This week, May 10-16, is National Skilled Nursing Care Week, designated by AHCA/NCAL. This year’s theme: Moments in Bloom.
“My residents” is how nursing home staff often refer to the people they care for – out of closeness, familiarity, and the deep relationships built through daily care.
Staff know who wants coffee early. Who likes the door open. Who needs a few minutes before care. Who eats better for one CNA than another. These are not small things when you live with people day after day. Many staff see their residents more often than they see their own family.
That is why the chart does not always tell the whole story.
In one aspect of a case, the record showed a resident at end of life with multiple pressure injuries who was taking only bites of hamburgers and eating very little else. Concerns were raised about whether the facility was offering appropriate variety and food texture, particularly because nutrition is often scrutinized in pressure injury cases. The initial assumption was that these were standard facility hamburgers, possibly too difficult for him to chew or manage. That is not what was happening.
He was asking for McDonald’s hamburgers. They were softer and familiar. The care team had tried everything else, and this was a trial. The reason behind the entries had not yet been captured in a way that explained the full context. The team was still seeing whether the pattern would hold. At that point, eating was more about comfort and pleasure.
The facility supported getting his favored hamburgers to him. Staff used the facility van to bring them back fresh. Some direct-care staff went further, stopping before work to buy them themselves, because they knew he might eat one.
They knew him. They knew what worked.
Upon reviewing the chart, the timing was the thread to pull. The hamburgers were being documented at shift change and during hours when the kitchen was closed and no cooking staff were on the clock. To anyone with real-world familiarity of how a skilled nursing facility runs, that mismatch stops you cold. You know the rhythm of the building: when trays/snacks come up, when the kitchen goes dark, what shift change looks like. On paper, that detail can disappear entirely. So, the right question had never been asked. If the kitchen wasn’t the source, where were those hamburgers coming from? Who was bringing them, and why?
And timing was not the only tell. The “R” beside many meals on the dining room flow sheets was misinterpreted as “refused.” At this facility, “R” meant “room tray.” This becomes apparent to a legal nurse when they evaluate the totality of charting in the records but could be easily missed by others with unfamiliarity of nursing home care delivery routines and documentation.
When interviewed, staff often focus on what is already in the chart. They may not realize the story behind an entry matters. To them, getting the hamburger was just what you do for one of your residents.
In litigation, that kind of detail can change the case evaluation, the witness questions, the defense narrative, and the way counsel understands whether the chart reflects neglect or individualized care that was not fully explained on paper.
That is where real-world nursing experience is invaluable. It connects the record to the bedside. When you have walked those halls, you understand the nuance. You can tell the difference between a system that is failing and dedicated people going above and beyond within it.
This week, we honor everyone who works in skilled nursing. Doctors, nurses, CNAs, maintenance, dietary, laundry, housekeeping, activities, social services, and beyond. Every role matters. The maintenance worker who stops to chat. The cook who remembers a favorite meal. The housekeeper who brightens a room. They all give residents purpose and joy.
That is what care really looks like. This is skilled nursing care
