Understaffing in Nursing Homes – A Profit-Driven Crisis in New York
Chronic understaffing is at the heart of New York’s nursing home crisis. In far too many facilities, owners and operators cut staffing levels to save money – often prioritizing profit over people’s lives. New York lawmakers responded in 2021 by passing landmark reforms: nursing homes must provide at least 3.5 hours of care per resident per day and spend at least 70% of their revenue on direct resident care (with 40% specifically on resident-facing staff). The state even capped nursing home profits at 5% of expenses to curb greed-driven cutbacks, as reported by medicareadvocacy.org. These measures recognize a troubling reality: when operators short-staff a facility, residents pay the price in substandard care.
Unfortunately, enforcement of these standards has lagged. Eighteen months after the staffing mandate took effect, more than 400 nursing homes – roughly 65% of facilities statewide – had violated the 3.5-hours staffing law, yet not a single one had been fined as of mid-2024. Regulators have been slow to impose penalties, and industry groups even sued (unsuccessfully) to block the law, claiming worker shortages made compliance impossible. Meanwhile, federal data shows New York’s nursing homes were providing only 3.59 hours of nursing care per resident per day on average – placing New York among the bottom ten states for staffing levels. In fact, 80% of New York facilities operate below the 4.1 hours per day that research recommends for safe basic care. The result is an ongoing, pervasive staffing crisis, especially in for-profit nursing homes, where cost-cutting can be most aggressive.
Evidence indicates that profit motives directly contribute to understaffing and poor care. Studies have found that facilities owned by private equity firms or other for-profit investors tend to employ fewer nurses and receive more health code violations compared to non-profits. New York’s Attorney General recently exposed a stark example: a major nursing home chain was accused of siphoning off $83 million in government funds – money that should have been spent on care – through a web of related companies, all while intentionally understaffing its homes. According to the Attorney General’s lawsuit, this profit-driven neglect led to horrific suffering: in one home a resident died of sepsis from an untreated bedsore, another resident fell and suffered brain damage after not receiving aid, and a man with dementia wandered away unsupervised due to a lack of staff. These tragedies are the direct result of too few caregivers on duty. The case ended in a $45 million settlement and court-ordered monitoring of the company’s facilities – a strong signal that New York authorities recognize how deadly understaffing can be.
Consequences of Neglect: Bedsores, Falls, and Other Preventable Injuries
When a nursing home doesn’t have enough trained staff, the real-world consequences for residents are devastating. Care tasks get skipped or delayed, supervision falters, and vulnerable seniors are put at risk. Some of the most common – and preventable – injuries and harms linked to understaffing include:
- Bedsores (Pressure Ulcers): These painful wounds develop when immobile residents aren’t repositioned regularly. Bedsores are a classic warning sign of neglect, arising when staff fail to provide basic skin care and movement. If left untreated, they can become infected; in one New York facility, an ignored bedsore led to a fatal septic infection. In fact, the very presence of bedsores is often used as evidence of nursing home abuse or neglect in legal cases because such wounds simply should not occur with proper care.
- Falls and Fractures: Understaffed homes have fewer eyes and hands available to assist residents with walking, transfers, and daily activities. Residents may try to get to the bathroom or move about without help and suffer dangerous falls. Broken hips, head injuries, and even fatal trauma can result. Alarmingly, studies have estimated that between half and three-quarters of nursing home residents suffer a fall each year – a rate exacerbated by inadequate supervision. Many of these falls could be prevented with proper staffing and attentive assistance.
- Dehydration and Malnutrition: When overworked aides have too many residents to feed, meals are missed or rushed, and water pitchers go unfilled. Residents who need help eating or drinking might not get enough nutrition or fluids. Weight loss, weakness, and related health complications (like kidney issues or infections) can quickly develop. These are quiet forms of neglect that worsen a resident’s underlying health problems over time.
- Poor Hygiene and Infections: In an understaffed facility, there may be no one available to change soiled bedding or incontinence briefs promptly, to help resident’s toilet, or to ensure handwashing and clean conditions. The lack of basic hygiene care leads to preventable infections (urinary tract infections, skin infections, COVID-19 outbreaks, etc.). During the COVID-19 pandemic, some short-staffed New York nursing homes failed to follow infection control protocols – a lapse that contributed to hundreds of deaths. Adequate staffing is critical for maintaining cleanliness and infection prevention.
