Standards of Care Framwork

A Lexcura Summit Reference Guide for Nursing Home Litigation Support

Purpose of This Framework

Nursing home cases hinge on one question: Did the facility meet the accepted standard of care?

This framework distills the essential clinical, regulatory, and operational standards attorneys rely on when evaluating liability, causation, and damages.

It is designed to:

• Provide a clear, litigation-ready structure for case evaluation

• Align clinical expectations with federal and state regulations

• Highlight common breach points that frequently appear in nursing home litigation

• Support attorneys in deposition prep, discovery strategy, and expert review

Download The Standards of Care Framework Checklist

Foundational Standards of Care

1. Federal Regulations (F‑Tags)

These form the backbone of nursing home compliance and are central to establishing breach.

Key domains include:

• Resident Rights & Dignity

• Assessment & Care Planning

• Staffing & Competency

• Quality of Care & Quality of Life

• Infection Control

• Accident Prevention

• Medication Management

Each domain can be expanded into case‑specific standards depending on the allegation.

A medical infographic with a circular chart displaying sections labeled health care, medication, symptoms, lung disease, installations, DNA studies, and others, surrounded by descriptions and icons; partially obscured by a doctor wearing a white coat and stethoscope.

II. Clinical Standards of Care

1. Assessment & Care Planning

Facilities must:

• Conduct timely, accurate assessments

• Identify risks (falls, pressure injuries, malnutrition, dehydration, elopement, behavioral changes)

• Develop individualized care plans

• Update plans with every significant change

Common Breaches:

Failure to reassess, copying and pasting care plans, missing interventions, and a lack of interdisciplinary involvement.

3. Fall Prevention

Standards include:

• Fall risk assessments

• Bed/chair alarms when appropriate

• Environmental safety

• Supervision during transfers

• Proper use of assistive devices

Common Breaches:

Unwitnessed falls, alarm failures, poor supervision, and incorrect transfer technique.

5. Medication Management

Standards include:

• Accurate administration

• Monitoring for side effects

• Avoiding contraindications

• Timely physician notification

Common Breaches:

Medication errors, polypharmacy issues, missed doses, and delayed reporting.

2. Skin Integrity & Pressure Injury Prevention

Standards include:

• Routine skin assessments

• Repositioning schedules

• Moisture management

• Nutrition optimization

• Pressure‑relieving surfaces

Common Breaches:

Late identification, undocumented turning, preventable Stage 3/4 injuries, and inconsistent wound care.

4. Nutrition & Hydration

Standards include:

• Monitoring intake/output

• Weight tracking

• Dietitian involvement

• Dysphagia precautions

• Fluid management

Common Breaches:

Unexplained weight loss, dehydration, aspiration events, and delayed diet changes.

III. Operational Standards of Care

1. Staffing & Supervision

Facilities must maintain:

• Adequate staffing levels

• Competent, trained personnel

• Proper delegation and supervision

Common Breaches:

Understaffing, agency overreliance, untrained aides, and delayed response times

2. Documentation Standards

Documentation must be:

• Accurate

• Timely

• Consistent

• Reflective of actual care

Common Breaches:

Charting gaps, retroactive entries, inconsistencies between disciplines, and missing incident details.

3. Communication & Escalation

Standards include:

• Timely physician notification

• Interdisciplinary communication

• Family updates

• Escalation of changes in condition

Common Breaches:

Failure to notify MD, delayed escalation, and poor handoff communication

IV. Litigation Application

This framework supports:

• Case screening

• Breach analysis

• Causation mapping

• Deposition outlines

• Expert report structure

• Settlement positioning

Attorneys can quickly identify:

• What should have happened

• What actually happened

• Where the breach occurred

• How the breach contributed to harm

Close-up of two people in business attire sitting at a metallic table, one person holding a document and a pen, the other resting hands on the table.

V. Downloadable Tools

Standards of Care Checklist
Breach Analysis Worksheet
Deposition Prep Packet
Care Intake Standards Map

Standards of Care Frameworks Define Clinical Duties, Regulatory Thresholds, and Liability Risk

Determining whether care met the applicable standard is central to healthcare litigation, regulatory investigations, and expert analysis. The Standards of Care Framework synthesizes federal regulations, state requirements, accreditation standards, professional guidelines, and accepted clinical practice into a structured, defensible reference tool. Our clinical-legal team applies this framework across care settings to evaluate deviations, breach allegations, causation theories, and expert opinion foundations.

Submit Records for Standards of Care Review
HIPAA-secure intake • Cross-setting standards analysis • Standard 7-day delivery