Nursing homes always have the right number of nurses and aides to care for their residents, right?

That would be nice.

In reality, the nursing homes I see as an attorney representing families whose loved ones are hurt or killed through carelessness are almost always understaffed.

Long empty nursing home hallway

Many of my clients describe the “ghost town” effect, especially at night and on weekends: empty halls and hard-to-find staff.

What is Nursing Home Understaffing, Really?

Nursing home understaffing is when there are not enough nursing home staff to meet the specific needs of all the residents.

Nursing homes provide care to residents through people (staff): nurses (registered nurses and licensed practical nurses), nursing aides (also called State Tested Nursing Assistants or STNAs in Ohio), therapists (physical, occupational, speech) and their assistants, janitorial / environmental staff, dietary / nutrition, and sometimes doctors.

In my experience, critical understaffing is in the nursing staff–nurses (RNs and / or LPNs) and aides (STNAs)–because they are the ones providing direct medical care, observation, and evaluation.  Without enough nursing staff, people die.

Without enough physical therapists, by contrast, residents might miss a session or two.  Not usually life-threatening.

Nursing homes know what their resident’s individual care needs are, because they evaluate every single resident’s needs on admission, and at least every 90 days thereafter under federal regulations.

How Many Nurses and Aides Should a Nursing Home Have?

The “State Minimum” Myth

States like Ohio have minimum numbers of nursing staff for the number of residents.  Sounds good, right?

Wrong.

This is really the bare minimum number of staff any nursing home has to have for the least care-intensive residents possible.  If you don’t have at least this number of staff, you ought to be shut down.

What Ohio’s minimum numbers misses is any relationship to the care needs of the residents in the nursing home.

For example, imagine a nursing home with 99% independent seniors who need minimal direct care–maybe just help taking medications.  Pretty light load for the nursing staff.

Now compare that with a nursing home with the same number of residents, but in which 99% of the residents require extensive care–help sitting up in bed, two people to help them transfer from bed to wheelchair, help getting dressed eating, brushing their teeth, combing their hair, intensive medical treatments like bandage changes and complex medicine regimes, etc.  an incredibly heavy load for nursing staff.

Which nursing home should have more nursing staff?  If all you use is the state minimum, they could both have a bare-bones staffing level.  That would be insanely stupid and result in residents dying.

Not to mention, even these state-minimum levels are far too low according to a 2016 report.

Staffing Based on Residents’ Needs (Acuity)

The right way to determine the number of nursing staff needed for a particular nursing home is to consider the individual resident’s care needs.  This is sometimes called “acuity.”

Almost every nursing home is required by Medicare to evaluate each resident’s care needs using a tool called the MDS.  This provides information on how much care a resident requires, from how independent they are taking care of daily needs like going to the bathroom and brushing their teeth, to how many medical conditions they have that require intensive care.

Medicare uses this information to assign each resident a score that represents how much nursing staff time is likely required to care for them.  The score is actually a set of “groups” of care level, called “Resource Utilization Groups,” or RUG scores.

This makes sense: how much staff resources will you utilize as a resident?

Nursing homes can use this information to forecast the right amount of each type of nursing staff–Registered Nurses, Licenses Practical Nurses, and State-Tested Nursing Assistants–for their residents’ needs.

Most either never do this evaluation, or ignore it.

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What are “Expected Staffing Levels”?

Expected Staffing Levels is the amount of nursing minutes available per resident based on the residents’ collective care needs, according to Medicare.

Medicare didn’t just put the care need evaluation forms (MDS) together, and break residents into Resource Utilization Groups.  Medicare also paid for studies to figure out the right amount of nursing staff required based on a resident being in one of those groups.  Take all the RUG scores together, add up the number of minutes of each type of nursing staff for each resident, and presto, you have your Expected Staffing Levels.

That’s right: Medicare paid for studies so that nursing homes could immediately know the amount of nursing staff–for each type of nursing staff, down to the minute–they need to have to care for residents.

