South Carolina Assisted Living vs Nursing Home Injuries: When a Facility Fails to Meet a Resident’s Changing Needs

If someone you love was seriously injured in a nursing home or assisted living facility, it’s normal to focus first on the injury itself:

• How did they fall?
• Why did they develop a bedsore?
• How did they wander away?
• Why were they dehydrated?
• Why didn’t anyone notice their condition was getting worse?

Those questions matter, but sometimes the injury is the end of a longer story. Before a nursing home or assisted living facility accepts a resident, it has to determine whether it can provide the care that person needs. But admitting the resident is only the beginning.

A resident who walked to the dining room on their own at admission may later need help getting out of bed after a hospital stay. Someone with mild memory problems may become more confused and start wandering. A wound may develop. New medications can require closer monitoring.

In those situations, the facility cannot keep providing the same care simply because it was enough when the resident moved in. It has to recognize the change, adjust the care and supervision being provided, and, when necessary, arrange a transfer. Sometimes a facility couldn’t meet the resident’s needs from the beginning. In other cases, the placement was appropriate at first, but the resident’s needs changed and the facility failed to respond.

This article explains how assisted living facilities and nursing homes differ in South Carolina, what they should consider when admitting a resident, how they should respond as a resident’s needs change, and when a failure to provide appropriate care may support a legal claim.

---

In This Article:

1. How Do Assisted Living Facilities and Nursing Homes Differ in South Carolina?
2. Was the Resident Properly Admitted?
3. Did the Facility Monitor the Resident and Adjust Their Care?
4. Injuries That May Point to Inadequate Monitoring or Care
5. What Legal Claims and Damages May Be Available?

---

1. How Do Assisted Living Facilities and Nursing Homes Differ in South Carolina?

Not every long-term care facility is designed to provide the same kind of help. Some people need little or no assistance with daily activities. Others need regular hands-on help, close supervision, or ongoing nursing care. The right setting depends on the person’s individual needs.

Residents in independent living communities generally do not require hands-on care. These communities may provide meals, housekeeping, transportation, and social activities, but they are not designed to provide regular personal care, supervision, or medical services.

For this article, we’ll focus on two common types of licensed long-term care facilities in South Carolina: [i]

• Community Residential Care Facilities, commonly called assisted living facilities; and
• Nursing homes.

A facility may use terms such as “senior living” or “retirement community” in its advertising, but its license determines the type of care it is permitted to provide.

Assisted Living Facilities

In South Carolina, a facility may describe itself as “assisted living” only if it is licensed as a Community Residential Care Facility, or CRCF. [ii] Because “assisted living” is the term most families recognize, we will use it throughout this article.

Assisted living facilities provide room and board along with personal care. [iii] Personal care is the hands-on assistance that distinguishes assisted living from independent living. It may include: [iv]

• Bathing, dressing, grooming, and other hygiene tasks;
• Walking, transferring, getting in and out of bed, and using the toilet;
• Supervision and monitoring within the facility;
• Keeping track of a resident’s general whereabouts; and
• Help with transportation, shopping, appointments, and other routine tasks.

Every resident is different. One person may need occasional reminders and help getting dressed, while another may require assistance with nearly every activity of daily living. That can be a lot of help, but assisted living has its limits.

It is generally intended for people who need help with daily activities, not residents who require hospital care, continuous skilled nursing attention, or certain forms of complex medical treatment. If a resident begins needing care beyond what assisted living can provide, the facility has to determine whether appropriate outside services will be enough or whether the resident needs to be transferred.

Nursing Homes

Nursing homes serve a different purpose. They provide more extensive nursing and medical care than assisted living facilities. In South Carolina, nursing homes are licensed to provide “intermediate or skilled care for persons who are not in need of hospital care.” [v]

Nursing home residents may receive many of the same services provided in assisted living, along with more extensive care, such as:

• Medication administration;
• Wound care;
• Rehabilitation after an illness, injury, or surgery; and
• Other medical or nursing services that cannot be provided in assisted living.

But nursing homes are not hospitals. If a resident develops an acute illness or injury that the nursing home isn’t capable of treating, the resident may need hospital care instead.