- Wandering and Elopement: Residents with dementia are especially at risk when staffing is thin. It only takes a few unsupervised minutes for a cognitively impaired resident to wander out of a building or into a dangerous area. The Attorney General’s investigation noted a dementia patient who walked out of a facility unnoticed. Such incidents can lead to injury or death (for example, exposure to cold, falls, or getting lost) and are a clear sign that there were not enough staff on duty to keep residents safe.
Every one of the outcomes above – bedsores, falls, malnutrition, infections, wandering – is preventable with proper care and oversight. They represent the “high cost of neglect” that residents pay when a nursing home puts profits or convenience ahead of compassion. Beyond the physical injuries, residents endure pain, fear, and loss of dignity. Families also suffer the anguish of seeing a loved one hurt by those entrusted with their care. Neglect robs seniors of the safe, comfortable life they deserve in their final years. This is why New York law and federal regulations set care standards – and why those standards must be enforced.
New York’s Regulatory Framework: Laws and Oversight vs. Reality
New York’s policymakers have acknowledged the staffing and neglect crisis and attempted reforms. As mentioned, state law now mandates minimum staffing and spending levels in nursing homes – a direct response to widespread complaints of substandard care. Specifically, since January 2022 every nursing home must provide 3.5 hours of direct nursing care per resident per day (with at least 2.2 hours by aides and 1.1 hours by licensed nurses) and spend at least 70% of its revenue on resident care (with at least 40% on staffing). This was one of the strictest state laws in the nation, intended to ensure facilities devote resources to bedside care rather than padding their bottom lines. Facilities that flout these requirements can, in theory, face fines of up to $2,000 per day per violation. New York also empowered the Department of Health to penalize homes that persistently receive low quality ratings or violate residents’ rights – part of a broader push to hold bad operators accountable.
On paper, New York’s regulations are robust. In practice, however, enforcement has been slow and uneven, undermining the promise of these reforms. Regulators delayed imposing penalties throughout 2022 and into 2023, partly due to a declared health worker shortage and legal challenges from the nursing home industry. As a result, no fines were issued for staffing shortages in the first year and a half after the law took effect, even though two-thirds of homes failed to meet the standard. Advocates have decried this lack of urgency, noting that “game-changing” laws mean little if not enforced. In mid-2024, under public pressure, officials indicated they would begin assessing fines and settlements for the worst offenders. But by then, the damage to residents had been done, while facilities essentially got a free pass for noncompliance.
New York’s Department of Health (DOH) is the primary regulator overseeing nursing homes. DOH inspectors conduct surveys (inspections) and investigate complaints of abuse or neglect. Troublingly, a recent investigation found New York had a backlog of overdue nursing home inspections, with some of the worst-staffed homes avoiding scrutiny for years. This oversight gap means dangerous conditions can persist without timely intervention. The federal Centers for Medicare & Medicaid Services (CMS) also plays a role, since most nursing homes receive Medicare/Medicaid funding. CMS publishes nursing home ratings and can impose its own fines or even cut off funding for facilities that endanger residents. Federal law requires that facilities have “sufficient staff” to meet every resident’s needs each, but this general mandate is often unenforced unless serious harm is documented. Notably, CMS is moving toward instituting a nationwide minimum staffing rule in the coming years, but as of 2025, that federal rule is still pending implementation.
Are New York’s new profit cap and spending rules making a difference? It’s too early to tell the full impact, but there are signs of pushback. The 2021 state law also capped nursing home profits at 5% and required operators to reinvest excess funds into care. The industry sued, claiming this was unconstitutional – but in 2024 a state appellate court upheld the law. The court’s message was clear: the state can demand that caring for residents comes before lining owners’ pockets. New York’s Attorney General has likewise taken an aggressive stance by pursuing civil fraud and neglect lawsuits against egregious operators. The $45 million settlement in 2024 against Centers Health Care (one of New York’s largest chains) is a prime example: that case not only recovered funds to be put back into patient care, but installed independent monitors to oversee the chain’s compliance going forward. These enforcement actions send a strong signal that chronic understaffing and neglect will face legal consequences. Still, the fact that such extreme neglect occurred (multiple deaths, injuries, and COVID outbreaks) shows that much stronger proactive oversight is needed to prevent harm before it happens, not just punish after the fact.
