Understaffing in Nursing Homes

Nursing home understaffing is a pervasive issue that affects the quality of care provided to vulnerable elderly residents. The lack of staffing leads to longer wait times for assistance, increased health risks, and even abuse or neglect. The COVID-19 pandemic has further highlighted the dangers of understaffing, as many nursing homes struggle to provide adequate care to their residents. Addressing this issue requires increased funding, improved working conditions for staff, and better regulations for nursing home facilities.

Male nurse assisting in nursing home

Staffing levels play a critical role in determining how nursing home residents fare in terms of health, both physical and mental. Adequate staffing can help caretakers provide quick and efficient medical treatment for any physical ailments, reduce isolation and loneliness in residents, and improve their overall mental state.

According to the Long Term Care Community Coalition (LTCCC), which compiles nursing home staffing data across every state in the U.S., less than a quarter of all nursing homes in the United States met the required total care staff threshold of 4.10 HPRD (hours per resident per day) in the fourth quarter of 2020. These staffing ratios were determined by a landmark federal study that was prepared for Congress in 2001.

Based on more recent data collected in Q3 2021, the LTCCC showed that nursing homes were still understaffed, with an average of 3.62 Total Nurse Staff Hours per resident day (HRPD) and were experiencing a 7.8 percent drop in staffing levels since the first quarter of 2021. During this same time period, the number of residents in the nursing homes from the report increased by 5.1 percent.

Understaffing in nursing homes is a serious problem that must be immediately addressed by care centers around the country. Having a happy and healthy senior population is possible, but it requires several adjustments in the way nursing homes currently operate.

Elder Patient Helping Nurse Hand

Why are nursing homes understaffed?

There are several reasons why nursing homes are understaffed to dangerously low HRPD levels, with the most significant reasons relating to staff turnover, labor costs, and exhaustion due to the number of hours worked.

Significant Staff Turnover

Staff turnover has been a real problem in nursing homes in recent years and is often a problem that amplifies itself. When one nursing home employee leaves, the remaining workers must perform their previous duties and also take on the work of the person who left. As more caregivers leave, skilled nursing facilities fall into a vicious cycle where the few remaining staff members must take on a significant amount of work and increased responsibility, often with no additional pay.

Pay & Labor Costs

Nursing home staff turnover can be attributed to low pay rates as well as the increasing cost of labor for certain nursing homes. According to the U.S. Bureau of Labor Statistics (BLS), certified nursing assistants earned an average hourly wage of just $15.41 as of May 2020. As the cost of living in the United States increases, staff seek out better opportunities and higher wages, often causing nursing home staff to leave their jobs as caretakers and look for greener pastures.

Exhaustion Due to Excessive Overtime Hours

Nursing home staff who remain in their position after their coworkers leave are faced with an exceeding amount of overtime work, stress, and exhaustion. When nurses and other health care workers can no longer handle the pressure, they may opt to leave their place of employment, compounding the issue of nursing home understaffing.

nurse helping senior man

How to Fix Nursing Home Understaffing Problems

While the problems plaguing most nursing homes and assisted living facilities in the country are significant, there are solutions that can be implemented to keep the problem from growing. This includes paying workers more, hiring additional staff, and ensuring their current staff members are taken care of and satisfied in their work environments.

Increase Pay to Attract More Workers

Increasing pay can be a challenging subject as business margins can be tight, but pay raises for nursing assistants and general nursing home staff are an excellent way to attract workers. While pay rate increases are one solution, signing bonuses and additional job perks can be another way to attract more qualified caregivers and fill staffing gaps.

Hire Additional Nursing Home Staff

After a nursing home has been able to entice more job applicants through increased pay, signing bonuses, or additional perks, they should begin a marketing campaign to attract job applicants and showcase why their work environment is preferable to the competition.

Keep Current Staff Happy

A running joke in the nursing community is that a “pizza party” held by administrative staff will instantly solve any dissatisfaction that employees may have, causing them to happily return to their jobs without reservations. As we can imagine, this is not the case. Nursing home administrators should listen to their employees’ thoughts and cater to their wants and needs. Listening to your employees is one of the best ways to ensure you’re acting in their best interest.

How Does Understaffing Affect Patient Care?

Family members of nursing home residents expect that their loved one is receiving the level of care mandated by law. But understaffing in nursing homes negatively affects patient care and can lead to an increased risk of elder abuse and nursing home neglect. While there are nursing home regulations in place that protect residents, extreme staffing issues can lead to severe problems — including injury and death — among the resident population.

Resident-to-Staff Ratios

Nursing home staffing is determined through a resident-to-staff ratio, which was created to ensure that each resident has adequate caretakers and staff to cater to their needs. Additionally, a good resident-to-staff ratio helps staff perform their duties more efficiently and effectively, something they wouldn’t be able to do if they were overworked.

If nursing home residents are neglected, they may suffer problems such as:

  • Bedsores due to lack of movement and adjustment
  • Reduced check-ins by staff and fewer notes regarding any changes in their health
  • The inability to keep residents clean to prevent infections
  • Reduced ability to help residents move around and prevent dangerous falls

Standard of Care

Having an adequately staffed nursing home facility is essential to raising the standard of care for residents and ensuring they are taken care of and happy in their living situation.

By increasing awareness of nursing home understaffing among general members of the population and pushing for additional measures to increase staffing, such as increased pay and less exhaustive overtime, nursing home facilities can address the problem and help to reduce injuries and neglect in facilities.

Medically Reviewed by:

Dr. Patricia Shelton, MD

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  • University of Washington, Doctor of Medicine – MD. June 2008
  • University of Washington, Bachelor of Science – BS, Jun 2003


Neuroscience and Medicine


  • Dr. Shelton primarily writes content for health-related websites, but has also written test prep materials, white papers, published research articles, court documents, and more.
  • Dr. Shelton teaches anatomy and physiology at the college level for the National Institutes of Health.

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Our fact-checking process begins with a thorough review of all sources to ensure they are high quality. Then we cross-check the facts with original medical or scientific reports published by those sources, or we validate the facts with reputable news organizations, medical and scientific experts and other health experts. Each page includes all sources for full transparency.
Our fact-checking process begins with a thorough review of all sources to ensure they are high quality. Then we cross-check the facts with original medical or scientific reports published by those sources, or we validate the facts with reputable news organizations, medical and scientific experts and other health experts. Each page includes all sources for full transparency.