So all the nursing homes staff at the Expected Staffing Level, right?  Or higher?

Nope.

Why do Nursing Homes Routinely Under-Staff?

In particular for nursing homes that are for-profit companies (instead of nonprofit or religious), profit is king.

And how do nursing homes (or any company) make profit?  By having more income (revenue) with less cost (expenses).

The number one income source for every nursing home I have ever sued has been the number of residents (and, often, they get paid more for resident who have the highest care needs, reflected by the Resource Utilization Group score).  Want revenues to go up?  Fill those nursing home beds with residents, the sicker and needier, the better.

The number one expense for every nursing home I’ve ever sued has been nursing staff.  Want expenses to go down?  Hire fewer nursing staff members, pay them less, and have them work fewer hours.

The result is an almost undeniable temptation to under staff: have as many residents cared for by as few nurses and aides as you can get away with.

And with Ohio’s under-funded inspectors, they can get away with some pretty egregious under staffing levels.

How Well Staffed are Ohio Nursing Homes?

Ohio nursing homes are some of the worst-staffed nursing homes in the country, according to various reports.

According to a report card published by the advocacy group Families for Better Care, Ohio has some of the worst staffing levels in the country in 2013 and 2014.  Ohio got an “F” for “Direct Care Staffing Above Average,” ranking 48th in the country.

Ouch.

Compare that with the low number of deficiencies, and you can see there’s a gap between the nursing home performance, and inspections.

Here’s a map of the 2014 rankings (note Ohio got a D overall–in part because of few numbers of cited deficiencies):

A map of the US with each state color coded from grade A in green to grade F in red

The state-by-state report card for nursing home quality in 2014 from the organization Families for Better Care, available at www.nursinghomereportcards.com

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What are some of the Worst-Staffed Nursing Homes in Ohio?

Based on Medicare’s star-rating system, the below nursing homes rank among the worst in Ohio for staffing AND how residents do (“quality outcomes”).  (This is based on information pulled from the US News database, not our trial database.)

Austinburg Nursing and Rehabilitation Center

2026 State Route 45, Austinburg, OH 44010

Austinburg Nursing and Rehabilitation Center in Austinburg, OH, is rated 1.0 stars overall. It is a large facility with 139 beds and has for-profit, corporate ownership. Austinburg Nursing and Rehabilitation Center is not part of a continuing care retirement community.

Cambridge Health and Rehabilitation Center

1471 Wills Creek Valley Drive, Cambridge, OH 43725

Cambridge Health and Rehabilitation Center in Cambridge, OH, is rated 1.0 stars overall. It is a large facility with 144 beds and has for-profit, corporate ownership. Cambridge Health and Rehabilitation Center is not part of a continuing care retirement community.

Hanover House

435 Avis Avenue NW, Massillon, OH 44646

Hanover House in Massillon, OH, is rated 1.0 stars overall. It is a large facility with 181 beds and has for-profit, corporate ownership. Hanover House is not part of a continuing care retirement community.

Horizon Post Acute Care

3889 East Galbraith Road, Cincinnati, OH 45236

Horizon Post Acute Care in Cincinnati, OH, is rated 1.0 stars overall. It is a large facility with 162 beds and has for-profit, individual ownership. Horizon Post Acute Care is not part of a continuing care retirement community.

Lake Pointe Health Care

3364 Kolbe Rd, Lorain, OH 44053

Lake Pointe Health Care in Lorain, OH, is rated 1.0 stars overall. It is a large facility with 158 beds and has for-profit, corporate ownership. Lake Pointe Health Care is not part of a continuing care retirement community.

Logan Health Care Center

300 Arlington Avenue, Logan, OH 43138

Logan Health Care Center in Logan, OH, is rated 1.0 stars overall. It is a large facility with 144 beds and has for-profit, corporate ownership. Logan Health Care Center is not part of a continuing care retirement community.

