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Insufficient Staffing in Nursing Homes


Nurses and staff are responsible for the care and wellbeing of the elderly in nursing homes and care facilities. Without their work and diligence, the overall comfort and safety of people staying and living in those facilities may diminish. Yet, despite the critical importance of nursing home staff and the care they provide, the rate of nursing home wage and hourly infractions have increased alarmingly in recent years. Violations of wage and hourly rules and laws for staff in nursing homes hurts both the employees and the residents in nursing homes.

Staff Ratio

As of 2010, the California nursing home staffing mandate requires 3.2 nursing hours per patient per day. This is the minimum staff ratio that is needed for proper and adequate care to be provided to residents or patients of a nursing home without overworking the staff. The ratio rule was established not only to ensure that every patient at a nursing home is given adequate attention and care from staff but also to provide support for workers in a demanding and high-stakes working environment.

In addition to an hourly ratio, federal and state guidelines exist for nurses on duty. According to federal law, any Medicare and Medicaid certified nursing home must have a director of nursing (DON) on duty at least 8 hours a day for seven days a week and a registered nurse (RN) on duty for the remainder of the time.

The Center for Medicare and Medicaid Services (CMS) came out with a report in 2000 stating that the optimal nursing staff ratio and levels in a nursing home were three hours of nursing assistant time and one hour of licensed nurse time – one hour more than is federally mandated. Another recent study at the University of California San Francisco School of Nursing found that raising the minimum staffing ratio directly impacts the quality of care received by nursing home residents.

Nursing Assistants

The staff ratio and other regulations exist in California for nurses. However, nurse’s aides or nursing assistants do not receive the same consideration in terms of federal staffing requirements.

According to §483.25 of the Medicaid and Medicare rules and regulations, Nursing homes are mandated only “to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident.” Unfortunately, such a standard gives nursing homes almost unlimited license for interpretation. In difficult economic times, it can be easier for nursing homes to hire fewer staff members for longer hours at the economic benefit of the institution and at the expense of the well-being of both the staff and the patients or residents. Nurse’s aides are in charge of most of the daily care of nursing home residents. Because there are no set regulations for nurse’s aides, they are some of the staff members who get hit the hardest by such measures.

Overtime Pay

Nurses, like other workers, are entitled to overtime pay in California. Unfortunately, the culture surrounding many institutions that employ nurses has made it commonplace for nurses not to receive the benefits they deserve by law. The following is a brief outline of most employment benefits a nurse should receive, and how to know if those benefits are being provided or breached.

In California, all employees are entitled to overtime pay for work past 8 hours in a day. In healthcare professions and fields, employers may often use an arrangement called an “alternative workweek.” According to this arrangement, employees may work over 8 hours a day for fewer days of the week. For example, a 4/10 week would call for four days of working 10 hours per day. Alternative workweeks can seem like they do not necessitate overtime pay since the total number of hours worked weekly does not exceed the number of hours in a standard workweek, but California law requires that employers must still pay overtime for all hours worked over 8 per day. Moreover, any work done past 12 hours in a day should be treated as double-time pay.


Federal and state regulations guiding staffing ratios and overtime pay for nurses and staffers in nursing homes exist for the benefit of the nurses and patients. If you are or are considering being an employee or a resident in a nursing home, be sure to inquire about the staffing rules and policies of the institution. Often, the recommended optimal staffing ratios are higher than the federally or state-mandated minimum, and experts have said that this directly affects the standard of care provided. It is essential that nurses and staffers in nursing homes be treated and employed and treated fairly in order that they are able to provide the necessary care to their elder patients and residents.

Protect Your Family By Reaching Out to a California Employment Lawyer Today

If you or a loved one are concerned about nursing home abuse or wage and hourly issues in California, contact the Evans Law Firm for a free and confidential consultation.

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