C.N.A.'s Understaffed at Nursing Homes

While families often turn to nursing homes when they can no longer provide their aging loved ones with sufficient care, geriatric health experts say these facilities generally lack the manpower needed for optimal treatment.

The appropriate staffing ratio during peak care hours at nursing homes should be one Certified Nursing Aide, the primary basic caregivers in these facilities, to every five or six patients, according to John Schnelle, director of the Vanderbilt Center for Quality Aging.

In reality, the average ratio during labor intensive daytime and evening shifts is one aide to anywhere between eight and twelve patients, Schnelle said, which creates major problems.

“It takes a lot more time than aides have, even if they’re working at high productivity,” Schnelle said, “which would explain why there are reoccurring scandals and problems.”

An average of six out of 10 nursing home patients require incontinence care throughout the day, Schnelle said, and feeding a patient can take 15 to 20 minutes per meal. Aides faced with work overload don’t have time for important but non-essential tasks, such as mobilizing patients, which leads to decline.

Budget problems, along with understaffing, are especially common to nursing homes that have a high proportion of Medicaid patients. This is because reimbursement for Medicaid patients is lower than that for Medicare and private-pay patients.

“Most homes that are staffed at a desirable level are private pay or subsidized,” Schnelle said, adding that inner-city nursing homes have an especially high rate of Medicaid patients who generate much less income for the facilities, and therefore receive less adequate care.

Schnelle said lack of employee incentive compounds the staffing shortage in many nursing homes. The aides are not paid well, they often work double shifts and become fatigued, and their unrealistic care load leads to a high rate of turnover.

“You start to wonder if people have any motivation to work at a high productivity level,” Schnelle said. “(Nursing homes are) worse than a typical fast food place in terms of work conditions.”

As the aging population in the U.S. expands, labor projections show a growing need for long-term health care providers, not just for nursing homes, but also for in-home care. Despite a possibly unsavory work environment, experts say certified nursing aides will continue to have economy-proof jobs. As senior care moves to the home for individuals who do not qualify for Medicaid or Medicare nursing home benefits, many nursing aides are seeking one-on-one care positions with senior home care agencies. Assisted living communities, hospitals and hospices also hire part-time and full-time certified nursing aides.