Understanding Standard of Care in Long-Term Care Facilities: What Attorneys Need to Know

When litigation arises involving nursing homes or other long-term care facilities, one phrase appears in nearly every complaint and deposition: standard of care. But what does it really mean and how is it determined? As an expert witness specializing in long-term care cases, I have seen firsthand how misunderstandings about standard of care can make or break a case. Let’s break it down.

What Is the Standard of Care?

In the simplest terms, the standard of care is what a reasonably prudent provider would do under the same or similar circumstances. In long-term care, it is shaped by:

• Federal and State Regulations: For example, CMS Requirements of Participation, state health codes, and licensing requirements.

• Facility Policies and Procedures: Internal policies should reflect regulatory standards, but they don’t always.

• Industry Best Practices: Standards published by professional organizations and recognized guidelines.

It’s not about guaranteeing perfect outcomes; rather, it’s about providing care that meets accepted professional standards for residents’ individual needs.

Common Misunderstandings

One of the biggest misconceptions is that the standard of care is a fixed rulebook. It is flexible and depends on many variables, such as a resident’s condition, acuity levels, and care plan. Standard of Care does not equal perfection. Another misunderstanding: simply having policies in place doesn’t mean they were followed in practice. Attorneys often rely too heavily on documented policies without comparing them to actual care delivery, a key step in proving or defending a breach. Finally, it’s important to remember that gaps in documentation don’t always equal substandard care.  However, they do create openings for allegations.

Factors That Influence Standard of Care

Each resident’s care is highly individualized. Factors that shape what’s reasonable and appropriate include:

• Resident Acuity: A resident with advanced dementia or high fall risk requires more interventions than an independent resident.

• Staffing and Competency: Were there enough qualified staff available? Did they have appropriate training?

• Special Circumstances: During the COVID-19 pandemic, for example, regulatory waivers and infection control guidance evolved rapidly.

Understanding these nuances is vital when evaluating whether care met the standard.

Why It Matters in Litigation

Allegations of negligence, malpractice, or wrongful death in a long-term care or post-acute care setting hinge on whether the facility or staff breached the standard of care, and whether that breach caused harm. Expert testimony is usually required to establish what the standard was, if it was breached, and what should or could have been done differently. This often comes down to a detailed and exhaustive comparison of records, policies, and actions.

How an Expert Witness Evaluates Standard of Care

When I’m retained on a case, my process typically includes:- Comprehensive Case Records Review: including medical records, staff notes, care plans, incident reports.- Policy and Regulatory Comparison: verifying if the actions were consistent with facility policies and compliant with state and federal requirements?- Pattern Analysis: One missed documentation may not prove a breach, however multiple missed documentation and/or patterns of neglect or systemic issues do support breaches. I look for evidence that care was reasonable under the circumstances, or whether lapses fell below acceptable standards.

Closing Thoughts

In nursing home and long-term care cases, standard of care is rarely black and white. A thorough, objective review can reveal whether care was truly deficient or whether it falls within acceptable limits. If you’re handling a case involving long-term care for either plaintiffs or defendants, I encourage you to consult an expert witness early. Understanding these nuances upfront can save you time, strengthen your case, and help achieve a fair outcome.

Ready to discuss a case? Feel free to contact me at (516) 655-2134 or www.stevensmythexpertconsulting.com . I’m here to help you navigate these complex matters with confidence.