NEW BEDFORD — It felt like someone was hammering an ice pick into Lynette Couture’s leg.
The 55-year-old was recovering in Plymouth Harborside Healthcare’s rehab unit last fall after a horrific car crash shattered her left leg. Doctors had drilled a metal device into her bones to reconnect them.
Couture asked staff for pain medicine three times between 9:40 and 10:40 one night in September, according to a journal where she meticulously logged her care. Her call light was still on as the clock ticked past 11:20, 11:35, 12:00, 12:10.
Still suffering from the stabbing pain, with no nurse in sight, Couture called the nursing station from her cell phone twice. But no one answered. A non-medical staffer pulling a double shift finally got a nurse to dispense the medicine at 12:15 a.m. — more than 2½ hours after she started asking for it.
“The angrier I got, the more I cried,” Couture recalled in an interview with The Light. “I made it known to everyone that walked past my room: it was excruciating.”
Couture says Plymouth Harborside was short-staffed. She was right. Like half of Massachusetts’ 341 nursing homes, it failed to meet state staffing requirements last summer.
Five years ago, state health officials set minimum staffing levels to help improve care for nursing home residents. But staffing levels in Massachusetts nursing homes are, in some ways, worse now, a New Bedford Light analysis of federal data has found.
When there isn’t enough staff, care deteriorates, experts and advocates say. Frail residents can fall when they try to get out of bed without help. They can get sick with infections from sitting in soiled diapers. Their skin can deteriorate into open wounds — bedsores — when they aren’t repositioned often enough.
The Light’s monthslong investigation uncovered:
• Half of the state’s nursing homes failed to meet one or both of the state’s minimum staffing standards at the end of last year.
• Most for-profit facilities were out of compliance with staffing standards at the end of last year. Most nonprofit facilities were in compliance.
• The state’s penalties aren’t strong enough to deter profit-seeking nursing home owners from failing to provide enough staffing, resident advocates say.
• State officials recently reduced penalties for dozens of understaffed nursing homes at the request of an industry trade group.
• The state’s minimum staffing standard for registered nurses isn’t enforced at all.
• State health inspectors have only issued a few dozen health violations for inadequate staffing since 2024, even though 251 nursing homes have dipped below the state minimums in that time.
Critics of the nursing home industry say understaffing maximizes profits. The numbers are a sign that some companies are understaffing on purpose, the critics add.
State prosecutors have targeted the owner of Plymouth Harborside for just that. The nursing home is part of the Next Step Healthcare chain, which reached a $4 million settlement with the Massachusetts attorney general in 2024 to resolve allegations that it hurt residents by deliberately cutting staff. The chain was “systemically noncompliant” with state staffing standards, prosecutors said.
Next Step did not respond to requests for comment for this story.
The Attorney General reached a similar settlement worth $2.75 million with Bear Mountain Healthcare this year to resolve allegations that residents of the chain were neglected because of chronic understaffing.
Another facility in the Next Step chain, Fall River Healthcare, spent more than a year on a federal list of the “worst of the worst” nursing homes in the country, The Light previously reported. Most of Next Step’s facilities, including Plymouth Harborside, were placed in a receivership in January, after a group of landlord companies took the chain to court over millions of dollars in unpaid rent.
“It’s amazing how indifferent state and federal regulators are to the well-being of nursing home residents,” said Sam Brooks, director of public policy for the National Consumer Voice for Quality Long-Term Care. “You see over and over the horrific outcomes that come from understaffing, and yet the regulators do nothing.”
What it’s like to live in an understaffed nursing home
Couture described a bleak experience during her seven weeks at Plymouth Harborside.
Her roommate’s mattress was breaking down from built-up urine, trash sat on the floor of the hallway for days, the facility constantly smelled like feces, and her bathroom was caked in filth and human excrement that stuck to her socks, she said.
Her wound dressings weren’t changed every day, according to her journal, even though her doctor said they should have been changed twice a day. She was reeling from the emotional trauma of her car accident. She asked for mental health support, she said, but no counselor ever came.
“There were some nurse’s aides that were helpful,” Couture said. “But they were few and far in between.”
When she was admitted as a patient there in September, Plymouth Harborside had nursing staff levels in the bottom 7% of Massachusetts nursing homes, The Light’s data analysis found.
“That nursing home was the worst experience of my life,” she said.
Staffing regulations widely flouted
In 2020, as COVID-19 ripped through Massachusetts nursing homes, then-Gov. Charlie Baker announced a package of reforms designed to support facilities and hold them accountable. It included a plan to establish staffing minimums, which went into full effect in April 2021.
The new state regulations based staffing requirements on the number of residents and the hours worked by nursing staff providing direct care. That ratio is called Hours Per Patient Day, or HPPD.
There are two required ratios in the regulations. Massachusetts nursing homes must provide at least 3.58 HPPD with a combination of nurses and nurse aides. Registered nurses, who have the most education and responsibility for patient care, must provide at least 0.508 HPPD of that total.
For example, a facility with 100 residents must provide at least 358 hours of nursing care in a day. That works out to about 45 nursing staff working eight-hour shifts. At least seven of those 45 staffers must be registered nurses.
The Light’s analysis found widespread noncompliance with these standards.
At the end of last year, half of the state’s nursing homes were out of compliance with one or both of the state’s staffing standards. Some didn’t have enough overall nursing staff. Others didn’t have enough registered nurses. Some were understaffed according to both measures.
Total staffing compliance improves
Massachusetts has focused its enforcement efforts on getting nursing homes to improve their overall nursing staff levels. How is it doing?
At the end of 2025, one-third of Massachusetts nursing homes in the state were below the overall nursing staff minimum — the state’s primary staffing standard.
That level of compliance is actually an improvement from recent years. About half of nursing homes were out of total staffing compliance during parts of 2021 and 2022.
MassHealth, the state’s Medicaid program, has collected $58 million in penalties over five years — an average of $11.6 million a year — from nursing homes for not meeting the overall staffing minimum, according to Stacey Nee, a spokesperson for the agency.
That amounts to just 0.5% of the $2.3 billion in revenue that Massachusetts nursing homes received from MassHealth in 2024, according to figures provided by the Center for Health Information and Analysis.
In an email to The Light, Nee said “statewide compliance has improved significantly” in recent years because of the penalties. An improved labor market and more state funding have also helped, she said.
Nee provided statistics from past years that showed even more noncompliance than The Light found in 2025 data. From 2021 to 2024, Nee said, 53% to 74% of nursing homes failed to meet overall staffing minimums.
Advocates for nursing home residents say the current level of noncompliance is still unacceptable. They say the penalties for understaffing are still too low, and nursing home owners see them as the cost of doing business.