Manor at Whitehall

4805 Langley Avenue, Whitehall, OH 43213

Manor at Whitehall in Whitehall, OH, is rated 1.0 stars overall. It is a large facility with 150 beds and has for-profit, corporate ownership. Manor at Whitehall is not part of a continuing care retirement community.

Manorcare Health Svcs-Belden Village

5005 Higbee Avenue NW, Canton, OH 44718

Manorcare Health Svcs-Belden Village in Canton, OH, is rated 1.0 stars overall. It is a large facility with 139 beds and has for-profit, corporate ownership. Manorcare Health Svcs-Belden Village is not part of a continuing care retirement community.

Maria Joseph Living Care Center

4830 Salem Avenue, Dayton, OH 45416

Maria Joseph Living Care Center in Dayton, OH, is rated 1.0 stars overall. It is a very large facility with 280 beds and has for-profit, corporate ownership. Maria Joseph Living Care Center is not part of a continuing care retirement community.

Marietta Center

117 Bartlett Street, Marietta, OH 45750

Marietta Center in Marietta, OH, is rated 1.0 stars overall. It is a large facility with 150 beds and has for-profit, corporate ownership. Marietta Center is not part of a continuing care retirement community.

Mchs-Westerville

140 Old County Line Road, Westerville, OH 43081

Mchs-Westerville in Westerville, OH, is rated 1.0 stars overall. It is a large facility with 174 beds and has for-profit, corporate ownership. Mchs-Westerville is not part of a continuing care retirement community.

Mentor Woods Skilled Nursing and Rehabilitation

8881 Schaefer St., Mentor, OH 44060

Mentor Woods Skilled Nursing and Rehabilitation in Mentor, OH, is rated 1.0 stars overall. It is a large facility with 150 beds and has for-profit, corporate ownership. Mentor Woods Skilled Nursing and Rehabilitation is not part of a continuing care retirement community.

Omni Manor Nursing Home

3245 Vestal Road, Youngstown, OH 44509

Omni Manor Nursing Home in Youngstown, OH, is rated 1.0 stars overall. It is a large facility with 200 beds and has for-profit, corporate ownership. Omni Manor Nursing Home is not part of a continuing care retirement community.

Park East Care and Rehabilitation Center

3800 Park East, Beachwood, OH 44122

Park East Care and Rehabilitation Center in Beachwood, OH, is rated 1.0 stars overall. It is a very large facility with 274 beds and has for-profit, corporate ownership. Park East Care and Rehabilitation Center is not part of a continuing care retirement community.

Regency Manor Rehabilitation & Subacute Center

2000 Regency Manor Circle, Columbus, OH 43207

Regency Manor Rehabilitation & Subacute Center in Columbus, OH, is rated 1.0 stars overall. It is a very large facility with 275 beds and has for-profit, corporate ownership. Regency Manor Rehabilitation & Subacute Center is not part of a continuing care retirement community.

Signature Healthcare of Warren

2473 North Rd NE, Warren, OH 44483

Signature Healthcare of Warren in Warren, OH, is rated 1.0 stars overall. It is a large facility with 150 beds and has for-profit, corporate ownership. Signature Healthcare of Warren is not part of a continuing care retirement community.

Stone Crossing Care Center by Lamplight Communities

836 West 34th Street NW, Canton, OH 44709

Stone Crossing Care Center by Lamplight Communities in Canton, OH, is rated 1.0 stars overall. It is a large facility with 150 beds and has for-profit, partnership ownership. Stone Crossing Care Center by Lamplight Communities is not part of a continuing care retirement community.

The Chateau at Mountain Crest Nursing & Rehabilitation Center

2586 Lafeuille Avenue, Cincinnati, OH 45211

The Chateau at Mountain Crest Nursing & Rehabilitation Center in Cincinnati, OH, is rated 1.0 stars overall. It is a large facility with 199 beds and has for-profit, partnership ownership. The Chateau at Mountain Crest Nursing & Rehabilitation Center is not part of a continuing care retirement community.

