LTC Risk Identification Guide
A quick‑reference guide to the most common risk areas in long‑term care and the standards required to prevent harm.
LTC Risk Identification Guide
This guide outlines major clinical risks commonly implicated in long-term care litigation and the baseline interventions expected to mitigate them. Use it to identify breach indicators, evaluate facility compliance, and strengthen case theory by linking risk recognition → intervention selection → monitoring → documentation.
Practical use cases: early intake screening, breach triage, deposition planning, and timeline reconstruction (especially the first 72 hours and post-change-in-condition windows).
Fall Risk
Risk → Prevention → Monitoring
✔ Required Assessments
Admission: Documented fall risk assessment upon entry (baseline mobility, cognition, orthostatics, prior falls).
Reassessment: After any change in condition (sedation, illness, new meds, dizziness, weakness).
✔ Required Interventions
Bed/chair alarms (when clinically indicated) with documented response expectations.
Non-skid footwear + appropriate assist devices (walker, wheelchair safety, transfer belt).
Supervision / assist level consistent with care plan (toileting, transfers, ambulation).
Environmental safety checks (lighting, clutter, call light access, bed height, floor hazards).
Litigation linkage: Fall cases often turn on whether the risk was identified, whether the care plan matched the risk, and whether staff followed the assist level in real time (especially toileting rounds and shift transitions).
Red Flags
DocumentationNo documented fall risk assessment or missing reassessments after status changes.
Intervention FailureAlarms ordered but not used, not functioning, or alarms documented without response.
Event PatternUnwitnessed falls, repeated falls, or inconsistent narratives between CNA notes and nursing notes.
Pressure Injury Risk
Risk → Repositioning → Skin Integrity
✔ Required Assessments
Braden Scale: Completed on admission and repeated per policy and after changes in mobility/health.
Routine Skin Checks: Each shift, with focused checks for bony prominences and device-related pressure.
✔ Required Interventions
Repositioning plan with frequency documented and executed (including night shifts).
Pressure-relieving surfaces (mattress, cushions) based on risk and skin condition.
Moisture management (incontinence care, barrier protection, prompt brief changes).
Nutrition support (dietary evaluation, protein/calorie plan, supplements when indicated).
Litigation linkage: Pressure injury claims commonly hinge on “predictability.” Once risk is documented, non-execution of the turning plan and gaps in skin documentation become breach accelerators.
Red Flags
Clinical DeteriorationNew or worsening pressure injuries without clear escalation, staging, or wound protocol initiation.
Execution GapMissing repositioning documentation, identical copy-paste charting, or long intervals without skin checks.
Infection Risk
Early Recognition → Escalation → Stabilization
✔ Required Monitoring
Vitals trends (temp, HR, RR, BP, O2) and mental status changes.
Urinary symptoms (dysuria, frequency, retention, new incontinence) and hydration status.
Respiratory changes (cough, O2 drop, increased work of breathing).
Skin integrity and wound changes (odor, drainage, erythema, warmth, swelling).
✔ Required Interventions
Escalation: Early physician/NP notification when triggers appear.
Workup: Lab testing per symptoms (UA/culture, CBC, imaging orders as appropriate).
Support: Hydration and close reassessment; higher-level care transfer if instability emerges.
Litigation linkage: Infection cases often become sepsis cases. The pivotal question is whether early indicators were recognized and acted upon—particularly when symptoms are subtle (confusion, lethargy, appetite decline).
Red Flags
Delayed RecognitionSymptoms documented repeatedly without escalation, labs, or provider notification.
Sepsis Pathway MissedSepsis indicators (trend deterioration, hypotension, tachycardia, AMS) not identified or treated as urgent.
Dehydration & Malnutrition Risk
Intake → Trends → Intervention
✔ Required Monitoring
Intake/output tracking when indicated (especially poor PO intake, diuretics, illness).
Weight trends (baseline and scheduled re-weights; monitor abrupt loss).
Hydration status indicators (dry mucous membranes, labs if ordered, lethargy, dizziness).
✔ Required Interventions
Fluid encouragement protocols (assisted hydration rounds; preferred fluids).
Dietitian involvement for low intake or weight loss; meal plan modifications.
Supplements ordered and documented as provided (with tolerance/acceptance recorded).
Litigation linkage: The breach story often sits in the “trend line.” Early documentation of poor intake without escalation, re-weighing, or dietitian involvement can establish foreseeability.
Red Flags
Trend FailureWeight loss without intervention steps, re-weigh confirmation, or plan change.
Non-ResponsePoor intake noted repeatedly with no escalation or documented corrective actions.
Medication Risk
Reconciliation → Administration → Adverse Effects
✔ Required Monitoring
Side effects and sedation monitoring, especially after new orders or dose changes.
Missed doses tracking with follow-up actions (reason documented + escalation when needed).
High-risk medications review (anticoagulants, opioids, insulin, antipsychotics, benzodiazepines).
Additional detail: Medication risk frequently overlaps with fall risk and change-in-condition recognition. New sedation, hypotension, hypoglycemia, or confusion should trigger reassessment and care plan adjustment.
Red Flags
Error PatternMedication errors, omissions, late administration, or inconsistent MAR vs nursing documentation.
Escalation FailureAdverse effects documented without timely physician notification or medication adjustment.
Long-Term Care Risk Identification Exposes Early Warning Signs and Regulatory Exposure
Long-term care liability often develops over time through missed warning signs, inadequate assessments, delayed interventions, and failures in monitoring or escalation. The LTC Risk Identification Guide evaluates resident assessments, care plans, staffing patterns, incident history, and documentation against federal nursing facility requirements, state regulations, and accepted standards of long-term care practice. Our clinical-legal team identifies emerging risk patterns, systemic vulnerabilities, and compliance gaps that inform early case valuation, regulatory review, and litigation strategy.
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