A recent report from the Nurses Services Organization and CNA Financial Corp. reveals a troubling 32% increase in malpractice claims against assisted living nurses from 2018 to 2023, with claims frequency rising to 0.71 per 100 beds and average severity reaching $284,000. Common allegations include falls (28%), pressure injuries (17%), and wrongful death (15%). A majority of nurse professional liability claims involved treatment/care allegations (56.2%). The second most frequent category of allegations involved patients’ rights/abuse/professional conduct claims (18.2%). These trends, highlighted in McKnight's Senior Living article on October 2, 2025, underscore systemic vulnerabilities in institutional care settings, where understaffing and complex health needs heighten the risk of neglect and errors. Among the drivers of these claims is "increasing resident acuity," specifically "acuity mismatches."
Acuity and Acuity Mismatch
In healthcare, acuity refers to the severity or complexity of a resident's health needs, encompassing physical, cognitive, and emotional conditions. An acuity mismatch occurs when a resident's care needs exceed the capabilities, resources, or staffing levels of the assisted living facility in which they reside. In the context of the CNA report, acuity mismatches arise when facilities accept or retain residents with complex conditions, such as advanced dementia, severe mobility limitations, or chronic illnesses requiring intensive medical oversight, without adequate staff training, numbers, or infrastructure to provide appropriate care.
A resident with significant cognitive impairment, for example, might require one-on-one supervision to prevent falls or wandering. An understaffed assisted living facility, however, may lack the personnel or specialized training to meet these needs. This mismatch can lead to neglect, errors, or inadequate monitoring, resulting in incidents like falls, pressure injuries, or even wrongful death. These outcomes comprised the vast majority of claims in the study.
How Acuity Mismatches Drive Malpractice Claims
Acuity mismatches contribute significantly to malpractice claims because they create conditions where care failures are more likely:
- Inadequate Staffing: Facilities often operate with low staff-to-resident ratios, unable to meet high-acuity needs. For instance, a resident requiring frequent repositioning to prevent pressure sores may be neglected if staff are stretched thin, leading to costly claims averaging $284,000.
- Lack of Specialized Training: Nurses may lack expertise in managing advanced dementia or complex medical conditions, increasing risks of errors like improper medication administration or failure to recognize warning signs.
- Facility Misalignment: Assisted living communities are designed for residents needing moderate support, not intensive medical care. Unfortunately, care needs change. Accepting or retaining high-acuity residents without transferring them to better-oriented assisted living facilities or skilled nursing facilities can result in injury and claims.
- Regulatory Gaps: While states like Missouri have tightened oversight with 2025 laws mandating better staffing and reporting, enforcement varies, and many facilities struggle to comply. Facilities failing to comply with standards and regulations may leave residents with less capable staff that might be necessary to meet individual and collective needs, heightening malpractice risks.
For readers of the Aging-in-Place Planning and Elder Law Blog, this surge serves as a powerful incentive to prioritize home-based strategies that minimize exposure to such hazards inherent in institutional care. As discussed in our "Rethinking Elder Abuse Strategies: How Prophylactic Planning Can Safeguard Autonomy and Aging in Place," proactive tools such as trusts and powers of attorney can help avoid institutional pitfalls altogether. This article examines the report's findings and offers practical guidance for leveraging aging-in-place planning to mitigate these risks.The CNA Report: Escalating Risks in Assisted LivingThe study, analyzing claims data from its Aging Services program, attributes the rise to chronic staffing shortages, exacerbated by post-pandemic turnover, and to residents with higher care needs, such as those with dementia or mobility issues. Falls remain the top claim, often linked to inadequate supervision, while pressure injuries highlight gaps in routine care. Wrongful death claims, though less frequent, carry the highest severity, resulting in significant payouts due to allegations of negligence. Industry leaders like Argentum note that these trends reflect broader challenges, including regulatory pressures and workforce deficits, which could lead to higher insurance premiums and operational costs for facilities.
For consumers, this means that assisted living, once viewed as a safe middle ground between independent living and nursing homes, now carries growing liabilities and risks. The report recommends enhanced training, improved risk assessment, and technology integration (e.g., fall-detection systems) to curb claims. Still, these fixes don't eliminate the inherent risks and uncertainties of institutional environments.Why the Findings Incentivize Aging-in-Place PlanningThe rising number of malpractice claims is a wake-up call: institutional care, despite regulations, remains prone to human error and systemic flaws that can result in harm and legal battles. These risks are not unique to nursing homes. Aging in place offers a compelling alternative, allowing seniors to control their environment and care, reducing risks like those highlighted in the CNA report. By planning ahead, you can avoid the emotional, physical, psychological, legal, and financial toll of facility-based mishaps, preserving autonomy.
Key incentives from the report:
- Reduced Exposure to Neglect: Home settings minimize risks through targeted modifications like grab bars or smart sensors, unlike understaffed facilities.
- Customized Care: Family or vetted caregivers can provide personalized attention without the acuity mismatches driving claims.
- Financial Savings: Avoiding high-severity incidents cuts potential medical and legal costs, redirecting funds to home supports.
Invest in aging-in-place planning technology, medical devices, and security devices and monitors to secure home caregiving. These steps not only mitigate malpractice risk and dangers but also align with the CNA's call for better preparation in senior care.
While this article has provided a thoughtful examination of the rising malpractice claims in assisted living and their role as an incentive for aging-in-place planning, it is by no means comprehensive. The landscape of care risks evolves rapidly, influenced by staffing trends, regulatory changes, and individual circumstances that no single resource can fully capture. Readers, therefore, must remain vigilant, continuously educating themselves through reliable sources like CNA reports, AARP, local elder law attorneys, and this Blog, while regularly evaluating their personal situations to identify potential risks. By combining awareness with tools such as legal safeguards, caregiver screening, and home modifications, seniors and their families can better safeguard independence and thrive as they age in place. For ongoing support, consult a professional and stay informed. Your security depends on proactive engagement.