The Meadows at Osborn Park

3916 Perkins Ave, Huron, OH 44839

The Meadows at Osborn Park in Huron, OH, is rated 1.0 stars overall. It is a large facility with 130 beds and has county ownership. The Meadows at Osborn Park is not part of a continuing care retirement community.

Tuscany Gardens

7400 Hazelton Etna Road SW, Pataskala, OH 43062

Tuscany Gardens in Pataskala, OH, is rated 1.0 stars overall. It is a large facility with 123 beds and has for-profit, corporate ownership. Tuscany Gardens is not part of a continuing care retirement community.

Villa Angela Care Center

5700 Karl Road, Columbus, OH 43229

Villa Angela Care Center in Columbus, OH, is rated 1.0 stars overall. It is a very large facility with 225 beds and has for-profit, corporate ownership. Villa Angela Care Center is not part of a continuing care retirement community.

Vista Center at the Ridge

3379 Main Street, Mineral Ridge, OH 44440

Vista Center at the Ridge in Mineral Ridge, OH, is rated 1.0 stars overall. It is a large facility with 168 beds and has for-profit, corporate ownership. Vista Center at the Ridge is not part of a continuing care retirement community.

Walton Manor Health Care Center

19859 Alexander Rd, Walton Hills, OH 44146

Walton Manor Health Care Center in Walton Hills, OH, is rated 1.0 stars overall. It is a large facility with 150 beds and has for-profit, corporate ownership. Walton Manor Health Care Center is not part of a continuing care retirement community.

Westmoreland Place

230 Cherry St., Chillicothe, OH 45601

Westmoreland Place in Chillicothe, OH, is rated 1.0 stars overall. It is a large facility with 150 beds and has for-profit, corporate ownership. Westmoreland Place is not part of a continuing care retirement community.

Winchester Place Nursing & Rehabilitation Center

36 Lehman Dr., Canal Winchester, OH 43110

Winchester Place Nursing & Rehabilitation Center in Canal Winchester, OH, is rated 1.0 stars overall. It is a large facility with 181 beds and has for-profit, corporate ownership. Winchester Place Nursing & Rehabilitation Center is not part of a continuing care retirement community.

To do your own research on Ohio nursing homes using US News’s site, see http://health.usnews.com/best-nursing-homes/area/oh.

How do I Hire You to be my Nursing Home Understaffing Lawyer?

The first thing to do is complete the contact form at the bottom of this page. That way, you can put in details that we can review before we schedule a phone call.

You can also call us at 216-777-8856 if you prefer.

You will likely not speak to us immediately, but will schedule a phone or in-person meeting. Why? Because we’re busy working on the important cases other families have entrusted to us. Just like we would not constantly take phone calls when we’re entrusted to work on your case.

You should also gather all the records and papers you have from the medical providers, go back and look for dates, names, and events that happened, and otherwise prepare to discuss the case. We’ll have a meeting and, if it seems like a case we’d be a good fit for, we’ll move into an investigation phase.

Once we’ve investigated, we’ll candidly tell you what we think about what happened, whether the medical provider is to blame, and what we think about the strength of the case.

Fair warning: we only take on clients whose cases we believe have very strong merits. We’re not lazy—the cases are still very complex, difficult, and expensive—but the risk to your family of being drawn into a difficult process with little chance of a positive outcome is not something we do.

Which means when we do take on a case, our reputation tells the other side this is a serious case we believe in.

If for whatever reason we do not take on the case, and we think there is some merit to the case, we’ll try and help you find a lawyer who might take it on.

