Inadequate Training in Nursing Homes

Nursing home training equips staff to provide safe, effective care and protect residents from infections, injuries, and medical complications. Inadequate training in nursing homes has been linked to a reduced quality of life, a heightened risk of nursing home abuse, and higher mortality rates among nursing home residents. Nursing homes that fail to provide staff training are liable for the resulting harm.

Nursing home residents typically have special needs that require skilled care. When you place a loved one in a nursing home, you rightfully expect your loved one to receive quality care from qualified staff. Even if they mean well, poorly trained staff can cause irreversible harm.

If your loved one has suffered harm as a result of inadequate training in a nursing home, our nationally recognized nursing home abuse attorneys can help you pursue significant damages against the nursing home and the responsible staff. Contact us now for a free case evaluation.

What is the Current State of Nursing Home Training in Illinois?

A 2020 survey published by the Journal of Advanced Nursing found that 72 percent of nurses agreed that the number of unqualified care workers in nursing homes was too high. Funding problems, nursing shortages, and high staff turnover drive this assessment.

Funding Problems

Nursing home providers are often wealthy corporations in the nursing home business to make money. They maximize profits by keeping staffing levels at the bare minimum and investing as little as possible into personnel, including training and wages.

According to the Bureau of Labor Standards, the average pay for CNAs is just $16.90 per hour. Nearly 40 percent of CNAs live 200 percent below the federal poverty level despite working long hours and being overburdened mentally and physically throughout their work shifts.

These working conditions are among the most important reasons nursing homes cannot attract and retain qualified, well-trained staff.

What Does Understaffing Have To Do with Inadequate Training?

According to the American Health Care Association, 84 percent of nursing homes in the United States are short-staffed, and the problem is rising. Approximately 96 percent of nursing home operators have reported difficulties hiring new staff.

Understaffing in nursing homes is so severe that more than two-thirds of nursing home operators have concerns that they will have to close facilities. One of the biggest hurdles to hiring qualified staff is a lack of qualified candidates. This creates strong incentives to hire unqualified staff, with residents paying the price.

Illinois regularly ranks last among all 50 states for nursing home staffing. Of the 100 most understaffed facilities in the United States, 47 are located in Illinois. This increases the risk that Illinois nursing home residents will receive care from unqualified or poorly trained staff.

High Staff Turnover Rates and Inadequate Training

The turnover rate measures how often staff resign and are replaced. In Illinois, the average turnover rate among certified nursing assistants, registered nurses, and licensed nurses is 52 percent, meaning over half of all nursing staff quit and get replaced yearly.

A constant influx of new staff interrupts the continuity of care and prevents staff from developing familiarity with each resident and their specific needs and preferences. It also increases the burden on nursing homes to provide training.

In many cases, inexperienced certified nursing assistants, or CNAs, replace experienced nursing staff. State and federal regulations allow new CNAs to start work for up to four months before completing their training. They are not even required to begin training until 45 days after they start.

Nursing Home Training Requirements

CNAs account for about 40 percent of nursing homes’ workforce and provide as much as 90 percent of residents’ care. Yet they are the least trained of all nursing staff.

Ironically, RNs are the most trained nurses but provide the least direct patient care.

Federal Training Requirements

Federal law requires CNAs to undergo at least 16 hours of supervised hands-on training as part of the 75 hours of basic CNA training. Nursing homes are prohibited from allowing CNAs to perform any patient services for which they have not been fully trained and tested competent.

CNA training must include all of the following:

Communication
Infection control
Safety and emergency procedures
Promoting residents’ independence
Respecting resident rights
Basic nursing skills
Personal care skills
Mental health and social services needs
Cognitive impairment
Basic restorative services, such as self-care, assistive devices, maintaining range of motion, bowel and bladder training, and use of prosthetic devices

CNAs must work under the supervision of licensed and registered nurses, although federal law stops short of specifying a staffing ratio. The law does require skilled nursing facilities to ensure at least one RN is on duty for eight consecutive hours every day. In addition, an RN or LPN must be on duty 24 hours a day, seven days a week.

