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Will Minimum Staffing Requirements Become A Reality In Alabama Nursing Homes?

Huntsville LawyersToday, I want to talk about nursing home staffing. Across Alabama, nursing homes and assisted living facilities are UNDER-staffed. This lack of staffing lowers the quality of life for many residents. And, it puts our elderly relatives and neighbors at risk of neglect and injury.

This lack of staffing also causes problems for those workers dedicated to helping elderly residents. Imagine being the only worker left to monitor and care for far too many residents. Burnout is an issue. And, worker injury is an issue. Over the years, we’ve seen many serious work-related injuries and disabilities suffered by nursing home workers forced to work too many hours and care for too many patients.

Staffing issues impact our vulnerable, elderly neighbors. They also impact the people trying to care for them. Earlier this year, the President proposed new rules to create minimum staffing standards. Let’s take a look at the problem and potential solution.

Staffing Shortages In Alabama Nursing Homes Put Residents At Risk!

For years, Alabama families worried that their elderly relatives in nursing homes were left without proper help or care. Much of the time, these worries stemmed from a lack of staffing. Too many nursing homes and assisted living facilities were chronically under-staffed. Almost every call we receive at our law firm starts with a facility that lacked the personnel to monitor and care for its residents.

I’m always reminded of a horrible injury case we worked many years ago. An elderly assisted living resident in Huntsville was brutally attacked by fire ants over the course of several nights. During the case, we learned the facility had serious (and longstanding) fire ant infestation issues. The managers were unwilling to commit the staff or other resources needed to protect residents. Rather than allocate the manpower to remedy the infestation, management simply handed a can of bug spray to its few staff members so they could kill pests once seen in patient rooms. I’ve written previously about this tragic injury case. Across the southeastern United States, fire ants are a real danger in nursing homes where patients lack mobility.

Staffing was an issue long before the coronavirus. In the aftermath of Covid-19, already existing problems from staffing shortages increased tremendously. In a September 2021 survey by the American Health Care Association, 86% of nursing homes said their workforce situation had worsened over the last three months.

Here is a recent stat that highlights current staffing shortage dangers — In a June 2021 survey by The American Health Care Association, a full 94% of nursing home providers admitted they had suffered a staffing shortage in the last month. For assisted living facilities, it was 81%. These are the facilities that admitted the problem!

A recent nj.com article tell the story of one facility inspection. What happened? An inspector arrived to see a resident who required observation due to his fall risk. Upon arrival, the inspector knocked. No answer. When he entered, he found the staff member asleep. I mean the staff member who was assigned the task of actually monitoring the resident. The inspector learned the staff person had worked a double shift (due to staffing shortages). He also learned the facility had operated below that state’s staffing requirements for 7 of the last 24 shifts. Although this inspection occurred in another state, it could easily have been Alabama. In fact, it is probably more likely in Alabama where our state inspections seem to so often fall short. In our practice, we hear so many family members tell us stories of facilities where loved ones are left without support or help. It’s a longstanding problem that is growing in magnitude.

What Is The Nursing Home Bill Of Rights For Residents? How Should It Protect Alabama Nursing Home Patients?

Federal law provides certain basic protections and rights for nursing home residents. Nursing homes must meet these Federal requirements if they participate in Medicare and Medicaid.

Patients have the right to be informed, make their own decisions, and have personal information kept private. This Bill of Rights also lists a number of other rights, including these:

  • The right to be treated with respect.
  • The right to be free from discrimination.
  • The right to be free from restraints.
  • The right to proper medical care.
  • The right to manage your money.
  • The right to spend time with visitors.
  • The right to social service.

While this Bill of Rights is an essential list for proper resident care, the lack of basic staffing means many nursing homes and assisted living facilities fall far short. As with every other part of patient care, the most essential requirement is that the facility have the staff needed to meet safety standards. Too many Alabama nursing homes fall far short. Because of that, our loved ones are at risk for neglect and injury.

Staffing Shortages Lead To Neglect In Alabama Nursing Homes. What Are Some Signs Of Neglect?

On our firm website we have a page devoted to Alabama nursing home neglect and abuse issues. I wrote the page and listed a number of red flags or warning signs that may indicate your loved one is a victim of neglect or abuse. You can read our full page for more information. But, here are a few red flags or signs that nursing home neglect may have occurred:

  • Unexplained changes in behavior or alertness. Has your loved one withdrawn from social activities? Has your loved one experienced troubling changes in sleeping or eating habits?
  • Caregivers who are too verbally or physically aggressive. This includes caregivers who are insulting, controlling, uncaring, or who are overly concerned with spending any money.
  • Fearfulness around other residents or caregivers.
  • Lack of good hygiene, food / water or clean clothes.
  • Lack of available medical aids. (Examples include glasses, hearing aids, dentures, etc.).
  • Patients left without care or supervision.
  • Pressure Sores, especially untreated ones. (bed sores).
  • Unexplained wounds or injuries. (Like lacerations, fractures, bruises, cuts, sores, burns, restraint marks or bloody clothes).

If you visit or care for a loved one in a nursing home, be aware of any telltale signs or changes. Pay close attention to insure your loved one is receiving the basic care he or she needs. Be an advocate for your relative. Too many elderly citizens lack the family support needed.

Will Proposed Minimum Staffing Requirements Better Protect Alabama Nursing Home Residents?

Earlier this year, the Biden Administration made several proposals to reduce nursing home neglect and abuse. The statement issued by the White House starts with the following statement:

All people deserve to be treated with dignity and respect and to have access to quality medical care.

. . .

The President believes we must improve the quality of our nursing homes so that seniors, people with disabilities, and others living in nursing homes get the reliable, high-quality care they deserve.

The current proposal includes a directive to establish minimum nursing home staffing requirements. The proposal directs CMS (Centers For Medicare And Medicaid Services) to conduct research and issue proposed minimum staffing rules within one year.

In just the last few months, our office has reviewed several nursing home injury cases directly attributable to the lack of staffing. In one case involving a Huntsville-area facility, the family called the facility repeatedly seeking help for their loved one. Yet, the facility was so short-staffed that nobody even answered the phone. Their loved one languished un-helped, suffering excruciating pain in distress, for hours. The patient was ill and a fall risk. In another case, a facility lacked the staff to monitor key vital signs in the resident. Due to illness, the patient’s doctor specifically ordered that vital signs be monitored every shift. They were not. The result was tragic.

In the days and weeks following this proposal for minimum staffing limits, nursing home lobbyists have begun to organize their opposition. So often, basic proposals to protect people fail because of lobbyist money. When it comes to highway safety, medication safety, food safety and the safety of our most vulnerable citizens in nursing homes, Congress seems to listen more to lobbyist money than the needs of people. Let’s hope this proposal gets the fair discussion it deserves.

In Alabama (and across the United States), the lack of staffing puts residents at risk for suffering, injury and death. We need some minimum standards to ensure all residents have the staff needed for their care and needs.


We are Alabama personal injury and wrongful death lawyers. From our law office in Huntsville, we help families statewide. If you have questions about an accident or personal injury issue, let us know. We are happy to discuss answers. Our consultations are always completely confidential and free.