What Are the Staff Requirements in California Nursing Homes?

American nursing homes have a staffing problem. Eight in 10 facilities report that they are moderately or severely understaffed, which means that patients are not getting the optimal level of care. Residents at understaffed nursing homes are at risk of neglect, abuse and even death.

If nursing home administrators know the risks of an understaffed facility, why do they allow this problem to continue? And what is California doing to protect vulnerable patients? You might be surprised to learn about the current staffing guidelines that nursing homes must follow.

California Requirements for Nursing Home Staffing

Nursing homes fall under the umbrella of skilled nursing facilities, which are a type of healthcare facility that provides patients with 24-hour nursing, medical and rehabilitative services. Staff may include a mixture of physicians, licensed nurses (LPNs), registered nurses (RNs) and certified nursing assistants (CNAs). CNAs typically make up most of a nursing home’s staff and provide the majority of care to patients, including assisting them with tasks of daily living, administering some medications, and monitoring vital signs and medical conditions.

California nursing home staffing requirements are set forth in California Health & Safety Code §1276.5, which was last updated in 2018. Per this rule, skilled nursing facilities must provide residents with a minimum of 3.5 hours of direct care per day, with at least 2.4 of those hours of care provided by a CNA.

Other than this, California has no requirements regarding staff to resident ratios. Nursing homes do not need to employ a minimum number of staff, so long as they can meet the 3.5 hours of direct care requirement.

Federal Requirements for Nursing Home Staffing

Nursing homes that receive Medicaid and Medicare funding (which includes virtually all nursing homes) must meet federal staffing requirements. Per federal rules, these facilities must:

• Employ a full-time director of nursing;
• Have at least one RN on duty for eight hours straight a day; and
• Have an RN or LPN on duty 24 hours a day.

The federal government recommends that facilities have one RN for every five patients, but so long as a single nurse is on duty, nursing homes are in compliance. Federal guidelines do not require facilities to have a specific number of CNAs on staff; they just have to “provide sufficient staff and services” to patients.

With such lax requirements at both the state and federal levels, it’s no wonder that many nursing home administrators try to cut costs by hiring the minimum number of staff.

How Understaffing in Nursing Homes Can Lead to Neglect

Understaffing is the underlying cause of many cases of nursing home neglect and abuse. CNAs and RNs may care deeply about their patients, but when staffing ratios are too high, they are simply too overworked and busy to provide adequate care. When there are too many patients to care for at once, CNAs and nurses must prioritize time-sensitive issues over other tasks, like turning residents to avoid bedsores.

These working conditions often lead to a high turnover rate, which is another contributing factor to neglect. CNAs provide the vast majority of direct care to patients, yet they are paid the least because they are considered paraprofessionals. Many nursing homes must urgently hire and onboard staff throughout the year as burnt-out employees leave. Facilities suffer from a constant flow of underqualified staff who are unfamiliar with patients, have a minimal amount of training, and are more likely to make mistakes. The quality of care suffers—and so do patients.

Types of Nursing Home Neglect

The Centers for Disease Control and Prevention defines neglect as “the failure to meet an older adult’s basic needs.” These needs include essential medical care, shelter, food, water and hygiene. Although the term “abuse” is often associated with physical or sexual abuse, nursing home neglect is, in fact, a form of abuse. In its most severe form, neglect can lead to death.

When nursing home staff are stretched thin, the risk of neglect increases. Common forms of neglect that may be linked to understaffing include:

• Leaving patient rooms and common areas dirty
• Failing to change diapers or clean accidents in a timely manner
• Providing patients with inadequate food and water
• Failing to move patients who cannot move themselves
• Failing to properly administer medication
• Failing to call a doctor when necessary
• Leaving residents alone for too long
• Keeping the environment at an uncomfortable temperature
• Failing to bathe patients adequately
• Failing to change patients’ clothes or bedding regularly

In a 2020 World Health Organization (WHO) survey, 12 percent of nursing home staff admitted they had neglected patients. Overall, 2 in 3 staff said they had engaged in some form of abuse against residents, including neglect, psychological abuse and physical abuse. Although there are many reasons why a caregiver might abuse a patient, WHO suggests that providing services to help relieve the burden of caregiving could help prevent it. There is clear evidence that nursing homes that do not provide staff with enough support are putting patients at risk.

Nursing home understaffing has a simple solution: hire more qualified people and provide them with adequate training and a better working environment. Unfortunately, many nursing homes choose to ignore this problem and, in turn, expose patients to neglect and abuse.

Contact a Nursing Home Abuse Lawyer

An experienced nursing home abuse lawyer can provide a wealth of resources to help you protect your loved one and determine whether to file a nursing home abuse lawsuit. Since 1993, Garcia & Artigliere have been protecting our most vulnerable by being leaders in elder and nursing home abuse litigation. Garcia & Artigliere have obtained more than $3 billion in results for its clients. Call or contact us today for more information. We serve clients out of our Long Beach and Los Angeles offices.