Updated: April 17th, 2025
When someone you love enters a nursing home or assisted living facility, you expect them to be cared for by trained, attentive staff. But across the U.S., chronic understaffing is putting residents at serious risk.
A 2024 American Health Care Association report found that 99% of nursing homes have job openings, and 89% struggle to hire registered nurses. In California, daily staffing hours per resident have fallen by 0.15 in the past decade, while care-related problems have jumped by 6.2%.
Understaffing means there aren’t enough workers to meet residents’ basic needs. And the consequences go far beyond delayed care—residents may miss medications, suffer from poor hygiene, injuries like bedsores and infections, and experience severe emotional distress.
Many families feel it when something’s wrong. Trust that instinct if you’re concerned about your loved one’s care. Learn what signs to look for and how to speak up.
Why Nursing Homes Are Understaffed
There are many reasons nursing homes struggle with staffing. Some stem from broader issues like industry-wide hiring shortages, while others reflect how the facility manages its budget, staffing priorities, and overall approach to resident care, such as:
Cost-Cutting at the Expense of Care
Some for-profit nursing homes reduce hours or avoid hiring full-time workers to lower costs. For example, some facilities stick to the bare minimum, like the 3.48 nursing hours per resident per day required in skilled nursing homes, just enough to avoid penalties but not enough to provide real care.
High Turnover and Burnout
Low wages, long hours, and burnout drive many caregivers to leave the field. As trained professionals walk away, facilities struggle to maintain consistent staffing, and residents suffer from gaps in care. Two-thirds of U.S. nursing homes report they could face closure without enough staff, putting even more pressure on an already strained system.
Continued Shortages Post-Pandemic
COVID-19 caused a major drop in staffing as many workers left for good. 72% of nursing homes say current staffing levels are lower than before the pandemic. Facilities already stretched thin now have fewer resources and more demands.
When nursing homes don’t have enough trained employees, it can lead to catastrophic outcomes for residents and their families.
Consequences of Understaffing
Nursing home staff handle most of the day-to-day care for residents, including feeding, bathing, giving medications, and responding to needs. When there aren’t enough nurses or support staff, it can affect a resident’s health, safety, and well-being in the following ways:
Physical Neglect and Health Decline
Without enough caregivers, basic needs often go unmet. Residents may sit in soiled clothing, miss meals, or wait hours for help getting out of bed.
Immobility increases the risk of bedsores, infections, and dangerous falls. Chronic neglect can cause long-term health issues and lower life expectancy.
Missed or Delayed Medical Care
Nurses and aides are responsible for administering medication, monitoring health changes, and helping residents attend medical appointments.
When there aren’t enough staff, medications can be missed, symptoms overlooked, and treatment plans pushed aside. In serious cases, like untreated bedsores or infections, delayed care can lead to hospitalization or irreversible harm.
Increased Risk of Elder Abuse
Understaffed facilities may rely on unqualified or unvetted workers, including temporary staff unfamiliar with residents’ care plans. Stress and lack of oversight can also create environments where verbal, emotional, or physical abuse goes undetected. Residents with dementia or limited communication abilities are especially vulnerable.
Emotional and Mental Distress
Elderly residents thrive on routine, connection, and reassurance. When staff members rotate constantly or rush through care, residents may feel isolated, confused, or abandoned.
Loneliness can worsen symptoms of depression or dementia. Inconsistent care also breaks trust and undermines a resident’s sense of safety.
Warning Signs Families Should Watch For
If something feels off during visits with your loved one, it could indicate they aren’t being cared for properly. Understaffing often reveals itself through small but telling signs like the following:
- Unanswered call lights. If residents press the call button and wait a long time for assistance, it could be a sign that the facility doesn’t have enough aides on staff.
- Poor hygiene. Unbrushed hair, unchanged clothes, or foul odors suggest neglect in basic grooming and cleanliness.
- Hunger or signs of dehydration. Dry lips, confusion, or sudden weight loss may mean residents aren’t being helped with meals or getting enough water.
- Unclean rooms. Overflowing trash cans, stained linens, or dirty floors are red flags of poor housekeeping and sanitation.
- Sudden behavior changes. Agitation, withdrawal, or fearfulness can signal distress or mistreatment, especially in residents with limited speech.
- Inconsistent staffing. Frequent staff changes can disrupt routines and lead to gaps in care from one shift to the next.
- Lack of updates. Unclear or evasive responses from caregivers often hint at larger problems behind the scenes, like staffing shortages or poor coordination.
Noticing signs of poor care can be upsetting, but knowing your loved one’s rights is the first step to protecting them.
California Elder Protection Laws
California law takes resident safety seriously and provides explicit protections for those living in nursing homes and assisted living facilities.
Here’s a quick overview of their legal rights under the Elder Abuse and Dependent Adult Civil Protection Act (EADACPA ):
- Protection from physical abuse, neglect, and abandonment
- Access to medical care and help with hygiene
- Safe and clean living conditions
- Timely responses to care needs
- Proper nutrition and hydration
- Protection from health hazards
- Protection from abuse, exploitation, or mistreatment
In legal terms, neglect includes the failure of caregivers to assist with personal hygiene, medical care, nourishment, or shelter. A facility does not have to cause harm intentionally to be held accountable.
If a resident is injured or becomes ill due to inattention or understaffing, that may meet the threshold for elder neglect.
What To Do if You Suspect Understaffing or Neglect
Feeling overwhelmed is normal, but support is available. Follow these steps to raise concerns and keep your loved one safe:
- Keep a log. Write down what you observe during visits, such as missed meals, unexplained bruises, unusual smells, long wait times, or behavior changes. Include dates, staff names, and photographs. A detailed log builds a clear picture of patterns that may show neglect.
- Request care records. Families have the right to review care logs, medication records, and incident reports. Missing or withheld information could be a serious red flag. Families have the right to review care logs, medication records, and incident reports. Missing or withheld information could be a serious red flag.
- Speak up, then follow up. Raise concerns with the facility’s administrator or director of nursing. Ask for specific responses, not just reassurances. If problems persist, escalate the issue by filing a complaint with the California Department of Public Health or the local Long-Term Care Ombudsman.
- Contact an elder abuse attorney. If your loved one has suffered injury, illness, or emotional harm due to suspected understaffing or neglect, speak with a compassionate and qualified lawyer. They can help you understand your rights, gather evidence, and pursue compensation or corrective action.
Facilities must provide proper care and be held accountable when they fail to meet it.
Seek Legal Guidance for Your Loved One
At Gharibian Law, we believe every elderly resident deserves safety, respect, and proper care. Understaffing is not just a management problem; it’s a legal and moral failure that risks vulnerable lives.
Our firm represents families across California who suspect nursing home neglect or elder abuse. We help find the truth, hold facilities liable for improper care, and advocate for justice for seniors and their loved ones.
If you’re worried about a family member in a nursing home or assisted living facility, take action. Contact Gharibian Law today for a free, confidential consultation to discuss what you’ve seen, what options are available, and how we can help protect your loved one’s interests.