What “Memory Care” Means

Memory care can be confusing because it sounds like a separate category of facility. In South Carolina, it isn’t. “Memory care” generally refers to a specialized program for residents with Alzheimer’s disease or another form of dementia. A memory-care program may operate within either an assisted living facility or a nursing home. [vi]

The facility’s underlying license still determines the medical and nursing services it may provide. But memory-care programs may also use secured areas and additional supervision to address risks such as wandering or elopement. If a facility offers an Alzheimer’s special-care unit or program, South Carolina law requires it to disclose what care or treatment makes the program especially suitable for residents with Alzheimer’s disease. [vii]

Why These Differences Matter

The important point is that these facilities are not interchangeable. Assisted living facilities and nursing homes are designed to provide different types of care, and even facilities with the same license may offer different services.

That means a facility should not accept a resident simply because they generally qualify for assisted living or nursing home care. It also has to determine whether that particular facility can meet the resident’s individual needs.

---

2. Was the Resident Properly Admitted?

The admission process must involve more than simply confirming that a room or bed is available. Before a facility says yes to a new resident, it should know that it can provide the services that person needs.

Assisted Living Facilities

South Carolina law limits who may be admitted to or remain in an assisted living facility.

Those restrictions generally include residents who need: [viii]

• Daily skilled monitoring for an unstable or complex medical condition;
• Close monitoring of medications that require frequent dosage changes;
• Intravenous medication or fluids;
• Regular injections that must be given by facility staff, subject to specific exceptions;
• Treatment of a Stage 2 or more serious pressure injury, multiple pressure injuries, or another widespread skin disorder;
• Assistance with a urinary catheter, feeding tube, suctioning, or tracheostomy care that the resident cannot manage independently; or
• Newly prescribed oxygen that requires adjustment and evaluation.

Even within those limits, not every assisted living facility offers the same services. South Carolina regulations require each facility to establish admission criteria based on the care and assistance it actually provides. [ix] A person may therefore be generally appropriate for assisted living but still require more help than a particular facility can provide.

This means the admission decision comes down to two main questions:

Does the person need care that an assisted living facility is not permitted to provide? If so, the person should not be admitted to assisted living.

If assisted living is generally appropriate, can this particular facility meet the person’s individual needs? If not, that facility should not accept the person as a resident.

Nursing Homes

A physician must order nursing-home care before someone can be admitted. [x] That order only establishes that the person needs nursing-home care generally. It does not mean that every nursing home can meet that person’s particular needs. Like assisted living facilities, nursing homes must still determine whether they are capable of providing the care the person requires. [xi]

At a nursing home, the admission decision generally comes down to three questions:

Has a physician ordered nursing home care? Without a physician’s order, the person should not be admitted.

Does the person have an acute illness or injury that requires care beyond what a nursing home can provide? If so, and hospitalization is consistent with the person’s condition, prognosis, and wishes, the person should receive hospital care instead.

Can this particular nursing home meet the person’s individual needs? Even when nursing home care is generally appropriate, a facility should not accept someone whose needs exceed what it can safely provide.

Admission is Only the Beginning

Not every injury starts with a bad admission decision. A facility may have been the right fit at first and become the wrong fit later. A resident may become weaker, start experiencing dementia symptoms, suffer repeated falls, develop a wound, or begin needing more nursing care.

That is why continuing to monitor them is so important.

---

3. Did the Facility Monitor the Resident and Adjust Their Care?

A resident’s needs can change a lot after admission. Sometimes the changes are sudden. Other times they happen little by little. Either way, the facility can’t keep following the same plan simply because that plan worked before.

Recognizing Changes in the Resident’s Condition

Staff are often the first people in a position to notice that something has changed.

Those changes may involve the resident’s:

• Strength, balance, or ability to walk and transfer;
• Memory, judgment, confusion, or behavior;
• Eating, drinking, or weight;
• Skin condition or development of a wound;
• Ability to bathe, dress, use the toilet, or perform other daily activities;
• Response to medications; or
• General medical condition.

