When we think about workplace safety issues, it’s easy to default to a mental image of construction workers or firefighters. Those jobs have very visible risks thanks to big machinery and precarious working conditions. However, caretakers at nursing homes face serious workplace risks as well. This is due largely to employers’ and owners’ failures to adequately staff these facilities.

In a recent New Jersey incident , a nursing home caretaker suffered a dislocated shoulder after trying to move a wheelchair-bound patient by herself, because no one else was available to help. Recent studies have found that three-fourths of nursing homes seldom complied with staffing requirements put forth by the Centers for Medicare and Medicaid Services (CMS). Instead, nursing facilities tended to inflate staffing numbers reported to the government and pass the profits along to their owners.

This is a problem according to experts. “Staffing is one of the most important measures of nursing home quality, and it accounts for about two-thirds of a facility’s spending on average,” notes David Grabowski, healthcare policy professor at Harvard Medical School. A poor nurse-to-resident ratio means staff are overworked and residents are inadequately cared for. Nurses at all levels are more likely to suffer from stress which increases the risk of patient abuse or neglect. This, in turn, can cause psychological problems, illnesses, and even result in death among residents. For residents, as many as 24% experience at least one instance of physical abuse while in a nursing home.

New Jersey is one of 8 states that require nursing homes to report their staffing ratios. This effort towards transparency, which started in 2008, has benefited nursing home working conditions. However, according to the Centers for Medicare and Medicaid Services, a quarter of New Jersey’s nursing homes rated “below average” or “much below average” after a series of poor inspection results.

When researching nursing homes for loved ones, staffing should be the top factor to consider. Reviewing the CMS reports online is a good place to start, but in person visits at night and on weekends can also be helpful.