CMS pressure ulcer guidelines for nursing homes, outlined under F686, establish the federal standard of care for preventing and treating pressure ulcers in long-term care settings. These guidelines are part of the Centers for Medicare & Medicaid Services’ (CMS) mission to ensure that nursing homes provide safe, quality care.
When correctly followed, F686 helps protect residents from developing avoidable pressure injuries and supports healing where damage has already occurred. For families, understanding these regulations is essential. If a facility fails to meet these requirements, it may be liable for neglect.
F686 is a federal regulation found in 42 CFR §483.25(b), part of the Centers for Medicare & Medicaid Services (CMS) State Operations Manual.
It mandates that nursing homes ensure residents do not develop pressure ulcers unless clinically unavoidable. If a resident develops an ulcer, the facility must provide necessary care to promote healing, prevent infection, and prevent new ulcers.
These rules are based on professional standards and the resident’s clinical condition. F686 is a key benchmark when evaluating a nursing home’s commitment to quality care. Non-compliance risks resident health and can trigger citations, fines, and legal consequences for the facility.
Pressure injuries remain a serious concern in nursing homes, especially among residents with limited mobility. These wounds—called decubitus ulcers—range in severity from a persistent red area on intact skin to deep, infected wounds exposing underlying soft tissue or subcutaneous fat.
The risk factors include prolonged immobility, poor nutrition, and chronic conditions. In advanced stages, pressure ulcers can lead to sepsis, amputations, and even death. Detection can be more difficult for residents with darkly pigmented skin, as early signs may appear as purple hues rather than redness.
Under the CMS pressure injury guidelines for nursing homes, facilities must implement proactive strategies to protect residents from developing ulcers. These include routine skin assessments, risk evaluations, repositioning at scheduled intervals, and pressure-relieving devices like specialized mattresses or foam cushions.
Staff must be trained to identify early signs, such as persistent red or discolored areas, especially over bony prominences. Nutrition and hydration also play a crucial role, as does regular hygiene.
When a facility fails to implement interventions based on a resident’s risk, it may violate F686 and endanger the resident’s skin integrity, opening the door to regulatory penalties and legal claims.
If a resident develops a pressure ulcer, F686 requires the nursing home to provide individualized treatment based on the wound’s stage and the resident’s clinical condition.
This may include keeping the wound bed clean, applying appropriate dressings, and removing dead tissue when needed. Infection control protocols must be in place, along with routine monitoring for signs of healing or worsening.
Facilities must also ensure the adjacent tissue is protected to prevent further breakdown. Coordination with wound care specialists is often necessary for more advanced wounds, like a stage 4 or unstageable pressure ulcer. Failing to follow these treatment guidelines may constitute nursing home neglect.
A deep tissue injury involves localized damage beneath intact skin, often presenting as a dark purple or maroon area. These injuries may evolve quickly, resulting in open wounds or significant tissue loss. Because these injuries are often difficult to detect, especially in residents with darker skin tones, early intervention is critical.
F686 requires that nursing homes treat suspected underlying soft tissue injuries with the same urgency as visible pressure ulcers, including protective measures and careful documentation. Prompt diagnosis and appropriate response can prevent these injuries from worsening, reducing the risk of infection and permanent harm. Delayed treatment is a serious F686 violation.
F686 clarifies that all nursing home staff involved in pressure ulcer care must be adequately trained and demonstrate ongoing competency. This includes knowing how to perform skin assessments, recognize risk factors, use repositioning techniques, and manage pressure wound care effectively.
Staff must also understand how to monitor for signs of infection and follow individualized treatment plans. Competency expectations apply to CNAs, nurses, and other medical professionals working with residents. Without sufficient training, even basic care tasks may be overlooked, leading to preventable tissue damage.
Facilities that don’t ensure qualified staff are in place may face citations, lawsuits, or both.
Accurate medical record keeping is vital under F686. Every nursing home must maintain detailed, up-to-date records that reflect each resident’s risk level, prevention strategies, treatment plans, and the progression of any existing wounds.