What matters is whether the staff noticed those signs, documented them, told the right people, and acted. South Carolina’s assisted-living regulations, for example, require the facility to make observation notes at least daily after a significant medical change or serious incident. And they must continue those daily notes until the condition stabilizes or is resolved.

Those regulations also require the facility to document the care and services provided and to report serious health concerns or injuries to the resident’s physician and responsible party. [xii]

Reassessing the Resident and Adjusting Care

Assisted living facilities and nursing homes must develop an Individual Care Plan, or ICP, for each resident. The plan identifies what the resident needs and what services will be provided. [xiii] Assisted-living care plans must be reviewed at least every six months, while nursing-home care plans must be reviewed at least quarterly.

But those are not waiting periods. If the resident’s needs change sooner, the facility must review the care plan sooner and revise it as needed. Simply updating the care plan on paper is not enough. The changes have to actually be put into action. [xiv]

Arranging a Transfer When Necessary

Sometimes more help can be added where the resident already lives. Sometimes it can’t. At that point, transfer becomes part of the care decision. For assisted living residents, South Carolina regulations require a transfer when the facility’s own services, even when combined with appropriately licensed outside services such as home health or hospice, no longer meet the resident’s needs. A transfer is also required when the resident needs continuous medical or nursing supervision or the facility no longer has the ability to provide the necessary care. [xv]

Nursing homes also have transfer requirements. A resident who continues to need care or supervision must be transferred to a location that is licensed and appropriate for those needs. Except in an emergency, the transfer generally occurs on a physician’s order. [xvi]

Moving a resident can be difficult for both the resident and their family. But once the facility determines that a transfer is necessary, it should begin discussing the transition with them before the resident’s condition becomes an emergency. Until that transfer occurs, the facility still has responsibilities to the resident. It should continue providing and coordinating care and make sure the receiving facility gets the information, medications, care plan, and other materials needed to avoid unnecessary gaps in care.

---

4. Injuries That May Point to Inadequate Monitoring or Care

A serious injury does not automatically mean that a nursing home or assisted living facility was negligent. Falls can happen even when appropriate precautions are taken, and medically fragile residents may develop complications despite proper treatment. Sometimes though, the injury is the culmination of a longer pattern. In those cases, the question is whether the resident’s needs had been changing and the facility failed to respond.

Falls

A fall may indicate that a resident needed more help with walking, transfers, toileting, or getting in and out of bed.

Important questions may include:

• Had the resident fallen before?
• Did the resident’s strength, mobility, or balance recently decline?
• Did they need more help or supervision than they were receiving?
• Was appropriate equipment provided?
• Was the care plan changed after an earlier fall or near fall?

Pressure Injuries

Pressure injuries, sometimes called bedsores or pressure ulcers, can develop when a resident remains in one position for too long or does not receive adequate assistance with repositioning, skin care, nutrition, or hydration. When a pressure injury develops, the concern isn’t just how the wound was treated after it appeared. It is also important to consider whether the resident needed a specialized mattress or other equipment, more frequent repositioning, or additional nursing care before the wound became serious.

Wandering or Elopement

Residents with Alzheimer’s disease or another form of dementia may wander within a facility or leave the premises without supervision.

After a wandering or elopement incident, important questions may include whether the resident needed:

• A secured memory-care area;
• More frequent supervision or monitoring;
• Alarms or other safety systems; or
• Care from staff trained to respond to dementia-related behaviors.

The issue is not simply that the resident wandered. It is whether the facility recognized the risk and took reasonable steps to address it.

Dehydration, Malnutrition, and Weight Loss

Some residents cannot reliably eat or drink without reminders, encouragement, supervision, or hands-on help.

Unexplained weight loss, dehydration, or repeated difficulty eating may indicate that the resident needed:

• More assistance during meals;
• Closer monitoring of food and fluid intake;
• A dietary evaluation;
• Treatment for swallowing or feeding problems; or
• More frequent medical assessments.

Medication Problems

Medication problems may involve missed doses, incorrect medications, improper administration, overdoses, or failure to monitor how the resident responds to a medication. Sometimes the problem is an isolated mistake. In other cases, it may show that the resident’s medication needs had become more complex than the facility could manage.

