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What Is a Nursing Home Care Plan?
A nursing home care plan is the individualized, written blueprint for how a facility will care for a specific resident every day. It spells out what the resident needs and exactly how staff will meet those needs. Every resident in a Medicare- or Medicaid-certified facility must have a comprehensive care plan in place.
Who Creates the Care Plan?
Care plans are developed by a team that includes physicians, registered nurses, dietitians, therapists, and social workers.
Families have the right to participate in care plan meetings and provide input about their loved one’s preferences and history. Families have the right to review and receive a copy of the care plan upon request
Families have the right to participate in care plan meetings and provide input about their loved one’s preferences and history. Families have the right to review and receive a copy of the care plan upon request
What Must a Care Plan Include?
The care plan must address every identified need of the resident, including:
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Activities of daily living: Bathing, dressing, eating, and toileting assistance-
Medical needs: Wound care, medication schedules, and chronic condition monitoring
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Fall risk precautions: Transfer protocols, assistive devices, and supervision levels
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Dietary requirements: Specialized diets, thickened liquids, and mealtime assistance
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Mobility assistance: Repositioning schedules, physical therapy, and ambulation support
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Federal Law Requires Nursing Homes to Follow Care Plans
The obligation to follow a care plan is not a best practice. It is a legal requirement.
The Nursing Home Reform Act of 1987 (OBRA ’87) and its implementing regulations at 42 CFR Part 483 require every Medicare- and Medicaid-certified nursing home to develop, implement, and regularly update each resident’s care plan.
The Centers for Medicare and Medicaid Services (CMS) oversees compliance. Facilities that fail to meet these standards risk citations, fines, and the loss of their Medicare and Medicaid funding.
When a facility ignores a resident’s care plan, it is violating federal law.
The Nursing Home Reform Act of 1987 (OBRA ’87) and its implementing regulations at 42 CFR Part 483 require every Medicare- and Medicaid-certified nursing home to develop, implement, and regularly update each resident’s care plan.
The Centers for Medicare and Medicaid Services (CMS) oversees compliance. Facilities that fail to meet these standards risk citations, fines, and the loss of their Medicare and Medicaid funding.
When a facility ignores a resident’s care plan, it is violating federal law.
What Happens When a Care Plan Is Ignored?
When staff fail to carry out the instructions in a resident’s care plan, the consequences are often serious and sometimes irreversible.
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Falls and fractures: A care plan may require a gait belt and two-person transfers. When staff skip those precautions, a fall can result in broken bones or head injuries.
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Pressure ulcers (bedsores): A care plan may call for repositioning every two hours. When staff skip those steps, a bedsore can progress to the bone and cause life-threatening infections.
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Malnutrition and dehydration: Dietary protocols and fluid intake schedules exist for a reason. When ignored, residents can lose dangerous amounts of weight in weeks.
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Medication errors: A missed blood thinner can lead to a stroke. An incorrect insulin dose can trigger a diabetic emergency. These are preventable when the plan is followed.
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Infections: Untreated wounds, poor hygiene protocols, and missed care steps create conditions for serious infections including sepsis.
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Wrongful death: In the most tragic cases, sustained care plan neglect contributes to organ failure, untreated infections, or fatal injuries.
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How Failure to Follow a Care Plan Constitutes Negligence
Under Arizona law, a nursing home neglect claim requires proving four legal elements.
Duty of Care
A duty of care is a legal obligation to act with reasonable caution to prevent harm. By admitting a resident and accepting payment, the facility takes on the responsibility to meet that resident’s documented needs. The care plan itself defines the scope of that duty.
Breach of Duty
A breach of duty occurs when the nursing home fails to meet the standard of care it was obligated to provide. If the care plan requires turning a resident every two hours and nursing notes show gaps of eight or ten hours, that is a breach.
Causation
Causation means showing that the facility’s failure actually caused the injury. Lawyers call this “proximate cause,” which simply means the injury would not have happened if the nursing home had done what it was supposed to do.
Damages
Damages are the actual harms suffered as a result of the negligence. These can include physical pain and suffering, additional medical costs, emotional distress, and, in wrongful death cases, losses sustained by surviving family. Arizona law allows families to seek both economic damages (medical bills) and non-economic damages (pain, loss of quality of life).
Your Loved One’s Rights Under Arizona and Federal Law
The federal Residents’ Bill of Rights, codified at 42 CFR § 483.10, provides enforceable legal protections for every nursing home resident, including:
The right to participate – in developing their own care plan
The right to access – their medical records and care documents
The right to be free – from neglect, mistreatment, and abuse
The Arizona Department of Health Services licenses and inspects nursing homes and can take enforcement action against facilities that fail to meet care standards.
The Care Plan as Legal Evidence
In a nursing home neglect case, the care plan is not just background information. It is the legal measuring stick.
The care plan defines what the nursing home agreed to do for your specific family member. It sets the standard of care for that resident in that facility.
Attorneys use the care plan alongside nursing notes, incident reports, staffing records, and medical records to show the gap between what was documented and what was actually done.
