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Under-staffing equals Neglect – A form of Elder Abuse 

The defense attorney gave me a look as if to say I was crazy.
“Wendy,” he said, “How is a caregiver who just dropped your patient and suffered a hip fracture – how is that neglect?”

Well, I told him. It’s not just what happened, it’s why it happened.
Oftentimes, the severity of an injury causes us to look at a case in the first place.

Yet, I can confidently state that the reason such neglect and abuse is manifested in a major injury is because of systematic corporate decisions to cut resources that result in a deprivation of care.
Injury or death can and does result from understaffing, not using the right type of licensed staff, not providing training, or not having systems in place.

Neglect is defined as a deprivation of care and services
that a resident or patient needs. Neglect is a form of abuse.
Deprivation of care and services shows itself in many ways:

Not giving enough food.

Not giving enough hydration.

Not giving enough caregiver services to prevent injury or death.

If a resident or patient is at risk for falls, you have to supervise them and have systems in place to prevent a fall.

Whenever I see these types of cases and see the injury,
I always take one step back and start with this thought process:
I see the injury. How did the facility respond to the injury?
And why did it happen?

For that hip fracture case, I started by getting the staffing records,
business records, administrator reports from management to the parent company, and the business goals the parent company set for the administrator. What I immediately saw happening was
that the administrator of the facility had a budget that was set by the parent company.

Whenever the administrator went over his budget in staffing,
she had to write a report to the parent company explaining the increased expense. No one likes to write reports that explain why labor costs went over budget, especially when compensation is directly tied to coming in under budget. So the administrator did the logical thing: She kept the staffing at corporate levels. The company understaffed. The parent company was happy. Her boss was happy. She got a bonus. But the facility and its residents suffered.

Facilities want what is known as “high acuity” patients,
the ones who require lots of care and attention because those patients generate much more in revenue and reimbursements from Medicare.
The problem is that institutions are sometimes not staffing to the acuity level, they’re staffing at a bare-bones level.

Understaffing equals neglect because if the facility does not have enough staff, it can’t deliver enough or sufficient care.

That’s why bad things can and do happen.

Here’s what also happens when facilities understaff. The nurses and caregivers are under more pressure, which often makes them more irritable with the residents. They get rough. They sometimes become verbally aggressive. They rush to do things because they’ll be resident call lights going off and they can’t respond to them all. It’s stressful.

In 2013, a class-action lawsuit was filed by 12 former residents of Arkansas nursing facilities owned by a company called Golden Living.
The lawsuit alleged that between 2006 and 2009,the facilities were chronically understaffed which violated a number of Arkansas state laws.
Evidence of understaffing in this case included:

  • Violations of state staffing standards.
  • High rates of undocumented care for activities of daily living.
  • Staffing levels below expected levels calculated by the Centers for Medicare and Medicaid Services.
  • Evidence of inflated staffing levels reported by facilities.
  • Medical records showing serious quality problems.
  • And documentation that corporate officials knew about staffing complaints. In 2017, the case was settled for $72 Million.

Understaffing results in abuse and neglect. Facilities and the corporations that own them both need to be held accountable.
I’m Wendy York from York Law Firm in Sacramento.
Thank you for watching.