The Right to Dignity and Quality Care – Not Just Moral, But Legal
Every nursing home resident is entitled to safe, compassionate care – not as a privilege, but as their legal right. Both federal and state laws include a “Residents’ Bill of Rights” that facilities must uphold. Under New York law, each nursing home resident has the right to dignity, respect, and a comfortable living environment, as well as the right to quality care and treatment without discrimination. Residents must be safeguarded from abuse and neglect, assured privacy, and allowed to make their own choices whenever possible. The New York Codes, Rules and Regulations (NYCRR) explicitly state that a nursing home must protect and promote the rights of each resident, ensuring a dignified existence and self-determination. In short, nursing homes are supposed to be homes – places where elderly individuals live out their days with as much dignity and fulfillment as their health allows, not warehouses where their basic needs are ignored.
Neglect due to understaffing directly violates these rights. There is nothing dignified about being left in a soiled bed for hours, or going hungry because no aide was available to help with your meal. It is not respectful or humane for a frail elder to lie in pain from an open bedsore that didn’t have to form, or to live in fear of falling because no one answers the call bell. Family members who entrust a loved one to a licensed facility have the right to expect that someone will be there to care. Both New York’s Public Health Law and federal Nursing Home Reform Act (OBRA ’87) set forth standards of care that facilities must meet – including providing adequate supervision, hydration and nutrition, hygiene, medical treatment, and social engagement. When a nursing home fails to meet these obligations, it’s not just a breach of ethics; it’s a breach of the law.
Crucially, New York gives families and residents powerful tools to enforce these rights. Under Public Health Law §2801-d, for example, a nursing home resident (or their estate) can sue the facility if any of the resident’s rights or benefits guaranteed by contract or law are violated and cause injury. This means families can bring a lawsuit not only for classic negligence (e.g. a fall caused by a careless aide), but also for regulatory violations (such as chronically low staffing or inadequate care planning) that lead to harm. The law even allows recovery of punitive damages and attorney’s fees in cases of willful or reckless neglect – a strong deterrent against cost-cutting at the expense of resident care. In practice, this statute and related regulations empower families to seek justice when a loved one is harmed, by holding the facility directly accountable for any substandard care or denial of the resident’s rights.
Holding Negligent Nursing Homes Accountable: What Families Can Do
If you suspect a loved one is suffering due to nursing home neglect or understaffing, you are not powerless. Both legal authorities and elder advocates urge families to speak up and take action – not only to secure justice for your loved one, but to protect other residents from the same mistreatment. Here are key steps to consider:
- Recognize the Warning Signs: Pay close attention to your family member’s condition. Red flags of neglect can include unexplained weight loss, dehydration (dry mouth, infrequent urination), untreated bedsores, poor hygiene, frequent falls or bruises, sudden mood changes, or your loved one appearing fearful or withdrawn. Staffing-related issues like call lights going unanswered for long periods or chronically overworked, scarce personnel on the floor are also cause for concern. Trust your instincts – if something feels “off” or dangerous about the care being provided, it very well may be.
- Document Everything: Keep a written log of problems as they arise. Note dates, times, and descriptions of incidents (e.g. “Mom was left in bed all day without being helped up”; “Dad fell in the bathroom – no aide was around”). Take photos of any injuries or conditions, such as bedsores, and save facility reports or medical records that relate to the neglect. This documentation can be vital evidence later. Also, speak to the nursing home administrators about your concerns – sometimes issues can be remedied if addressed early. Be sure to follow up any verbal complaints with written communications (email or letter) so there is a paper trail.