The care plan defines what the nursing home agreed to do for your specific family member. It sets the standard of care for that resident in that facility.
Attorneys use the care plan alongside nursing notes, incident reports, staffing records, and medical records to show the gap between what was documented and what was actually done.
What Legal Guidance Exists About Failure to Follow Care Plans?
Care plans are one of the central tools nursing homes are required to use to identify a resident’s needs and provide appropriate care. Federal nursing home regulations require facilities to assess each resident, create a person-centered care plan, implement the services and interventions in that plan, and revise the plan when the resident’s condition, risks, or needs change.
The following CMS F-tags represent the most common regulatory standards surveyors use when investigating whether a nursing home properly assessed a resident, created an appropriate care plan, followed the plan, updated the plan, and documented the care provided.
The following CMS F-tags represent the most common regulatory standards surveyors use when investigating whether a nursing home properly assessed a resident, created an appropriate care plan, followed the plan, updated the plan, and documented the care provided.
F656: Comprehensive Care Plan
F656 requires a nursing home to develop and implement a comprehensive, person-centered care plan for each resident. In a failure-to-follow-care-plans case, this is usually the primary F-tag because it focuses on whether the facility created a meaningful plan and actually implemented the services and interventions identified in the resident’s assessment.
F656
42 CFR §483.21(b) Comprehensive Care Plans
42 CFR §483.21(b)(1)
The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at §483.10(c)(2) and §483.10(c)(3), that includes measurable objectives and timeframes to meet a resident’s medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan must describe the following:
(i) The services that are to be furnished to attain or maintain the resident’s highest practicable physical, mental, and psychosocial well-being as required under §483.24, §483.25, or §483.40; and
(ii) Any services that would otherwise be required under §483.24, §483.25, or §483.40 but are not provided due to the resident’s exercise of rights under §483.10, including the right to refuse treatment under §483.10(c)(6).
F657: Care Plan Revision
F657 applies when a facility fails to review or revise a resident’s care plan after assessments, quarterly reviews, significant changes, new risks, injuries, declines, or failed interventions. This tag is important when the issue is not just that a care plan existed, but that it was outdated, ignored, or not changed after the resident’s needs changed.
F657
42 CFR §483.21(b) Comprehensive Care Plans
42 CFR §483.21(b)(2)(iii)
A comprehensive care plan must be—
(iii) Reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments.
F655: Baseline Care Plan
F655 applies to the initial care plan that must be developed and implemented shortly after admission. This tag may apply when the facility failed to create an immediate care plan for known risks such as medications, fall risk, wandering, elopement, pressure sores, dietary needs, physician orders, therapy, or other care needs.
F655
42 CFR §483.21(a) Baseline Care Plans
42 CFR §483.21(a)(1)
The facility must develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care. The baseline care plan must—
(i) Be developed within 48 hours of a resident’s admission.
(ii) Include the minimum healthcare information necessary to properly care for a resident including, but not limited to:
(A) Initial goals based on admission orders.
(B) Physician orders.
(C) Dietary orders.
(D) Therapy services.
(E) Social services.
(F) PASARR recommendation, if applicable.
F658: Services Meet Professional Standards
F658 applies when the care provided under a resident’s plan does not meet professional standards of quality. In a care plan case, this tag may be relevant when staff failed to follow accepted nursing, medical, therapy, wound care, fall prevention, medication, or documentation standards.
F658
42 CFR §483.21(b)(3) Comprehensive Care Plans
The services provided or arranged by the facility, as outlined by the comprehensive care plan, must—
(i) Meet professional standards of quality.
F659: Qualified Persons
F659 applies when services required by the resident’s written care plan are not provided by qualified people. This may be relevant when unqualified, untrained, or inappropriate staff were responsible for care-plan interventions.
F659
42 CFR §483.21(b)(3) Comprehensive Care Plans
The services provided or arranged by the facility, as outlined by the comprehensive care plan, must—
(ii) Be provided by qualified persons in accordance with each resident’s written plan of care.
F636: Comprehensive Assessments
F636 applies when the facility fails to conduct an accurate and complete assessment of the resident’s needs, strengths, risks, goals, history, and preferences. In a care-plan case, this tag matters because a care plan is only as good as the assessment it is based on.
F636
42 CFR §483.20 Resident Assessment
42 CFR §483.20(b) Comprehensive Assessments
The facility must conduct initially and periodically a comprehensive, accurate, standardized, reproducible assessment of each resident’s functional capacity.
A facility must make a comprehensive assessment of a resident’s needs, strengths, goals, life history and preferences, using the resident assessment instrument specified by CMS. The assessment must include at least the following:
Cognitive patterns; communication; mood and behavior patterns; psychosocial well-being; physical functioning and structural problems; continence; disease diagnoses and health conditions; dental and nutritional status; skin condition; activity pursuit; medications; special treatments and procedures; and discharge planning.
The assessment process must include direct observation and communication with the resident, as well as communication with licensed and nonlicensed direct care staff members on all shifts.
