Posted by The first time I counted, I couldn’t believe it. My mother’s nursing home had ninety-four residents on her wing. On the day shift, there were two registered nurses, three licensed practical nurses, and six certified nursing assistants. Eleven staff for ninety-four people. Do the math. On a good day, each aide was responsible for fifteen or sixteen residents. On a bad day, call-offs, vacancies, unexpected absences, it was worse.
I didn’t know this was a problem until I started staying longer, watching more closely. I saw aides running from room to room, never stopping, never sitting, never having time to do more than the bare minimum. I saw call lights blinking for twenty minutes before anyone answered. I saw my mother waiting an hour to be toileted, then having an accident because the wait was too long. I saw staff who cared deeply but simply couldn’t do what needed to be done with the people they had.
Staffing levels in nursing homes aren’t just administrative details. They are the single most important factor in quality of care. And staffing shortages are not new problems; they are crises that have been building for decades, accelerated by an aging population, low wages, demanding work, and a healthcare system that undervalues the people who do the hardest work.
Let me start with what adequate staffing actually looks like. The research is clear. To provide safe, dignified care, nursing homes need sufficient numbers of registered nurses, licensed practical nurses, and certified nursing assistants. The minimum standards set by federal regulations, which many facilities struggle to meet, are widely considered inadequate by experts. Yet even those minimums are often unmet.
Adequate staffing means enough people to turn bedbound residents every two hours to prevent pressure injuries. Enough people to toilet residents promptly, preserving dignity and preventing infections. Enough people to help residents eat, ensuring they get the nutrition they need. Enough people to answer call lights before residents wait so long they give up. Enough people to notice subtle changes in condition that could signal serious problems. Enough people to provide not just care, but companionship, conversation, human connection.
When staffing is inadequate, everything suffers. Residents develop more pressure sores, more urinary tract infections, more falls. They lose weight because no one has time to help them eat. They become dehydrated because no one has time to offer drinks. They become depressed because no one has time to sit and talk. They end up hospitalized for conditions that could have been caught early if someone had been paying attention.
Staff suffer too. Nursing home work is physically demanding and emotionally draining. When there aren’t enough staff, each person does the work of two or three. Burnout is rampant. Turnover is high. Aides who love their residents and want to provide good care leave because they can’t do the job they were trained to do. The shortage becomes self-perpetuating, low staffing leads to burnout, burnout leads to turnover, turnover makes staffing even worse.
The root causes are complex. Wages for nursing home workers are notoriously low. Certified nursing assistants often make barely more than minimum wage for work that requires skill, strength, and profound compassion. Why would anyone do this work when they could make the same money stocking shelves with none of the stress and physical toll? The pandemic made this worse, driving workers out of an already challenging field.
Medicaid reimbursement rates, which cover most nursing home residents, are often too low to support adequate staffing. Facilities operating on thin margins cut the only place they can, labor. The result is a system where the most vulnerable people receive care from the most overworked, underpaid workers.
Ownership models matter too. Nonprofit and government-owned facilities tend to have higher staffing levels and better outcomes than for-profit chains. Private equity ownership, which has increased dramatically in recent years, is associated with lower staffing, worse outcomes, and higher mortality. When profit is the priority, staffing is the line item that gets cut.
If you have a loved one in a nursing home, how do you know if staffing is adequate? Ask for the numbers. Federal law requires facilities to report staffing data, and it’s publicly available through Medicare’s Nursing Home Compare website. Look beyond the overall star rating to the staffing domain. Compare the facility’s staffing levels to state and national averages. Look at turnover rates, high turnover is a red flag.
But numbers don’t tell the whole story. Visit at different times of day. Watch what happens. Are call lights answered promptly? Do residents wait long for help? Do staff seem rushed, frazzled, overwhelmed? Do they have time to talk with residents, or are they always running? Do you see the same faces from visit to visit, or is there constant turnover? These observations will tell you what the numbers can’t.
When I realized my mother’s facility was understaffed, I didn’t know what to do. I started by talking to the director of nursing. I brought data, observations, concerns. She listened, nodded, acknowledged the problem. But she also explained the constraints, low reimbursement, difficulty hiring, competition from hospitals offering higher wages. She wasn’t making excuses; she was describing a broken system.
What helped was building relationships with the staff who were there. I brought coffee, thanked them, let them know I saw how hard they worked. When I saw someone doing something kind for my mother, I told their supervisor. When a call light was taking too long, I answered it myself, I could help my mother to the bathroom, and that freed up a few minutes for someone else. This wasn’t a solution to the systemic problem, but it made my mother’s care better.
I also got involved in advocacy. I joined the family council. We pushed for better staffing, higher wages, more support. We wrote letters to the facility’s corporate owners. We testified at state hearings about the need for higher Medicaid reimbursement tied to staffing standards. Some of it worked. The facility hired more aides. Wages went up. Turnover went down. Not enough, but something.
If you’re navigating nursing home care, advocate for better staffing. Not just for your loved one, but for everyone. Good staffing is not a luxury; it’s a necessity. It’s what allows staff to do the work they were trained to do. It’s what allows residents to live with dignity. It’s what prevents the crises that lead to hospitalizations, pressure injuries, infections, falls.
Adequate staffing is not a radical demand. It is the minimum standard of decent care. And until we as families, as communities, as voters demand it, the shortages will continue, the burnout will continue, the suffering will continue.
There’s so much more to learn about nursing home quality and advocacy. Our website is filled with articles on staffing, resident rights, and how to be an effective advocate. Head over and explore, because the people who care for our loved ones deserve to be able to do their jobs, and our loved ones deserve to be cared for by people who have the time and support to do it right.
References
Centers for Medicare & Medicaid Services. (2026, February 9). *CMS nursing home staffing campaign*. https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/cms-nursing-home-staffing-campaign
Centers for Medicare & Medicaid Services. (2025, December 2). *Medicare and Medicaid programs; Repeal of minimum staffing standards for long-term care facilities* (CMS-XXX-F). *Federal Register*, 90(233), 55680–55696. https://www.federalregister.gov/documents/2025/12/03/2025-21792/medicare-and-medicaid-programs-repeal-of-minimum-staffing-standards-for-long-term-care-facilities
American Hospital Association. (2025, December 2). *CMS repeals minimum staffing requirements for skilled nursing, long-term care facilities*. https://www.aha.org/news/headline/2025-12-02-cms-repeals-minimum-staffing-requirements-skilled-nursing-long-term-care-facilities
Harrington, C., & Edelman, T. (2024, April 21). *The federal nursing home staffing standard* [Issue brief]. Long Term Care Community Coalition. https://nursinghome411.org/federal-staffing-standard/
White, E. M., Black, B. S., Schwartz, L. S., Gruber-Baldini, A. L., & Temkin-Greener, H. (2024). Skilled nursing facility staffing shortages: Sources, strategies, and impacts on care. *Journal of the American Medical Directors Association*, 25(8), 1120–1128. https://pmc.ncbi.nlm.nih.gov/articles/PMC11622260/