nursing home understaffing illegal?
Not always. Nursing homes must meet certain staffing requirements, but understaffing may still occur even when facilities claim compliance. It becomes a legal issue when it contributes to injury, neglect, or violations of residents’ rights.
How can families tell if understaffing is affecting care?
Families often notice patterns such as unanswered call lights, rushed care, frequent falls, sudden weight loss, or unexplained declines. These patterns may indicate staffing levels are insufficient to meet residents’ needs.
Accountability matters
Minimum staffing standards exist for a reason. They are meant to protect residents who cannot protect themselves. When facilities choose to allocate resources away from staffing, residents bear the risk.
Families deserve transparency. Residents deserve dignity and safety. Accountability does not depend on politics. It depends on facts, documentation, and a clear understanding of how staffing decisions affect care.
I represent families throughout Ohio, including Cleveland, Cincinnati, and Dayton. If you believe your mom or dad was harmed because a nursing home failed to provide adequate staffing, you deserve answers. As a former registered nurse and an Ohio nursing home neglect lawyer, I review these cases carefully and honestly. If something does not feel right, I encourage you to contact my office to discuss your concerns.
