SAN DIEGO -- A quarter of a million Californians will land in a nursing home this year, 10News reported.

But will the nursing home provide the hands-on care you need?

Staffing is the single biggest factor in the quality of nursing home care.

One in eight Americans over age 65 are in nursing homes -- that number will double in 10 years, and some nursing homes already face difficult staffing shortages.

"For one person taking care of 14 to 17 people, (there's) just not a lot of time to take care of their individual needs," said the concerned wife, whose husband is in a nursing home.

10News didn't reveal her name because she fears retaliation.

Adequate staffing is a constant struggle for nursing homes.

The concerned wife took 10News inside her husband's nursing home. 10News found no posted staffing report as now required by state law.

Patient call lights that go unanswered, bathrooms inaccessable to the handicapped, equipment stacked in front of telephones are all signs that there are staffing issues at the nursing home.

"State law requires nursing homes staff their facilities at 3.2 hours of direct patient care per patient per day. It makes a huge difference in the total quality of their care," said Tony Chicotel, with Elder Law and Advocacy -- a watchdog group monitoring staffing levels.

Chicotel said many nursing homes don't meet that standard.

That new staffing law says nursing homes have to post their daily work schedules where anyone can see them, and the homes are to give visitors a copy of the report if they ask.

10News found 10 nursing homes locally with a history of being understaffed, according to the nonprofit California Health Care Foundation.

The numbers are a couple years old, so 10News asked each of the nursing homes to send staffing figures from the last three months.

Two nursing homes -- The Royal Home and Collingwood Manor -- gave 10News work schedules.

Chicotell said he doesn't trust the documents.

Another nursing home -- Grossmont Gardens -- gave 10News a summary that doesn't work either.

Seven of the homes provided detailed information, telling 10News how many licensed care givers were actually working that day. Again, the homes had a history of short-staffing.

Brighton Place East, Cresta Loma, Palomar Heights, Bradley Court and Victorias Special Care now meet the state minimum standard at least 99 percent of the time.

Mission Hills Care Center meets the state minimum 72 percent of the time.

Hillcrest Manor in National City meets state minimum 64 percent of the time.

"In my opinion, it's an unreachable challenge," said Gary Byrnes, with Hillcrest Manor.

Byrnes said it's tough keeping good employees without more money from insurance companies and government reimbursements.

"This is where the rubber meets the road, and we are not getting a lot of help," said Byrnes.

Chicotel agreed and said nursing homes need more qualified employees.

"You need to hire a better quality of people to provide a better quality of care," said the concerned wife.

New federal money is now trickling into California nursing homes -- an extra $6 a day per patient. It's enough for modest raises to keep and hire more nursing staff.

To find the best nursing homes, consumers need to shop referrals and do the sensory test -- the smell, look and feel of a nursing home.

NURSING HOME INFORMATION, RESOURCES:

California Advocates For Nursing Home Reform -- www.canhr.org
California Association Of Health Facilities -- www.cahf.org
California Health Care Foundation -- www.chcf.org

Request nursing home staffing data
Pursuant to Title 42 CFR Section 483.30(e), the public is entitled to access to staffing records for nursing homes. Nursing homes must post their daily staffing data in the facility where it's visible to the public. The public can also make a written or oral request for copies of the staffing records. The staffing information is a public record and nursing homes are required by law to comply with a request. If the nursing home refuses to provide records to the public, they must state their reason in writing.

Title 42 CFR Section 483.30(e)
(e) Nurse staffing information
(1) Data requirements. The facility must post the following information on a daily basis:
(i) Facility name.
(ii) The current date.

(iii) The total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift:

(A) Registered nurses.

(B) Licensed practical nurses or licensed vocational nurses (as defined under State law).

(C) Certified nurse aides.
(iv) Resident census.

(2) Posting requirements. (i) The facility must post the nurse staffing data specified in paragraph (e)(1) of this section on a daily basis at the beginning of each shift.

(ii) Data must be posted as follows:

(A) Clear and readable format.

(B) In a prominent place readily accessible to residents and visitors.

(3) Public access to posted nurse staffing data. The facility must, upon oral or written request, make nurse staffing data available to the public for review at a cost not to exceed the community standard.

(4) Facility data retention requirements. The facility must maintain the posted daily nurse staffing data for a minimum of 18 months, or as required by State law, whichever is greater.

[56 FR 48873, Sept. 26, 1991, as amended at 57 FR 43925, Sept. 23, 1992; 70 FR 62073, Oct. 28, 2005]