All nursing home staff are required to undergo annual continuing education, which must include training in the following at a minimum:

Freedom from abuse, neglect, and exploitation and how to report it
Managing dementia and preventing resident abuse
Infection control
Compliance and ethics
Behavioral health
Feeding assistance training for any staff that assists residents with feeding

CNAs must undergo 12 hours of in-service training that includes dementia management, resident abuse protection, and training that addresses areas of weakness or special needs of their residents.

Training Requirements During the COVID-19 Pandemic

The federal government relaxed training requirements during the COVID-19 pandemic due to an extreme understaffing crisis by allowing CNAs to work longer than the usual four-month maximum without completing training.

This ended in 2022 overall, but individual nursing homes were still permitted to apply for waivers to delay training until September 2023. During the pandemic, for every two nursing home residents who died from COVID-19, one died from a non-COVID cause—often resulting from neglect.

Infection control was especially important during the pandemic, yet inadequate infection control was one of the most common deficiencies for which nursing homes were cited. Illinois nursing homes had one of the worst records of poor COVID-19 practices in the nation.

While understaffing and lack of supplies played important roles in these deficiencies—and the tragically large number of deaths from both COVID and non-COVID causes—lack of training in nursing homes is also to blame.

State Training Requirements

Although the federal government establishes training guidelines, the states can impose requirements that exceed federal guidelines. Illinois is one of the states that has done so.

CNA Training Requirements

While CNAs are a valuable part of the patient care team, if they lack training and competency, they can jeopardize the safety, well-being, and even the lives of nursing home patients.

Illinois requires all CNAs to complete 120 hours of training, which includes 80 hours of instruction and 40 hours of practical training. For perspective, the average college semester is 240 hours, which means CNAs in Illinois are only required to have the equivalent of half a semester of training.

The state also requires CNAs to undergo training in the following areas:

Dementia care
Cardiopulmonary resuscitation, or CPR
Communication and interpersonal skills
Infection control
Safety and emergency procedures, including clearing an airway
Promotion of resident rights and independence

Illinois nursing facilities can hire CNAs as young as 16 with only an 8th-grade education. A new CNA has 45 days from the employment date to begin the required 120-hour training program.

Director of Nursing

Every nursing home must employ a Director of Nursing, or DON, and nursing homes with 100 or more residents must also employ an assistant DON. Both must be RNs trained in nursing service administration and restorative or rehabilitative nursing. They must have “some knowledge and training” in caring for the types of residents the nursing home serves.

Memory Care Nursing Supervisors

Any nursing staff member working in a supervisory capacity in a nursing home’s dementia unit must undergo 12 hours of annual continuing education and eight hours of annual dementia care training. They must also have at least one of the following qualifications:

Associate’s degree or bachelor’s degree
Qualification as an RN with at least one year of experience working with people with dementia, plus training in ability-centered care
Five years of experience working with people with dementia, including two years of management experience and completion of ability-centered care training

All Nursing Staff

Skilled nursing facilities must provide the following nursing home education for staff that provides direct care, including CNAs, RNs, and LPNs:

Identifying the risks of injury
Safe lifting policies and techniques
How to use the available lifting equipment.

Nursing homes must provide specialized in-depth training to safe lifting teams, including how to use equipment, proper techniques, ergonomics, safe locations for lifting, and policies and procedures for maintaining resident choice.

Staffing Ratios

Licensed nurses with at least the qualifications of an LPN must provide at least 25 percent of care. RNs must provide at least 10 percent of patient care. Illinois requires facilities to employ enough nursing staff for every resident to receive at least 3.8 hours of daily nursing and personal care.

What To Do If You Suspect Nursing Staff Is Inadequately Trained

When you entrust a nursing home with the care of your beloved family member, you are entitled to verify that every staff member attending to your loved one has the training and skills to provide safe, quality care. If you suspect your loved one is receiving incompetent care, you should do the following:

Obtain the names of the nursing staff members you suspect are poorly trained, report your concerns to the nursing home administrator, and request that the administrator verify the nursing staff member’s credentials.
Keep a written log of incidents that point to poor training.
Stay in close contact with your loved one and document all unexplained health changes.
Contact the long-term care ombudsman for your region. You can locate your regional ombudsman’s contact information through the Illinois Department of Aging.
If you suspect your loved one has experienced abuse or neglect, file a complaint against the nursing home by contacting the Office of Health Care Regulation at the Illinois Department of Public Health by calling 1 (800) 252-4343.
Contact an experienced nursing home abuse lawyer as soon as possible. When you contact our compassionate and skilled attorneys, we can help you file complaints with the appropriate agencies, gather important evidence, and protect your loved one.

