Understaffing in Nursing Facilities

A major concern with both nursing homes and assisted living facilities (ALF) is short staffing. In our practice, we routinely find the plaintiff’s injuries are directly related to inadequate staffing. If you have a loved one who is in a nursing home or ALF and are concerned about the staffing speak with the facilities administrator and/or a social worker. If you are unsuccessful contact the Ombudsman’s Office (this is an independent state-run office who advocate for the rights of elderly residents).

Liability in Negligence Claims

A common problem in the prosecution of nursing negligence claims is an over-emphasis on liability (i.e. the conduct of nursing staff) which an under-emphasis on the issues of causation. Many cases fail in their prosecution as a consequence of this oversight. Before pursuing any claim, it is essential to ensure that there is a strong and legitimate causation relationship between the conduct complained of and the injury itself.

You can read more practice tips in my chapter Screening the Nursing Malpractice Case, in a text edited by Patricia Iyer, RN MSN LNCC. More information about Nursing Malpractice, Third Edition, 2007 may be found at here.

Resident's Bill of Rights

N.J.S.A. 30:13-5 is commonly referred to as the Resident’s Bill of Rights. Below I have provided an abbreviated version of those rights. The purpose of this is to give you an idea of what type of rights a nursing home resident is entitled to. However, it is advised that you review this statute in its entirety and/or speak to an attorney about the statute.

Every resident in a New Jersey nursing home shall:

(1) Have the right to manage his own financial affairs;

(2) Have the right to wear his own clothing and right to retain and use his personal property;

(3) Have the right to receive and send unopened correspondence;

(4) Have the right to unaccompanied access to a telephone and the right to privacy;

(5) Have the right to retain the services of his own personal physician;

(6) Have the right to unrestricted communication, including personal visitation with any persons of his choice at any reasonable hour;

(7) Have the right to prevent grievances on behalf of himself or others at the nursing home;

(8) Have the right to a safe and decent living environment and considerate and respectful care that recognized their dignity and the individuality of the resident. This includes the right to expect and receive appropriate assessments, management and treatment of pain as an integral component of that person’s care consistent with sound nursing and medical practices;

(9) Have the right to refuse to perform services for the nursing home that are not included in therapeutic purposes of his/her plan of care;

(10) Have the right to a reasonable opportunity for interaction with members of the opposite sex;

(11) Not be deprived of constitutional, civil or legal rights solely by reason of admission to the nursing home.

Critical Documentation

Be alert to the possibility that critical documentation concerning the liability issue may not be found in nursing notes. Very often treatment may be in other ancillary records such as flow sheets, treatment administration records, the notes of physical or occupational therapy of the Minimum Data Set (for nursing home cases). It is very important to stress that experts need to review all parallel sections of a chart before a criticism arises related to lack of treatment.


You can read more practice tips in my chapter Screening the Nursing Malpractice Case, in a text edited by Patricia Iyer, RN MSN LNCC. More information about Nursing Malpractice, Third Edition, 2007 may be found at here.

Nursing Home Evaluation Checklist

In evaluating a nursing home for a loved one, it is advised that you go and visit the nursing home and ask yourself some of the following questions:

(1) Do the residents appear to be well taken care of?

(2) Is the building clean?

(3) Is the building well maintained?

(4) Are there any foul odors in the building?

(5) Do residents seem active or are they sitting around and appear ignored and bored?

(6) Does the food look appetizing?

(7) Do the staff members interact with you and especially the residents in a pleasant manner?

(8) Does the facility seem to be adequately staffed?

(9) Do the linens look clean?

(10) Does the staff seem to interact in a respectful manner with the residents?

(11) What is the lighting like?

(12) Ask staff members what they think of their work.

(13) Ask staff members if they are ever short-staffed.

(14) Ask the residents if they like the nursing home.

(15) Ask the residents if the staff is helpful and caring.

(16) Ask the residents what they think of the food.

Joint Commission Accredited Facilities

In addition to state records, check to see if the facility involved is a Join Commission accredited facility. If so, the Joint Commission will have surveys available to identify potential systemic problems at such a facility. Many of theses are available online from the JCAHO website. When requesting state records for a facility, make sure to request the survey file, the complaint file and the licensure file. Each of these contains different information, which may prove relevant to a case.

You can read more practice tips in my chapter Screening the Nursing Malpractice Case, in a text edited by Patricia Iyer, RN MSN LNCC. More information about Nursing Malpractice, Third Edition, 2007 may be found at here.

NCCNHR Membership

For thirty years, the National Citizens’ Coalition for Nursing Home Reform has expressed its continuing commitment to protecting and ensuring the safety and well being of nursing home residents across the country. The workers at NCCNHR are tireless in their works to ensure, through a number of different fronts, that nursing home residents receive the highest level of care and treatment. For those visitors to our blog who have an interest, membership to NCCNHR is available to anyone who wishes to do so. I would strongly recommend, for purposes of both edification and involvement, a visit to the NCCNHR website.

Considerations in Choosing a Nursing Home

When deciding on a nursing home for a loved one, it is recommended that you do a pre-visit investigation. Consider doing some of the following suggestions:

(1) Make a list of nursing homes that are close enough for family and friends to conveniently visit the resident;

(2) If your loved one will need assistance from Medicaid and/or Medicare in paying for their stay, list only those nursing homes that participate in the Medicare and Medicaid programs;

(3) Learn as much as possible about nursing homes by talking with:

(a) Others with loved ones in nursing homes;

(b) Clergy;

(c) Doctors;

(d) Social workers;

(e) Nurses;

(f) Nursing home employees; and

(g) Long-term care ombudsmen;

(4) Review state survey inspection reports. These reports are conducted by the state on an annual basis and can give you a good sense of what, if anything, the nursing home is failing to do in terms of care and treatment of its residents. These surveys should be posted in each facility that you visit. This is required by Federal Law. This information is also available on the internet at the Medicare website.