How real of a problem is under-staffing in nursing homes? I came across this post from the Nursing Home Reality blog from a nurse who works at a 200 bed facility.
I am an RN in a nursing home licensed for just over 200 residents that offers skilled, intermediate and personal care. This facility has four nurses stations/units. I work on a unit with 38 residents. Many of these individuals have dementia.
My unit is allowed four nurses aides and an LPN on day shift, 3 nurses aides and an LPN on evenings, 1 – 2 aides and an LPN on nights.
While I try hard to understand the “budget” for staffing on my unit, my repeated requests for additional help has been ignored. In August I had eight (8) resident falls on my unit and they all happened on evening shift. My unit’s LPNs are frequently out of time compliance on distributing medications.
I would like to see mandatory staffing based not only on the number of residents, but also on their needs. This is especially important on a unit that has residents with many needs.
Nursing homes are required to have minimum staffing ratios that are controlled by Medicare. 
However, when a facility has a combination of residents requiring 24-hour nursing, rehabilitation and personal care the lines of what is required get blurred. As this nurse points out, some people simply require more care than others and general staffing guidelines will not always provide sufficient care.
If this nursing home fails to listen to its staff complaints of under-staffing, they should recognize the problems with patient safety. If eight residents fell within one month, I bet at least several of of them sustained serious injuries requiring medical attention. These are the type of inexcusable cases where the nursing home should be held fully accountable for their deliberate choice to cut corners on patient safety by under-staffing their nursing home.