Determining Why an Injury Happened

After a serious injury, it is important to determine what the staff knew, when they knew it, and what they did next.

Relevant records may include:

• Medical records;
• Individual care plans;
• Medication administration records;
• Physician’s orders;
• Incident reports;
• Staffing records; and
• Communications with the resident’s family.

Those records can show whether:

• The resident’s condition had been declining;
• The facility knew that more care or supervision was needed;
• The care plan was updated;
• The changes described in the care plan were actually carried out; and
• The resident should have been transferred before the injury occurred.

Putting that information into a timeline can help show if the injury was an isolated incident or part of a broader failure to recognize and respond to the resident’s changing needs.

---

5. What Legal Claims and Damages May Be Available?

When a nursing home or assisted living facility accepts a resident, it takes on a responsibility to provide care that matches that person’s needs. A resident who was injured because the facility failed to use reasonable care may have a legal claim. Depending on what went wrong, that claim might involve ordinary negligence, medical malpractice, or both.

Ordinary negligence generally involves conduct that does not require professional medical judgment. For example, the South Carolina Supreme Court has explained that claims involving falling ceiling tiles or improperly maintained hallways or parking lots at a hospital are ordinary negligence claims. [xvii]

Medical malpractice, by contrast, involves negligent medical or nursing care that depends on professional medical judgment. [xviii]

The distinction depends on the conduct involved, not simply the job title of the person who provided the care. The type of facility can matter too. South Carolina’s medical-malpractice statute specifically includes nursing homes as health care institutions. Assisted living facilities that do not provide skilled nursing services are excluded from the statute’s definition of a nursing home. [xix]

In both ordinary negligence and medical malpractice cases, the regulations discussed above, along with the facility’s own policies, can be important because they help show what the facility should have done. [xx]

Depending on who made the relevant decisions and controlled the resident’s care, there may be legal actions available against other people and entities too, including:

• Individual employees;
• Nurses, doctors, or other healthcare providers; or
• A management or parent company.

Survival and Wrongful Death Claims

If the injury results in death, two different claims may be available.

A survival claim belongs to the resident’s estate and addresses the harm the resident experienced before death, including medical expenses and conscious pain and suffering.

A wrongful death claim is brought by the personal representative for the benefit of the resident’s statutory beneficiaries. It addresses the losses they suffered because of the death, including financial loss, grief, sorrow, and loss of companionship and support.

We discuss these claims in more detail in our article about wrongful death claims in South Carolina.

Damages After a Serious Injury

Residents who are injured may incur medical expenses and require future treatment, sometimes for the rest of their lives. Their injuries can also cause lasting physical, psychological, and emotional harm.

Those losses can be part of the damages recovered in a personal injury claim. However, because these cases can take years to resolve, it is important to document the resident’s condition as the case develops. Keeping records of the injuries, medical treatment, expenses, and changes in daily life can help show the full extent of the harm when it comes time to prove those damages. [xxi]

Punitive Damages

Punitive damages, which are meant to punish the defendant and deter future wrongdoing, may also be available if clear and convincing evidence shows that the facility or another defendant acted willfully, wantonly, or recklessly rather than merely negligently. [xxii]

---

Conclusion

Families rely on nursing homes and assisted living facilities to pay attention to their loved ones and provide the care they need. A facility’s failure to recognize a resident’s changing needs or adjust the resident’s care can result in serious injuries.

If your loved one was seriously injured in a South Carolina nursing home or assisted living facility and you have questions about whether you have a legal claim, we’re here to help. You can schedule a free personal injury consultation by calling our office at (803) 359-9000 or visiting wsblegal.com.

Last Updated: 10/1/2026

About the Author

Jason Yonge is a litigation attorney in Lexington, South Carolina. He represents clients across the state in serious personal injury, car accident, and wrongful death cases. For honest, straightforward advice about your situation, contact Jason to see how he can help.

Read Jason’s full bio

---

[i] S.C. Code Ann. Regs. 60-84.101(L) (defining a community residential care facility); S.C. Code Ann. Regs. 60-17.101(RR) (defining a nursing home).

