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Avoidable vs. Unavoidable Pressure Ulcers: A Summary of the Federal Regulations
Two Congressional acts ' the Omnibus Budget Reconciliation Act of 1987 and the Balanced Budget Act of 1997 ' resulted in the promulgation of regulations that have had a significant impact on nursing home practices. Some commentators have concluded that these regulations have essentially created the standard of care in nursing home negligence cases. David R. Thomas, MD, The New F-tag 314: Prevention and Management of Pressure Ulcers, Journal of the American Medical Directors Association (JAMDA), 523-531 (2006).
In addition to the federal regulations adopted pursuant to these acts, Appendix PP of the Long Term Care Survey published by the American Health Care Association (AHCA) contains interpretive guidelines of nursing home regulations issued by the Center for Medicare and Medicaid Services (CMS). These guidelines, commonly referred to as “F-tags,” are used by the government, long term care facilities and colleges and universities for training purposes. Long Term Care Survey, AHCA, “About This Manual,” (2012). F-tags provide further information about accepted standards of care applicable to nursing homes.
And the Centers for Medicare and Medicaid Services requires nursing homes to prevent avoidable pressure sores. According to 42 CFR 483.25(c)(1), after a comprehensive assessment, a nursing home must ensure that “a resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable.” Id.
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