Does Inadequate Training in Nursing Homes Constitute Medical Malpractice?

Medical malpractice occurs when a health care provider breaches their duty to provide a reasonable standard of care, and the patient is harmed. Healthcare providers include the following parties:

Registered nurses
Licensed practical nurses
Certified nursing assistants
Nursing supervisors
Physical therapists
Occupational therapists
Nursing home doctors
Pharmacists
Laboratory workers
Pathologists
Medication assistants
The nursing homes themselves

The reasonable standard of care is the level expected from a qualified, competent, and reasonable health care provider with the correct qualifications and skills for the position. When inadequate training results in substandard care that harms your loved one, the untrained staff member, supervisory staff, and the nursing home may be liable.

What Compensation Is Available for Nursing Home Malpractice?

Nursing home residents who are injured because of inadequate staff training deserve justice. Our award-winning nursing home abuse lawyers can help you pursue significant financial damages on behalf of your loved one for their financial and emotional losses, including the following:

Medical expenses stemming from the abuse
Costs associated with moving to a safe facility
Your loved one’s emotional distress
Your loved one’s physical pain and suffering
Loss of bodily functions
Your lost wages as a result of protecting, monitoring, or moving your loved one

If your loved one dies from the injuries, we can also help your family pursue damages for your financial and emotional losses, including your loved one’s final expenses, loss of companionship, and your loved one’s pain and suffering.

When Should I Contact a Lawyer?

You should contact a knowledgeable nursing home abuse lawyer as soon as possible after any of the following:

You suspect your loved one is receiving substandard care.
You notice an unexplained decline in your loved one’s health.
Your loved one suffers an injury in a nursing home.
Your loved one tells you they’ve experienced abuse or neglect.
Your loved one exhibits signs of nursing home abuse or neglect.

Even if your loved one has moved to a new facility, you shouldn’t wait to contact a nursing home abuse lawyer. Nursing home abuse and neglect are forms of medical malpractice. The Illinois statute of limitations requires most medical malpractice lawsuits to be filed within two years.

An experienced medical malpractice lawyer will need time to investigate your claim, gather evidence, and prepare your case before filing. If your case is not filed before the deadline, you will forever lose the right to pursue justice for your beloved family member’s injuries. Contact us today for a free case review.

What Are the Signs of Lack of Training in Nursing Homes?

If your loved one is not receiving competent care, you may notice a more rapid decline in health than before your loved one entered the nursing home. Your loved one may also experience preventable injuries, such as the following:

Injuries from falls
Pressure ulcers, also known as bedsores
Excessive weight loss from malnutrition
Urinary tract infections, seizures, or kidney failure due to dehydration
Severe emotional distress
Infections from poor wound care or inadequate staff hygiene
Injuries or death from choking as a result of incompetent feeding assistance
Internal injuries or death from improper medication administration

Any type of injury, health decline, or emotional distress your family member experiences could indicate inadequately trained staff.

Our seasoned nursing home lawyers have won multiple verdicts and settlements in the millions for nursing home residents harmed by improperly trained staff. Below are a few examples:

Partners Stevin Levin and Susan Novosad won a $1.5 million settlement on behalf of an 87-year-old female resident who suffered second and third-degree burns when a nurse placed her in a scalding sitz bath. The water for the sitz bath had been prepared in an industrial coffee machine.
Partners Stevin Levin and Michael Bonamarte IV negotiated a $1 million settlement for a 56-year-old who developed severe, painful bedsores in a nursing home. The nursing home staff claimed the sores were unavoidable, yet they healed and did not return after he was transferred from the facility.
We obtained an $800,000 settlement for the family of a 32-year-old resident who choked to death after staff failed to develop a plan to address her eating behaviors. This failure was the result of inadequate behavioral health training.

Why Is Training So Important for Nursing Home Staff?

Residents typically enter nursing homes because they require some level of skilled care. Every resident is unique, and nursing home staff must rely on their training and clinical experience to determine how to best meet the needs of each one.