This includes notes on repositioning frequency, dietary support, dressing changes, and observed changes in skin integrity.
Facilities must also develop a comprehensive list of interventions tailored to the resident’s clinical condition. Proper documentation ensures continuity of care and serves as critical evidence in audits or legal claims. Missing, falsified, or inconsistent records can suggest neglect and lead to regulatory or legal consequences.
Residents have the right to be fully informed about their pressure ulcer care. Under F686, this includes understanding prevention efforts, treatment plans, and potential outcomes. Facilities must explain any recommended interventions’ risks, benefits, and alternatives.
This is especially important for invasive procedures like removing dead tissue. Informed consent must be documented, and residents—or their legal representatives—can refuse or question care decisions.
Upholding these rights isn’t just ethical—it’s also a regulatory requirement. Failure to involve residents in their care decisions can violate F686 and lead to claims of nursing home abuse.
To maintain compliance with F686, nursing homes must implement ongoing monitoring and internal quality assurance programs. This includes tracking incidents of pressure ulcers, identifying patterns or failures, and evaluating whether staff follow care protocols.
Quality improvement teams should regularly review data on skin assessments, infection rates, and outcomes of wound treatment. The goal is to identify gaps in care before they harm residents. These programs also provide transparency to Medicare and Medicaid Services during audits or inspections.
A facility that fails to monitor its care systems puts residents at unnecessary risk and may face serious regulatory or legal repercussions.
Failing to comply with CMS pressure injury guidelines for nursing homes can lead to significant consequences. Nursing homes in violation may receive citations during state surveys, face civil monetary penalties, or lose eligibility for Medicare or Medicaid funds. Repeated or severe violations can trigger temporary state management or even facility closure.
Beyond regulatory action, non-compliance can expose a facility to lawsuits, particularly when a resident develops a stage 4 ulcer or dies as a result of poor care. Legal claims often cite F686 violations as evidence of nursing home neglect, making compliance a legal safeguard and a clinical standard.
Non-compliance with F686 isn’t just a regulatory issue—it can form the foundation of a nursing home neglect lawsuit. When a resident develops a pressure ulcer due to a failure to implement interventions, legal action may follow. If a facility did not follow proper prevention protocols, failed to monitor a wound’s progression, or allowed a sore to become infected, it may be liable for damages.
Legal claims often reference F686 to show the professional standards that were breached. Families may seek compensation for pain, suffering, medical expenses, and in severe cases, wrongful death. A documented F686 violation strengthens the legal case.
Families concerned about pressure ulcer care should first document what they observe—photos of the wound, signs of poor hygiene, or persistent red spots near bony prominences. Request copies of the resident’s medical record, including care plans and wound notes. Ask staff what prevention measures are being taken and whether a wound specialist is involved.
If answers are unclear or care seems lacking, raise your concerns with facility leadership. You can also report the issue to state health departments or the Centers for Medicare and Medicaid Services. If neglect is suspected, consult a lawyer experienced in nursing home abuse cases.
When a nursing home fails to meet F686 standards, families often turn to legal professionals for help. An attorney can review the medical record, interview witnesses, and consult experts to determine if the facility violated federal guidelines.
If so, they may file a claim on behalf of the resident for decubitus ulcer injuries, pain and suffering, and related losses. Lawyers experienced in pressure injury cases know how to hold facilities accountable and uphold residents’ rights.
In cases involving pressure injuries or fatal outcomes, legal intervention is often the only way to secure justice and protect others from similar harm.
At Nursing Home Law Center, we focus exclusively on holding nursing homes accountable for preventable injuries like pressure ulcers. If you suspect your loved one was harmed due to a violation of the CMS pressure injury guidelines for nursing homes, our legal team is here to help.
We offer a free consultation and don’t charge fees unless we win your case. With a deep understanding of F686 and its legal applications, we know how to uncover failures in care and pursue the compensation your family deserves.
Call us at (800) 926–7565 or fill out our contact form to speak with an attorney experienced in nursing home neglect cases.