Home Health Breach Analysis Worksheet
A structured tool for identifying deviations from home‑health standards of care, linking failures to harm, and organizing breach arguments with clarity and precision.
Home‑health cases require careful evaluation of assessments, visit frequency, medication safety, communication, and escalation. This worksheet guides attorneys through the critical steps of comparing what should have occurred to what actually occurred, identifying deviations, and determining whether those deviations contributed to preventable harm.
Use this worksheet during case screening, expert review preparation, deposition planning, and timeline reconstruction.
PATIENT & CASE OVERVIEW
Patient Information
• Name
• Age
• Primary diagnosis
• Home‑health admission date
• Setting (private home, ALF, family home)
• Baseline functional status
• Baseline cognitive status
Key Dates
• Admission
• Symptom escalation events
• Missed or shortened visits
• Medication changes
• Falls or injuries
• Hospitalizations
• Discharge
EXPECTED STANDARD OF CARE
Identify Applicable Standards
• Home‑health Conditions of Participation
• Agency policies
• Physician orders
• Plan of care (POC) requirements
• Medication safety standards
• Visit frequency requirements
• Communication and escalation protocols
Document What Should Have Happened
• Required assessments
• Required visit frequency
• Medication reconciliation
• Safety evaluations
• Communication with physician
• Escalation steps
• Documentation expectations
ACTUAL CARE PROVIDED
Document What Actually Happened
• Nursing visits completed
• Missed or shortened visits
• Symptom assessments
• Medication administration
• Wound care
• Therapy involvement
• Family/caregiver communication
• Physician communication
• Documentation entries
Identify Gaps or Inconsistencies
• Missing assessments
• No vitals documented
• Contradictory notes
• Late entries
• No documentation of caregiver education
• No documentation of physician notification
IDENTIFIED DEVIATIONS (BREACH POINTS)
List Each Deviation Clearly
• Missed or inadequate visits
• Abnormal vitals not addressed
• Medication errors
• No medication reconciliation
• Poor communication with physician
• Failure to escalate
• Unsafe home environment not addressed
• Inadequate monitoring
• Documentation failures
• Caregiver not educated
• Failure to follow the plan of care
For Each Deviation, Answer:
• What should have occurred?
• What actually occurred?
• Why is this a breach?
• What evidence supports this?
• What was the expected outcome if handled correctly?
CAUSATION LINK
Did the deviation contribute to harm or deterioration?
• Yes / No / Possibly / Unclear
Describe the Connection
• How the breach increased risk
• How the breach delayed intervention
• How earlier action could have changed the outcome
• Whether harm was foreseeable
Supporting Evidence
• Nursing notes
• Medication logs
• Family statements
• Physician communication
• Timeline reconstruction
TIMELINE RECONSTRUCTION (OPTIONAL BUT HIGH‑VALUE)
Build a Clear Sequence of Events
• Admission
• Missed visits
• Symptom escalation
• Medication changes
• Communication attempts
• Falls or injuries
• Hospitalization
• Discharge
Identify Delays
• Delayed recognition of deterioration
• Delayed provider notification
• Delayed medication adjustments
• Delayed escalation to 911
• Missed or shortened visits
COMMON HOME‑HEALTH BREACH INDICATORS
• Missed or inadequate visits
• Abnormal vitals not addressed
• Medication errors
• Poor communication with physicians
• Failure to escalate
• Unsafe home environment not addressed
• Documentation gaps or contradictions
• No caregiver education
• Failure to follow the plan of care
• No reassessment after interventions
These are the most frequent breach themes in home‑health litigation.