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
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.
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
V. Downloadable Tools
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