Of the myriad resident safety issues in long term care facilities, the issue that needs utmost attention is adequate staffing for the clinical complexity of residents. This is not to say that other areas-falls, infection control, abuse and neglect, medication management, equipment and technology, facility design, and staff training and education-are not also extremely important resident safety issues for long-term care facilities. They are all critical issues and must also be studied and resolved.

But as our older populations increase, so does the complexity of issues and needs of that population. With that complexity comes a whole host of safety issues for the long-term care facility's residents, along with a greater burden on the staff.

For example, on the floor of the skilled nursing unit in a long-term care facility where my mother-in-law, Laura, resides, all of the residents are in various stages of dementia. Most of them have three or more disabilities. Laura has dementia, total incontinence, dysphagia (swallowing disorder), an amputated leg, and has lost her ability to make transfers from her wheelchair. Because she can not assist in transferring, she needs a special sling to move her to the bed, toilet, or shower. This effort takes two aides and usually occurs five times a day. The aides also change her pads and skirt during toilet breaks as they are treating a pressure ulcer on her hip.

Laura is just one of thirty residents, who all have very different needs. And like Laura, as they age, their physical and mental issues continue to increase.

The staff, however, does not need to increase to meet these greater demands. So if there are four aides on duty for the morning shift and two of them are tending to Laura in the bathroom, and another resident is left for too long in his bathroom, he falls as he tries to get up by himself. Or a resident with severe dementia, left unattended, walks into another resident's room and throws something at that resident. These types of accidents happen all the time and it seems to take a toll on the staff, while increasing safety risks for residents.

Studies have shown that the clinical complexity of residents in long-term care facilities is greatly affecting both practice and staffing capacities. Fortunately my mother-in-law is in a privately funded retirement community that is able to address and resolve staffing issues. Other publicly funded long-term care facilities are not as fortified and the staff and residents all suffer the consequences.