Nursing Homes Short Staffing Causes and Effects

Short staffing in nursing homes affect residents as well as staff. Read on to learn more on how this has played a pivotal part in the short-staffing crisis. Specialties LTC Directors Article

Nursing Homes Short Staffing Causes and Effects

Short staffing in nursing homes due to cost-cutting decisions, nurses retiring due to age, or the added stresses of COVID-19, along with increases in patient caseload and complexity have played a pivotal part in the short-staffing crisis. The results of short-staffing significantly affect patient outcomes and have put our elder care in a crisis.

Causes of Long-Term Care Staffing Shortages

Many things affect staffing shortages; some are preventable, and others are difficult to change. One of the avoidable reasons is the managing of the business of eldercare, and whether we admit it or not, a nursing home is a business. 

It is a business that specializes in elder care – rising costs and complex payment reimbursements have resulted in cuts to staff. Sometimes that cut involves pivotal patient care employees.  The result is a business that is top-heavy but poor in providers that care for the elderly, which causes these areas to be short-staffed.

Adding to the short staffing issues are the large numbers of healthcare workers quitting and looking for less stressful employment.

They're tired. They're burnt out. They're physically exhausted. And even committed people in this industry will turn around and say, I don't know how much longer I can do this.

The result of the quitting medical staff is hiring staff that lacks education and training, resulting in low numbers of qualified staff, putting our residents in increased danger.

Effects of short staffing and weary staff can cause intentional or unintentional harm to residents and can even be considered abusive. The results can be devastating – trauma, increased medical emergencies, hospitalizations, and even death.

Short Staffing Effects on Residents

  • Resident injuries – Due to staff attempting to transfer a person with one staff member when it should be two staff members and the resident is dropped. 
  • Verbal and physical abuse– Tired staff can be short-tempered. Even though the staff member may not "be that type" of a person, being regularly short-staffed can lead a staff member to be fatigued and stressed, leading to verbal abuse and even physical abuse.
  •  Pressure Ulcers/Bedsores- Lack of turning a patient or the patient sitting for extended periods in soiled clothing can lead to pressure ulcers. Pressure ulcers reduce the quality of life for an individual and can even cause death.
  • Increased falls – Falls in residents are increased when a resident is waiting to go to the bathroom or get an item and attempts to do this task independently after extended periods of waiting.
  • Weight Loss or Dehydration – Due to poor intake, lack of time for staff to spend feeding or encouraging intake can lead to weight loss or dehydration in residents.
  • Withdrawal of Resident – the results of understaffing can affect a resident's personality leading to withdrawal, low self-esteem, and agitation in a resident as the resident spends more time alone or with short-tempered staff.

Understaffing leads to limited attention from staff. Residents are more likely to get hurt through falls, dehydration, malnutrition, or bedsores.

Short Staffing Effects on Staff

The reduction of staff makes the existing employees responsible for a greater workload. The added workload adds stress as the employee attempts to complete the work and provide adequate care. This scenario makes an employee feel they cannot achieve personal and facility expectations leading to a decline in the employee's physical health and mental health. The result is the increased time needed off work, as evidenced by increased sick pay and job turnover. 

Other short-staffing effects on employees can be:

  • Staff injuries – due to transfers, turning, changing, or care that should be completed with two and due to shortages are completed with one person.
  • Staff trauma – Due to COVID-19 deaths of patients, illness, and stress due to feeling they cannot do their job well.
  •  A lack of focus due to staff fatigue leading to medical errors or missed nursing care.

Adding to the difficulty is the overall population changes in nursing. Recent studies lists nursing as a hazardous occupation – Due to more aggressive individuals, short staffing, and exposing staff to a wide range of risks.

Short Staffing Effects on the LTC Facility

Short staffing affects the overall quality of care received in a LTC facility which can further damage the reputation of the LTC home and eventually lead to the failure of the business.

  • Short staffing causes increased costs to the nursing home. The nursing home is responsible for pressure ulcers acquired in their facility. According to one study, acquired pressure ulcers cost the United States 9.1 to 11.6 billion dollars per year.
  •   Lower scores on the Five-Star Rating System that a LTC facility receives showing the quality of care a facility provides. A low score will lead to fewer admissions.
  •  Pressure ulcers, falls with injuries, hospitalizations, and complaints are required to be reported to the state.  This can lead to more significant fines and state involvement in the facility.

Are there Answers to Our Long-Term Care Crisis?

First, we need to realize that the LTC short-staffing issue is not just a pandemic issue but has been an issue in LTC for a long time. 

A facility must be aware of that specific facility's needs for staff and have accurate calculations for PBJ reporting. This can be completed by having LTC workforce scheduling software that can help you quickly see the requirements your facility needs. This software will also help you see gaps so you can promptly address the needs and reduce the short-staffed scenario.

Hiring quality staff - long-term care services are labor-intensive; therefore, the quality of care depends mainly on the performance of the personnel. So careful interviewing and hiring are necessary. 