- Report to Authorities: If the facility does not promptly correct the issues or if serious harm has already occurred, file a complaint with the New York State Department of Health. DOH has an online form and hotline for nursing home complaints, and by law they must investigate allegations of abuse or neglect. You can also contact the New York State Long Term Care Ombudsman Program, which is an advocate for residents and can help mediate or escalate your concerns. In cases of egregious neglect or financial fraud, you may contact the New York Attorney General’s office – the Attorney General actively encourages anyone with information about alarming nursing home conditions or abuse to come forward at https://ag.ny.gov/nursinghomes. Remember that calling 911 is appropriate if your loved one is in immediate danger or needs urgent medical care due to neglect.
- Consult a Knowledgeable Attorney: To truly hold a nursing home accountable and to pursue compensation for harm, legal action is often necessary. An experienced New York nursing home neglect attorney can evaluate your case, advise you on your rights, and help gather evidence (including staffing records, internal reports, and expert medical opinions). Importantly, New York’s laws provide avenues to hold facilities liable for negligence or abuse and to pursue compensation for injuries or wrongful death. This can include damages for pain and suffering, medical expenses, and, in some cases, punitive damages to punish especially bad conduct. By filing a lawsuit, families not only seek justice for their loved one – they also send a message that substandard care will not be tolerated. Often, legal pressure prompts improvements in staffing or practices that benefit other residents as well. Many attorneys, including Hacker Murphy LLP, offer free consultations for nursing home neglect cases and work on contingency (meaning no upfront fees). Don’t hesitate to get legal guidance if you suspect neglect; there are strict time limits (statutes of limitation) to file claims, so acting sooner is better.
- Protect Your Loved One’s Rights: While legal proceedings are underway (or even if you decide not to sue immediately), make sure your family member’s resident rights are being observed. You have the right to attend care plan meetings, to ask questions about staffing levels, and to receive full information about any incidents or injuries. Facilities cannot retaliate against a resident for complaints or legal action – doing so would itself violate the law. If needed, you can request a transfer to a safer facility, though the home generally cannot force a discharge without a safe discharge plan. Throughout it all, remember that your loved one deserves dignity and proper care every day. Don’t let the nursing home “blame” the resident’s age or illness for problems that really stem from neglect. Hold the facility to the high standard of care that the law – and basic humanity – requires.
Prioritizing Care Over Profits
The plight of under-cared-for seniors in New York nursing homes is a deeply personal issue for families and a profoundly important public concern. The “high cost of neglect” can be measured in human lives, pain, and loss of dignity. It is paid by the grandmother who develops septic bedsores because nobody had time to turn her, or the father who falls and lays waiting in agony because the facility was short-staffed on the night shift. It’s paid by every family forced to watch a loved one suffer needlessly, and by dedicated but overwhelmed nurses and aides who want to provide compassionate care but aren’t given the resources. These costs are far too high.
New York’s laws – and basic decency – demand that nursing homes put care before profits. Residents have the right to be kept safe, healthy, and treated with respect, and operators who choose to cut corners must be held accountable. While recent reforms and enforcement actions are steps in the right direction, real change will require constant vigilance. Families, regulators, and advocates must continue to shine a light on understaffing and neglect, ensuring that failures are not swept under the rug. The elder members of our community deserve nothing less than attentive, dignified care in their twilight years.
If you have a loved one in a nursing home and are worried about their well-being, know that the law is on your side. You do not have to accept excuses from facility owners who claim they “can’t afford” adequate staff while pocketing millions. You have powerful recourse to demand better – from filing complaints to pursuing legal action against negligent facilities. At Hacker Murphy LLP, we are committed to helping families in New York fight for the justice and quality care their loved ones deserve. Our experienced attorneys understand the regulatory landscape and have a track record of holding nursing homes accountable. We believe that every senior has the right to live with dignity and receive proper care, and we fight tirelessly to enforce that right for our clients.
The bottom line: Understaffing and profit-driven neglect in nursing homes are not just regulatory infractions – they are breaches of trust and humanity. By insisting on accountability through both legal channels and public advocacy, we can compel nursing homes to fulfill their duty: to care for our elders as if they were their own family members. It’s time to put care back at the center of long-term care. The law provides the tools; together, we can ensure that no family has to suffer the high cost of neglect ever again.
[If you have questions about nursing home neglect or want to discuss a potential case, feel free to reach out to Hacker Murphy LLP for a consultation. We’re here to help families protect their loved ones’ rights and hold negligent facilities accountable.]