F684: Quality of Care
F684 is a broad quality-of-care tag that applies when a resident does not receive care and treatment consistent with professional standards, the comprehensive care plan, or the resident’s choices. In a failure-to-follow-care-plans case, it can help connect the plan failure to the broader requirement that the resident receive appropriate care.
F684
42 CFR §483.25 Quality of Care
Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident’s choices, including but not limited to the following.
F842: Medical Records
F842 applies when the resident’s medical record is incomplete, inaccurate, inaccessible, disorganized, or missing required information. In a care plan case, this can matter when the chart does not accurately show assessments, care plans, services provided, physician notes, nursing notes, treatments, or changes in condition.
F842
42 CFR §483.70(h) Medical Records
(1) In accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are—
(i) Complete;
(ii) Accurately documented;
(iii) Readily accessible; and
(iv) Systematically organized.
(5) The medical record must contain—
(i) Sufficient information to identify the resident;
(ii) A record of the resident’s assessments;
(iii) The comprehensive plan of care and services provided;
(iv) The results of any preadmission screening and resident review evaluations and determinations conducted by the State;
(v) Physician’s, nurse’s, and other licensed professional’s progress notes; and
(vi) Laboratory, radiology and other diagnostic services reports as required under §483.50.
What to Do If You Suspect a Care Plan Was Not Followed
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- Document everything. Write down dates, times, and details of concerning conditions, conversations with staff, and changes in your loved one’s health. Your notes can become important evidence.
- Request the care plan and nursing notes. Put your request in writing – a dated letter or email – so there is a record of when you asked.
- Photograph visible injuries or conditions. Date-stamped photos of bruises, bedsores, weight loss, or unsanitary conditions provide objective evidence that is difficult to dispute.
- Contact law enforcement. If the failure to follow the care plan has resulted in serious injury.
- Speak with a nursing home neglect attorney. An experienced attorney can review the care plan and medical records, assess whether the facility breached its duty, and advise you on your claim.
Frequently Asked Questions About Failures to Follow Care
What is a nursing home care plan and is the facility legally required to follow it?
A nursing home care plan is a written, individualized document that outlines the specific care a resident needs and how staff will provide it. It covers medical treatment, assistance with daily activities, dietary needs, fall prevention, and more. Under the Nursing Home Reform Act of 1987 and federal regulations at 42 CFR Part 483, every Medicare- and Medicaid-certified nursing home is legally required to develop, implement, and update a comprehensive care plan for each resident. Failure to follow the care plan is not just poor practice. It is a violation of federal law and can form the basis of a negligence claim in Arizona.
What are the most common injuries caused by nursing home care plan violations?
When a nursing home ignores a resident’s care plan, the most common injuries include falls resulting in broken bones or head trauma, pressure ulcers (bedsores) from failure to reposition the resident, malnutrition and dehydration from missed meals or inadequate fluid intake, and medication errors from failing to follow prescribed schedules. Infections, rapid weight loss, and emotional withdrawal are also common warning signs. In severe cases, sustained neglect contributes to wrongful death. Each of these outcomes is often preventable when the care plan is properly followed by trained staff.
How do I know if a nursing home ignored my loved one’s care plan?
Warning signs include unexplained injuries such as bruises, cuts, or fractures; new or worsening bedsores; sudden weight loss; frequent infections; poor hygiene; and changes in mood or behavior like increased agitation or withdrawal. You have the right to request a copy of the care plan and compare it against what you observe during visits. If the plan requires specific interventions and you see no evidence those are happening, that is cause for concern. An attorney experienced in nursing home neglect can review the plan and medical records to identify specific failures.
Can I request a copy of my loved one’s care plan from the nursing home?
Yes. Under the federal Residents’ Bill of Rights at 42 CFR § 483.10, residents and their legal representatives have the right to access all care records, including the comprehensive care plan. Make your request in writing and keep a copy for your records. The facility is required to provide the documents within a reasonable time. Having a copy of the care plan is an important step in evaluating whether the facility met its obligations.
What is the statute of limitations for filing a nursing home neglect claim in Arizona?
In Arizona, the statute of limitations for personal injury claims, including nursing home neglect, is generally two years from the date the injury was discovered or reasonably should have been discovered, under A.R.S. § 12-542. If the deadline passes without a claim being filed, the court will almost certainly dismiss the case regardless of its merits. Because nursing home neglect can involve injuries that develop gradually, determining when the clock starts can be complex. Consult with an attorney as soon as you suspect neglect so your family does not lose the right to seek compensation.
How does Solomon & Relihan handle nursing home neglect cases — and what does it cost?
Solomon & Relihan represents families of nursing home residents harmed by neglect or abuse. The firm begins every case with a free, confidential case review to understand what happened and assess legal options. If the firm takes your case, it is handled on a contingency fee basis, meaning you pay no attorney fees unless the firm recovers compensation on your behalf. There are no upfront costs and no out-of-pocket expenses. The firm’s attorneys investigate the facility’s records, consult medical experts, and pursue accountability through negotiation or litigation as the case requires.
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