Systemic Injustice Showcase: Nursing Home Understaffing

The systemic injustice diary entry that I will be elaborating on today is regarding the systemic issues in nursing home management that negatively impact residents. As I stated in my diary entry, “This past summer, I worked in a nursing home as a Certified Nurse Assistant (CNA). I worked there in the midst of the covid-19 pandemic which was an extremely eye-opening experience for me. I saw residents lose their daily socialization activities, not be able to be visited by loved ones, and even watched some residents lose their lives to the virus. Although the pandemic greatly affected the residents this past year, elder abuse in nursing homes is a longstanding issue that still plagues nursing homes to this day. I did not witness any physical abuse of residents while working there, however, there are systemic issues within nursing home management that take away rights from the individuals who reside there.”

There are numerous forums that allow reporting of nursing home abuse; however, direct abuse of residents is much less common than the neglect that occurs on a daily basis due to staffing and management issues. According to the nursing home abuse center, “Research indicates that as many as 95 percent of nursing facilities in the US are understaffed” (Nursing Home Abuse Support Team, 2021). The scariest part is that states have different definitions regarding what constitutes understaffing. For example, “the state of Florida mandates that there be at least one licensed nurse for every 40 residents” (Nursing Home Abuse Support Team, 2021). As an aide, I personally had 17 residents to myself one shift; high numbers like these were common. There is no way to provide the around the clock care that each patient needs when an aide is responsible for that many residents at one time. This leads to neglect, infections, sores, and many other health issues for residents. A study at Cambridge university found that nurse staffing below a critical level had a direct correlation with increased infections in residents (Scott, 1996). This is not because aides are trying to be neglectful or abuse their residents; it is because management does not provide adequate staffing due to monetary concerns, loose state ratio mandates, or high employee turnover.

This is a systemic injustice because proper aide-to-resident ratios are not in place in many states or are not upheld by management in states that may have proper ratios. The blame for abuse and neglect in nursing homes is often placed on aides. The reality is that aides are doing their best to care for far too many residents at a time because management and state mandates are allowing understaffing to continue. Another sad truth that relates to our reading in class is that the voices of those being abused are overpowered by management trying to cover up this issue and save money on staff since they are for profit organization. Resident testimony is often covered up by claiming that they are mentally delusional or ill. This is similar to the silencing of “other” voices in the one/other relationship. The video embedded in this post details the numerous signs that are present in nursing homes that are neglecting residents due to under staffing. People need to understand the true issues that are taking place in nursing homes and learn the signs of neglect. In order to right this injustice states and nursing home management need to set and enforce proper ratios to maintain the safety of residents and ensure they get the care that they deserve.




Fridkin, Scott K., et al. “The Role of Understaffing in Central Venous Catheter-Associated Bloodstream Infections.” Infection Control and Hospital Epidemiology, vol. 17, no. 3, 1996, pp. 150–158., doi:10.2307/30142373.

Nursing Home Abuse Support Team Last modified: March 2, et al. “Understaffing in Nursing Homes – Consequences & Dangers.” Nursing Home Abuse Center,,nurse%20for%20every%2040%20residents.

“What Is the Solution to Understaffing in Kentucky Nursing Homes?” Gray and White Law,


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