Hands-on practical training ensures staff are exposed to as many real-life scenarios as possible before they treat patients. Ongoing nursing home education for staff ensures nurses and CNAs remain up-to-date in their knowledge and skills so they are prepared to respond to patient emergencies and manage a wide range of health conditions.

Resident Safety

Staff with poor training pose an ongoing threat to the health, safety, and even the lives of nursing home residents. Poorly trained staff may be unprepared to recognize and respond appropriately to health emergencies. They may not know the proper techniques to safely perform basic care tasks. For example:

An untrained CNA may not recognize the signs of a stroke or cardiac event.
Poorly trained staff may fail to practice adequate hand hygiene or other infection control measures.
Inadequately trained nurses may dispense medication incorrectly.
Poorly trained staff may fail to properly position residents to avoid bedsores.
CNAs without adequate training may use improper techniques when repositioning or otherwise assisting residents.
An improperly trained lift team may drop residents when moving them.
Untrained nursing home staff may fail to recognize the signs of abuse.
Untrained staff may not know the proper procedures for reporting abuse.
Poorly trained staff may not know how to prevent falls.
Untrained feeding staff could cause residents to choke.

Prevention of Abuse and Neglect

Well-trained staff learn positive techniques to cope with the stress of working with residents, making them less likely to take their frustrations out on them. All nursing home staff must be trained to recognize, prevent, and report resident abuse and neglect. Without this training, staff could miss the subtle signs of abuse, allowing it to continue indefinitely.

Enhanced Quality of Life

Adequate nursing staff training gives residents a higher quality of life. Staff with adequate training can anticipate residents’ basic needs, prevent health declines, and provide a positive environment.

Well-trained staff are more confident and better able to anticipate a resident’s emotional, social, and health needs. Residents are more likely to trust their caregivers and feel comfortable in their environment.

Staff with adequate training in behavioral health and dementia care can minimize and manage agitation and other disruptive behaviors, benefiting all residents.

A study published by the American Geriatrics Society found that nearly half of all facilities lacked appropriate staff education in behavioral health. Up to 90 percent of nursing home residents have behavioral health disorders, and approximately one-third of their behavioral health needs were unmet.

Having more RNs with psychiatric training was associated with better care and coordination with community resources.

Why Should You Choose Levin & Perconti to Handle Your Illinois Nursing Home Abuse or Neglect Claim?

We have been helping nursing home abuse and neglect victims recover substantial compensation for more than 30 years. We were one of the first law firms to stand up to nursing homes and have won more than $2 billion in compensation for our clients. We have multiple record-setting results, and our cases often make the headlines.

Nursing home owners are large, wealthy corporations that fight to avoid paying the damages they owe. Standing up to them takes experience, perseverance, and significant resources. We have developed the most aggressive and effective approach for each nursing home case and have the resources to win.

Our success is well-known by nursing home owners and insurance companies, and they know that we will not settle for less than our clients deserve. This gives us powerful leverage in settlement negotiations, allowing us to recover maximum compensation.

We work alongside legislators to improve the laws and provide better protection for nursing home residents, and we are dedicated to getting justice for nursing home residents who have suffered harm because of abuse or neglect. If your loved one has experienced nursing home abuse or neglect, contact us now for a free consultation.

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Margaret, Daisy and Bryan. This magnificent cohesive team led by Margaret represented us for my mom's nursing home wrongful death case.

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Our deepest appreciation to the law firm of Levin & Perconti, and in particular to Margaret Battersby Black, in the handling of the lawsuit we field n behalf of our sister who sustained life-threatening injuries as a nursing home resident.

Margaret’s representation, guidance, and professionalism gave us the sense that we could put our trust in Levin & Perconti and the final outcome proved that to be true.

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Steven M. Levin

Founder and Senior Partner

Since 1976, Steve Levin has been dedicated to helping people injured by others’ negligence. He is one of the first attorneys in the U.S. to prosecute nursing homes for abuse and negligence. He's also helped write new legislation that governs the operation of nursing homes, including the Illinois Nursing Home Care Act. Moreover, Levin & Perconti has obtained the top three jury verdicts in nursing home negligence cases in Illinois.

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