About Nursing Home Staffing

In 1996 I picked this facility because the staffing ratio was one aide to ten residents. Back then this facility had 100 beds with 96 occupied when I arrived. I was anxious as I watched them care for so many, particularly at meal times. Two seatings were required in each of the two small dining rooms. One was for residents who ate on their own and the other for those who needed to be fed.

I wondered how they divided the aides’ time. I considered how difficult it was to care for 10 residents when some needed so much care. But at that time some of our residents were ambulatory and were able to get around and feed themselves. However, those with dementia needed aides for personal and incontinence care.

I remember at times we had six aides to care for 40-plus residents. I felt that should be more than adequate. But several aides complained that they were very overworked. Sometimes short staffing left us with three aides. I can remember an aide then saying, “This would be a great place to start a nursing home!” She was a very cute woman in her 60s who loved to make us laugh. It was very apparent to me that she was as tense with her situation as I was.

I did my best to go with the flow on the short staffed days. Back then, it seemed they happened less frequently, and it was easier to deal with them. Still, to relieve tension, the aides were encouraged not to talk about being short. They were told to say that they were ‘challenged.’ I understand that dwelling on fewer staff causes everyone to get upset. But I knew how many aides were supposed to be here and they were not able to hide much from me.

On short staffed days some of the care gets abbreviated. Many times I heard “Make sure they are clean and dry.” Residents went without showers and complained about it. Nurses would pitch in and help. Several years ago a day shift charge nurse used to shower me on the weekends to give the aides a break. That positively influenced my nursing home experience and I remember fondly that exceptional nurse.

My first summer, on a lovely June Saturday afternoon, six of the ten aides scheduled for afternoon shift called off. That left us with two aides on each unit. I remember how concerned I was. On some of those weekends the director of nursing worked on the floor as an aide. The assistant director of nursing sometimes worked as an aide on night shift. When management helped, I felt better and strangely guilty. But I always wondered what would happen if there were not enough aides to help us.

From my days of living on my own, I know well how difficult it was if a caregiver called off. Many times I had no one to fill in. Sometimes my one and only caregiver had to do a 24 hour shift until I got an aide from a home health agency. It was disruptive to my resolve, and my stomach took a beating every time. But at least I had a fallback system. It was not the best, or the least expensive, but it worked.

Since I am considered ‘total care’, I was warned about nursing home short staffing. I am very dependent on the aides for care, and some make me feel better just because they are here. When we are short I am cared for, but I feel stressed. As a two person assist, I have to wait longer for necessary things. I also wonder how the aides work under such pressure. .

Today the staffing ratio is one aide to every fifteen residents. This unit that once held 50 residents now holds 34. Periodically we have short staffing problems. It is more difficult to fill in when aides are off. Many years ago one facility owner used a home health agency for emergency staffing. The agency nurses did well and acclimated quickly. But the agency aides were a totally different matter. Some were very efficient and good, while others were not.

I have no new solutions for short staffing. I think expecting an aide to take care of 15 residents during a shift, given their possible level of care, is monumental. But I do realize that each resident can only get a few hours of care per day. I tried to keep my care hours down per day at home with my own caregivers. But I also used caregivers for companionship. Sometimes I went under on caregiver expenses, but going over was the most usual occurrence.

I can relate to management’s task to make the bottom line, while caring for the ill and disabled. In the future I hope there will be a way to relieve some of the stress from those involved with caring for residents. I have read that someday robots will assist with care and they can be here all the time. The “be here all the time” part sounds good to me, in theory anyway.

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