Nursing Home Understaffing Articles

Sapphire Nursing Home

“We Don’t Have Enough Staff to Take Care of You”

According to an article on News Channel 12's website, the Sapphire Nursing Home located at 46 Harriman Drive, Goshen, NY 10924 is under fire for not providing enough staff to properly care for the people who reside there. The New York Department of Health is investigating several major violations involving understaffing and resident neglect. Several complaints have been filed against the nursing home, including a complaint made by a man named Russell Kennedy, whose mother was a resident at the Sapphire Nursing Home. An article on News12 Westchester's website reports that:
Russell Kennedy says his 90-year-old mother is confined to a wheelchair and can barely hear, relying on staff at the Goshen nursing home to perform simple tasks like getting out of bed and putting in her hearing aid. He says they ring the bell for help and people don't come because they just don't have the staff to handle it.
By not providing enough staff for residents, the Sapphire Nursing Home is putting its residents at risks of serious injury or even death. Nursing home understaffing is when there are not enough nursing home staff to meet the specific needs of all the residents. Nursing homes provide care to residents through people (staff): nurses (registered nurses and licensed practical nurses), nursing aides (also called State Tested Nursing Assistants or STNAs in Ohio), therapists (physical, occupational, speech) and their assistants, janitorial / environmental staff, dietary / nutrition, and sometimes doctors. In my experience, critical understaffing is in the nursing staff–nurses (RNs and / or LPNs) and aides (STNAs)–because they are the ones providing direct medical care, observation, and evaluation.  Without enough nursing staff, people die. According to the News12 article, a nurses aid actually told the woman and her family that they cannot take care of her.
The facility reportedly lost half its ...
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Allenbrooke Nursing home sign

Report: Corporate Nursing Homes Providing Sub-Standard Care

A recent report in the New York Times describes how corporate nursing homes are underfunded, understaffed, and providing sub-standard or extremely poor care for their residents. The article reports that nursing homes such as Allenbrooke Nursing and Rehabilitation Center in Memphis, Tennessee are examples of corporate nursing homes that reported large deficits and there are claims of understaffing, yet the numbers are not adding up. According to the article, a lawsuit that is being brought on by a former resident's family claims that:

Allenbrooke Nursing and Rehabilitation Center, appeared to have been severely underfunded at the time, with a $2 million deficit on its books and a scarcity of nurses and aides. “Sometimes we’d be short of diapers, sheets, linens,” one nurse testified.

That same year, $2.8 million of the facility’s $12 million in operating expenses went to a constellation of corporations controlled by two Long Island accountants who, court records show, owned Allenbrooke and 32 other nursing homes. The homes paid the men’s other companies to provide physical therapy, management, drugs and other services, from which the owners reaped profits.

The same lawsuit claims that the resident, Martha Jane Pierce, was the victim of severe medical neglect. Her son came to visit her and noticed that something was amiss. The article reports that he:

peeled back the white sock that had been covering his 82-year-old mother’s right foot for a month, he discovered rotting flesh.

“It looked like a piece of black charcoal” and smelled “like death,” her daughter Cindy Hatfield later testified. After Mrs. Pierce, a patient at a nursing home in Memphis, was transferred to a hospital, a surgeon had to amputate much of her leg.

A nurse at the facility verified the conditions and attributed them to lack of staff and lack ...
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Silhouette of three business people in suits

