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

Recording of a 90-minute CLE video webinar with Q&A

This program is included with the Strafford CLE Pass. Click for more information.
This program is included with the Strafford All-Access Pass. Click for more information.

Conducted on Thursday, March 23, 2023

Recorded event now available

or call 1-800-926-7926

This CLE course will provide medical malpractice and personal injury attorneys an in-depth analysis of the unique aspects of proving or defending claims that a skilled care or nursing facility has failed to meet nurse staffing standards and has chronic understaffing, negligent hiring, training, and supervision problems. Now that the federal government uses daily payroll reports to document staffing levels instead of self-reporting, the severity of inadequate staffing has been exposed. The program will discuss best practices and strategies for counsel when understaffing is alleged.


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. The program will also discuss the best strategies for defending claims.



  1. Federal and state staffing requirements and patient ratios
    1. Causes of understaffing
    2. 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?


Brusca, Michael
Michael A. Brusca

Davis & Brusca

Mr. Brusca dedicates his practice to representing vulnerable individuals and their families in wrongful death,...  |  Read More

Prieto, Michael
Michael A. Prieto

Prieto Marigliano Holbert & Prieto

Mr. Prieto's litigation work focuses on representing patients and families against assisted living, skilled...  |  Read More

Valentino, Karie
Karie Valentino

Lewis Brisbois Bisgaard & Smith

Ms. Valentino is a member of the firm’s Long-Term Care and Elder Law, Healthcare, and Medical Malpractice...  |  Read More

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