Nursing Home Injuries: Proving Negligent, Reckless, or Intentional Understaffing and Inadequate Training and Supervision

Federal law requires skilled nursing facilities to hire trained staff to attain and maintain "the highest practicable, physical, mental and psychosocial well-being of each resident as determined by resident assessments and individual plans of care." 42 CFR 483.35. When litigation ensues from a resident's injury, claims assert that most nursing homes and skilled care facilities dangerously understaff and inadequately train and supervise employees.

Proving understaffing, high turnover, or inadequately trained employees presents unique challenges entirely different than proving or defending traditional medical malpractice. The plaintiffs must anticipate the "rogue-employee" defense, and defendants must stand firm if the injury is an isolated incident.

These cases require more discovery than medical malpractice cases and a thorough understanding of relevant federal regulations and exceptions. Counsel should expect numerous evidentiary battles over the admissibility of violations of regulations, internal policies and procedures, and other incidents at the subject facility and others managed or owned by the same entities.

Listen as our experienced panel discusses how to investigate understaffing cases, identify all applicable defendants, and discover factual staffing levels, as well as handle the admissibility of regulations and internal policies and procedures.

1. Federal and state staffing requirements and patient ratios
   1. 2024 CMS final rule on staffing requirements
   2. Causes of understaffing
   3. Exceptions to staffing requirements
2. Investigating and documenting staffing, training, and turnover
   1. Daily payroll records
   2. Use of hidden cameras
3. Identifying all proper defendants
4. Role of nursing home administration experts
5. Admissibility issues
   1. Federal and state regulations
   2. Internal policies and procedures
   3. Best practices for resolving pre-trial motions
6. Damages

The panel will review these and other key issues:

• What makes understaffing cases unique?
• Are there exceptions to staffing regulations?
• Are there any types of state or federal immunity statutes that impact liability?
• What types of claims and defenses are most likely to succeed?
• Who are the right experts and what are their proper roles?