Current Presidential Initiatives to Change the LTC Crisis

Biden Administration's new policy initiatives address staffing and other quality issues in LTC nursing facilities; this quote shows some of the initiatives:


To do this, the reforms the President is announcing will ensure that:

every nursing home provides a sufficient number of staff who are adequately trained to provide high-quality care; poorly performing nursing homes are held accountable for improper and unsafe care and immediately improve their services or are cut off from taxpayer dollars, and the public has better information about nursing home conditions so that they can find the best available options.

The LTC crisis is not a new issue, and it will take individuals pushing initiatives to make our nursing homes safer for both staff and the elderly entrusted to their care. If we work together, we can make the required changes. 


AHRQ. (2014, October). Preventing Pressure Ulcers in Hospitals. Retrieved from AHRQ- Agency for Healthcare Research and Quality

CMS. (2022). Guide to Improving Nursing Home Employee Satisfaction - CMS. Retrieved from CMS: 

Eunice Park-Lee, C. C. (2009, February 14). Pressure Ulcers Among Nursing Home Residents: United States, 2004. Retrieved from CDC: 

Kohler, G. S. (2001). Improving the Quality of Long-Term Care. Retrieved from Institute of Medicine (US) Committee on Improving Quality in Long-Term Care:

Nancy Ochieng, P. C. (2022, April 4). Nursing Facility Staffing Shortages During the COVID-19 Pandemic. Retrieved from KFF 

Nestor-Harper, M. (2022). Understaffing Issues in the Workplace. Retrieved from CHRON

Snap Schedule. (2013, July 5). Attendance Management. Retrieved from Snap Schedule

White (2022, Febuary 28). FACT SHEET: Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes. Retrieved from White

Susan Sears RN, BSN, CRRN has served as a nurse for over 15 years. Many of which were spent in the LTC setting.

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This issue will NEVER improve and will likely continue getting worse as long as (most) nursing homes continue to run as for-profit organizations that are owned by people who know very little about healthcare...

Specializes in Patient Safety Advocate; HAI Prevention.

Isn't it sad that those who deserve excellent care and who need it the most are often harmed and/or neglected in a LTC setting?  It is a catch 22, trying to get qualified and sufficient staff for nursing homes and assisted living facilities.  My own mother was neglected, after a known fall, in her AL.  The RA who was responsible for her was also responsible for about 60 other residents. No wonder I found my sweet mother in such a state her last morning in that facility.  I removed her that day. She was quite ill and did not live much longer after that.  She spent her last days first in a hospital, then in LTC.  In the LTC the staffing was more qualified, but 1 RN covered the entire place at night.  She got decent but not great care there.  As a patient safety advocate and activist, I always recommend that family members be their loved ones constant or almost constant bedside advocate.  We can't simply turn our loved ones over to care....WE have to care and be there as much as possible.  All of us want to trust and rely on nurses, of all levels, but the ones we cannot rely on are the people who do the hiring.  They just never hire enough nurses and other ancillary help.  Our loved ones generate dollars and profits, and their focus is on that. 

Specializes in Geriatrics, Dialysis.

Every state has staffing guidelines, which are typically a joke.  For many years as a night RN part of my job was to post daily the staffing grid which listed that days resident census and how many RN's/LPN's and CNA's were working each shift. This was used to calculate "nursing hours" per resident and had to be above whatever the acceptable number was the state required.  Included in those nursing hours was every nurse other than the DON/ADON which meant that unit mangers for every wing and 2 MDS nurses were included in that "nursing hours" metric despite the fact that they provided zero direct care. 

It's ridiculous how little staff the facility can provide while still meeting those required nursing hours. 

Specializes in Rehabilitation Nurse, LTC Manager, Freelancer.
On 5/9/2022 at 9:03 PM, SusanS said:
1 hour ago, kbrn2002 said:

I do agree we should only count nurses truly working on the floor. Unfortunately,  the state requirements are so vague that it is easy for a facility to save money by counting nurses this way. Though, this type of practice just adds stress to the floor nurse and doesn’t provide good patient care because  the nurse is so rushed to meet the large caseload of  patient needs.

     Here’s hoping in PA that the laws are changing this coming year 2023 and the next following 2024. They want to change the NA/LPN/RN’s to patient ratio’s and the NA’s dollar amounts per hour. This is long overdue, especially for the state of PA, as this state lags on its current stance of laws in providing care for the elderly. There is no definitive line on what each resident requires from a nurse’s asst./nurse in a shift from day to day. When they have their so called hours per resident in a day, they claim ( and it’s very vague by the way) that it goes by also the level of care required for that resident. Well, call me silly, but wouldn’t that change the 2.7 hours per resident if the home has you doing 1 on 1….15min checks on those severely prone to falls,(mostly a handful of residents quailify) and tending to 17 to 22 residents in conjunction? Also, with the variants on cognition and behaviors? Yeah, oh and sometimes nurse that is so pre-occupied doing med-secretary work between two halls (no fault of their own) that the nurse asst. is on their own for the vast majority of it. I’m mainly referring to nightshift here and that is what I, myself can best reference. So, I truly get it when I talk to the younger generation about seeing if they want to come to the LTC homes to work and they’re like, “No, that’s a solid pass for me!”