The Corporate Understaffing Game in For-Profit Nursing Homes

Earlier we reviewed the Plain Dealer article on Park East nursing home in Beachwood, Ohio, and it's poor ratings, big fines, and deadly care from understaffing. I thought I'd take a second to point out a familiar and disturbing part of how nursing homes are run: the corporate understaffing game. When I'm investigating a nursing home on behalf of a family whose loved one was killed in the nursing home, the common defense is that the person was old, sick, and dying.  Nursing home dehydration, for example, is easy to blame on a person's medical conditions. Dehydration can be caused by vomiting or diarrhea associated with infection, "third-spacing" fluids, or sepsis.  But dehydration from inadequate intake can cause illness and death itself--and quickly.  Or dehydration can cause otherwise stable medical conditions to become emergencies. What is one major reason people do not get enough fluid?  There aren't enough nursing staff members available to help them eat and drink, or to monitor and make sure they're eating or drinking enough.  (source) That's called understaffing.  (Learn more about Nursing Home Dehydration negligence.) Now, you might think there's a decision at the nursing home to under-staff.  Or a decision to staff a certain amount, but the amount of nursing staff is too, low.  Whether on purpose (to make more money) or because of carelessness, the nursing home in-building leadership should be to blame, right? Not in my experience. Most nursing homes are for-profit (source).  As Leading Age reported, there are some major differences--mostly bad--between for-profit and non-profit nursing homes, such as more hospitalizations, more deficiencies, and lower staffing levels. When those for-profit nursing homes are part of a chain, it is almost always the "corporate" level decision makers who control the money.  And it takes money to budget and staff a nursing home. Profiting from understaffing is a ...
Read More
Image of large brick building with blue sky.

One of the Worst Nursing Homes in Cleveland?

Most people understand—in a general way—that nursing homes can be a scary place.  But most people do not know the specifics.  How and why a nursing home can kill someone. I see that all too often. A Plain Dealer report by John Caniglia & Jo Ellen Corrigan this week included an article on a nursing home in Cleveland, Ohio that has earned the lowest possible rating on Medicare’s 5 star rating system. With over 200 beds, this is a large facility.  And it is located in a well-to-do suburb, Beachwood.  And it has been fined hundreds of thousands of dollars for substandard care the killed people. Park East Care and Rehab Center is a facility I’ve become familiar with from calls from the public.  And with this new report, some of the serious concerns from state investigations have been highlighted. One of the terrifying things I’ve found with nursing homes is how vulnerable you are.  The more care you need, the more vulnerable you are.  And the more dangerous it can be if the nursing home is understaffed or has poorly trained or monitored employees.  You could need help moving in bed to prevent bedsores, or help eating and drinking to avoid dehydration. That’s what makes the story the Plain Dealer reported so terrifying. A man who had a tube inserted into his windpipe so he could breathe, called a tracheotomy.  Those tubes, like our throats, can become filled with fluids. But unlike our throats, you can’t just clear the tube yourself.  You need someone to do it for you.  Or you can’t breathe. Overnight shifts are some of the worst-staffed shifts in nursing homes I’ve seen.  But that doesn’t mean people do not need care. As Caniglia & Corrigan report, things did not go well for this man overnight: ...
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Nursing Home Staffing Tricks: Inspection Bump

Nursing Home Staffing Tricks: Inspection Bump

If you're looking for a nursing home for yourself or a loved one, the federal agency that oversees nursing homes--the Centers for Medicare and Medicaid Services, or "CMS"--has a great resource to look up and evaluate nursing homes.  It's called "Nursing Home Compare," and you can find it here. But wait! As I've sued more nursing homes and gotten into the weeds on their staffing, I've found a disturbing trend.  There can be a "bump" in staffing around the time of the nursing home's annual "surprise" inspection.  (I say "surprise" because they are not supposed to know when it is happening.) Why does this matter? The Nursing Home Compare's 5-Star rating system evaluates things including staffing.  We know better nurse staffing leads to better resident outcomes.  So it is kind of important to be accurate about staffing. As it turns out, the staffing picture isn't based on the staffing data the nursing home submits to Medicare throughout the year.  It's based on just a 2-week snapshot from just before the inspection. Now, if nursing homes were really "surprised" by the inspection, that shouldn't matter, right?  Except, we see the bump, which means something is going on. Besides the possibility they are tipped off or find out when the inspection is coming, another possible explanation is that the two-week data is submitted on a different form than normal staffing data.  That gives the nursing home the opportunity to inflate the numbers.  not honest, not fair, but a possibility. So when using the resource, take the rating with a grain of salt ...
Read More

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In our experience, holding a medical corporation responsible and accountable for carelessly injuring patients through a money verdict at trial, or a settlement motivated by their fear of trial, is the best way to make sure there is change.

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