[ii] S.C. Code Ann. Regs. 60-84.101(L) (“These facilities may be referred to as ‘assisted living’ provided they meet the above definition of community residential care facility.”).

[iii] S.C. Code Ann. Regs. 60-84.101(L) (defining a CRCF as “[a] facility which offers room and board and which . . . provides/coordinates a degree of personal care for a period of time in excess of 24 consecutive hours.”).

[iv] S.C. Code Ann. Regs. 60-84.101(B), (MM) (defining “Personal Care” and “Activities of Daily Living (ADL)).

[v] S.C. Code Ann. Regs. 60-17.101(RR).

[vi] S.C. Code Ann. Regs. 60-84.101(F); S.C. Code Ann. Regs. 60-17.1101(F) (“Other than the limitations of resident movement in special instances, for example, Alzheimer’s unit, residents shall be assured freedom of movement.”).

[vii] S.C. Code Ann. § 44-36-520 (Alzheimer’s Special Care Disclosure Act).

[viii] S.C. Code Ann. Regs. 60-84.801(C).

[ix] S.C. Code Ann. Regs. 60-84.801(A) (“Individuals seeking admission shall be identified as appropriate for the level of care, services, or assistance offered.”); S.C. Code Ann. Regs. 60-84.401 (requiring facilities to develop and implement written policies and procedures “regarding resident care, rights, and the operation of the facility [which] accurately reflect actual facility operation”).

[x] S.C. Code Ann. Regs. 60-17.900(C).

[xi] S.C. Code Ann. Regs. 60-17.900(A)-(C), (F).

[xii] S.C. Code Ann. Regs. 60-84.601(G); S.C. Code Ann. Regs. 60-84.701(B)(3), (6).

[xiii] S.C. Code Ann. Regs. 60-84.703; S.C. Code Ann. Regs. 60-17.803.

[xiv] S.C. Code Ann. Regs. 60-84.901(B)-(C); S.C. Code Ann. Regs. 60-17.1001(B)-(C).

[xv] S.C. Code Ann. Regs. 60-84.801(D)-(F), 60-84.906.

[xvi] S.C. Code Ann. Regs. 60-17.803(B)(5), 60-17.804(B)(6), 60-17.1013.

[xvii] Dawkins v. Union Hospital District, 408 S.C. 171, 758 S.E.2d 501 (2014) (“However, not every injury sustained by a patient in a hospital results from medical malpractice or requires expert testimony to establish the claim. . . . For example, claims against a hospital for injuries caused by falling ceiling tiles or improperly maintained hallways or parking lots sound in ordinary negligence, and specifically in premises liability.”).

[xviii] Dawkins v. Union Hospital District, 408 S.C. 171, 758 S.E.2d 501 (2014) (distinguishing ordinary negligence from medical malpractice based on the nature of the care involved).

[xix] S.C. Code Ann. § 15-79-110(2), (3), (6)-(7).

[xx] Madison ex rel. Bryant v. Babcock Ctr., 371 S.C. 123, 638 S.E.2d 650 (2006) (explaining that the standard of care may be established and defined by statutes, administrative regulations, industry standards, and a defendant’s own policies and guidelines).

[xxi] Clark v. Cantrell, 339 S.C. 369, 529 S.E.2d 528 (2000) (“The purpose of actual or compensatory damages is to compensate a party for injuries suffered or losses sustained.”); Haselden v. Davis, 353 S.C. 481, 579 S.E.2d 293 (2003) (explaining that a personal injury plaintiff may recover the reasonable value of medical services made necessary by the defendant’s wrongdoing); Pearson v. Bridges, 337 S.C. 524, 524 S.E.2d 108 (Ct. App. 1999) (“Under South Carolina common law, future damages are generally allowed in personal injury and medical malpractice cases.”), aff’d in result, 344 S.C. 366, 544 S.E.2d 617 (2001).

[xxii] S.C. Code Ann. § 15-32-520(D); Clark v. Cantrell, 339 S.C. 369, 529 S.E.2d 528 (2000).