Private nursing homes deserve to make a profit – a fair profit. Nursing home operators, like those managing any other type of business, take steps necessary to maximize profit. However, far too often, the methods used to do so run afoul of nursing homes’ statutory and moral obligation to “attain or maintain the highest practicable physical, mental and psycho-social well-being” for their residents.
Many of the expenses in operating a nursing home are fixed – meaning there is nothing the operators can do to decrease them. Expenses such as rent, food, supplies, and electricity are not easily decreased. On the other hand, staffing is an area where money can be saved; however, often at the expense of the residents.
In the clinical setting, nursing homes typically have registered nurses, licensed professional nurses and certified nursing assistants. They may also have physical therapists, occupational therapists and speech therapists. The highest expense for a nursing home is staffing and the most expensive employees are registered nurses.
Our Jacksonville nursing home abuse and neglect lawyers see the effects of understaffing in nearly every case we handle. Most commonly, we see the number of registered nurses cut to the bare minimum. Why does this matter? It takes at least two years of college to become a registered nurse and many have a four year bachelor’s degree. In contrast, it takes about one year of schooling to become an LPN.
Florida’s Nurse Practice Act spells out the resulting difference: RNs are able to make assessments of patients’ conditions; while LPNs are not. This means that an RN has the training and experience to consider what is going on with a nursing home resident and make, or suggest, changes to his or her care plan, medication or treatments. LPNs, on the other hand, are not trained to make such assessments.
Many people think that the resident’s doctor will make rounds and perform global assessments on a frequent basis. This is not accurate. After an initial visit, it is common that doctors only see residents when a concern is brought to their attention. Without registered nurses performing assessments, a patient’s decline, whether it be from infection, malnutrition or dehydration, often goes unnoticed until it is too late.
We have seen many examples of this here in Jacksonville. In 2016, we resolved a wrongful death case against a large chain nursing home operator whose employees apparently did not notice its resident had an infection until it had gotten so bad that he was rendered unconscious by sepsis. He died within a day of being transferred to Memorial Hospital Jacksonville. Notably, the nursing home could not produce a single nurse’s note for the last week of his life. Had a registered nurse seen him, his infection may have been caught and treated before he became terminally ill. That nursing home was severely understaffed, and was found to be especially lacking in registered nurses. The man was only 61 years old.
Attending doctors will not take up the slack. It is important to understand that the doctors that make rounds at nursing homes are typically not employees of the nursing homes. Most residents are assigned a doctor by the nursing home. The nursing home chooses among several that it has contracts with; however, the doctor is not an employee of the nursing home. Further, any neglect on the part of the doctor is not attributable to the nursing home.
Florida has standards that require a minimum number of LPNs and CNAs. A nursing home’s failure to meet these standards can result in a moratorium on new admissions. In just about every nursing home case we litigate, we find that the nursing home staffed only to the level of these minimums regardless of how serious the needs of their residents are. We have also found examples where a nursing home inflated the number of staff performing direct care to the residents in order to make it appear that the standards were met. Continue reading