Hot Water & Scald Burns in Nevada Care Facilities

A scald injury suffered during a bath or a shower is not an ordinary household accident. In a licensed Nevada facility, water temperature is an engineered, monitored condition, and bathing is a supervised task assigned to trained staff. That is why a burn often raises questions about what happened before the resident ever reached the water. Our overview of nursing home abuse and neglect claims in Nevada explains how these matters are investigated generally; this page addresses hot water and scald injuries in particular.

Scald burns can also be among the more damaging injuries an older resident suffers. Skin thins with age and healing slows, so a burn a younger person would recover from can mean weeks of wound care, infection, surgery, and a lasting loss of independence. Families are often told that the resident turned the tap, or moved suddenly. Whether an explanation like that holds up usually depends on what the maintenance logs and the bathing assignment for that shift actually show.

O'Reilly Law Group has represented injured people and their families in Las Vegas since 1972. Our office is at 325 South Maryland Parkway, Las Vegas, Nevada 89101. If you would like the burn, the temperature records and the care plan reviewed, you can reach us at 702-382-2500. Nothing here is legal advice about your particular situation, and no result can be promised.

How scald burns happen in a care facility

Scald injuries in long-term care commonly trace back to a short list of failures, and most of them leave a trail in the facility's own paperwork.

• Water arriving too hot at the fixture. Building hot water is often stored well above bathing temperature for laundry, dishwashing and to suppress waterborne bacteria. It is supposed to be blended back down before it reaches a resident's tub, shower or sink. When a mixing valve fails, is set wrong, is bypassed during a repair, or was never fitted to a particular fixture, full-temperature water can reach the resident.
• Water never tested before the resident is placed in it. Bathing procedures generally call for staff to check the temperature at the fixture and again in the tub. A burn can mean that check was skipped, or was made by hand instead of with a thermometer.
• A resident left alone in a tub or shower. Someone who cannot safely be left unattended may lean on a lever, or may simply sit under water that is climbing.
• Basins, foot soaks and applied heat. Warm compresses, heating pads and soaking basins carry the same risk on a smaller scale, and are more often delegated without direct oversight.

Each of these is generally a task the facility controls rather than something a resident does alone. Whether any of them failed in a particular case is a question the records have to answer.

Why a resident may not be able to move away from hot water

Ordinary bathroom safety rests on an assumption: that a person who touches water that is too hot will pull back within a second or two. For many nursing home residents that assumption does not hold — and the facility often has notice of it, because the reason is written in the resident's own chart.

• Reduced sensation. Peripheral neuropathy, most often from long-standing diabetes, dulls or removes the ability to feel heat in the feet and lower legs, the parts of the body that enter the water first.
• Impaired judgment or speech. A resident with moderate or advanced dementia may not read pain as a reason to move, and a resident with aphasia after a stroke may not be able to call for help.
• Immobility. Weakness on one side, contracture, advanced arthritis or general frailty can leave a resident aware of the danger and still unable to lift out of a tub.
• Sedating medication. Drugs that slow reaction time can blunt the response to pain.

That is why safe bathing is generally treated as something to be built into the plumbing and the staffing plan rather than left to the resident's own reaction. Federal requirements direct a facility to ensure the resident environment remains as free of accident hazards as is possible and to provide each resident adequate supervision and assistance devices to prevent accidents (42 CFR 483.25(d)).

Safe water temperature is an engineered condition, not a judgment call

Federal requirements for nursing facilities state that the facility must ensure the resident environment remains as free of accident hazards as is possible, and that each resident receives adequate supervision and assistance devices to prevent accidents (42 CFR 483.25(d)). Water hot enough to burn in seconds is an accident hazard, and unsafe hot water and hot liquid temperatures are a recognized area of survey concern under that requirement.

The federal regulation itself does not set a temperature. The specific ceiling at a resident-accessible fixture comes from the facility's own policy and from applicable state and local licensing and plumbing requirements. In practice, fixtures a resident can reach are expected to be thermostatically controlled so the water cannot exceed that ceiling, and temperatures are expected to be checked on a schedule and written down. What makes a ceiling matter at all is the relationship between temperature and time. The American Burn Association's Scald Injury Prevention Educator's Guide reports that adult skin requires an average of five minutes of exposure at 120°F to sustain a full-thickness burn, and that at 140°F it takes about five seconds. Those are the guide's two figures, and they are set out with their limits in the table below.

Nevada licenses these facilities separately. NRS 449.030 requires a license to operate a medical facility or a facility for the dependent, and NRS 449.160 sets out the grounds on which a license may be denied, suspended or revoked. We have not identified a Nevada nursing-facility regulation that sets a numeric bathing-water ceiling, so the applicable ceiling generally comes from the facility's own policy and from applicable plumbing requirements rather than from a state nursing-home rule.

What the burn itself can tell you

Burn depth is assessed clinically, and it carries information about how hot the water was and how long the contact lasted.

• Superficial (first-degree) burns involve only the outer layer of skin — pink to red, dry, no blisters, usually healing in about five to ten days without scarring.
• Superficial partial-thickness burns reach the upper dermis. The wound bed is red or pink, blisters are common, the skin blanches when pressed, and healing generally takes on the order of 7 to 21 days.
• Deep partial-thickness burns reach the deeper dermis. The wound looks mottled, blanches only sluggishly, hurts less than a shallower burn, heals slowly and scars.
• Full-thickness (third-degree) burns destroy the epidermis and dermis and extend into the tissue beneath. The skin is leathery, stiff and dry, does not blanch, and is typically not painful at the burn itself because the nerve endings have been destroyed. These generally require surgery and more than eight weeks to resolve.

Two things follow. A quiet resident is not evidence of a minor burn — the deepest burns often hurt the least. And photographs taken early, before dressings and debridement change the appearance, are frequently among the more useful items in the file.

The Nevada law that applies

Enhanced damages. Under NRS 41.1395, when an older person — defined as a person who is 60 years of age or older — or a vulnerable person suffers a personal injury or death caused by abuse or neglect, the person who caused the injury or death is liable to that older or vulnerable person for two times the actual damages incurred by that person. If it is established by a preponderance of the evidence that a person liable under the section acted with recklessness, oppression, fraud or malice, the court shall order that person to pay the attorney's fees and costs of the person who initiated the lawsuit. The section does not apply to a person who did not know and had no reason to know that the harmed person was a vulnerable person.

Deadlines. NRS 11.190(4)(e) sets two years for an action to recover damages for injuries to a person, or for the death of a person, caused by the wrongful act or neglect of another. If a claim is instead characterized as professional negligence under NRS Chapter 41A, a different rule governs. NRS 41A.097 as it stands today contains several different periods, and which one applies depends on when the injury occurred rather than on which version of the statute is in force. Under NRS 41A.097(3), an injury occurring on or after October 1, 2023 must be sued on within 3 years after the date of injury or 2 years after the plaintiff discovers, or through the use of reasonable diligence should have discovered, the injury, whichever occurs first. Subsection 2 covers an injury occurring on or after October 1, 2002 and before October 1, 2023, with 3 years from the date of injury or 1 year from discovery. Subsection 1 covers an injury before October 1, 2002, with 4 years from the date of injury or 2 years from discovery. Subsection 4 tolls the limitation for any period during which a provider of health care has concealed an act, error or omission on which the action is based. NRS 41A.071 separately requires a supporting affidavit from a qualified medical expert at filing. Which framework applies turns on the conduct alleged, which is one reason not to wait.

Reporting. NRS 200.5093 requires listed professionals, including facility staff and nurses, to report suspected abuse or neglect of an older or vulnerable person as soon as reasonably practicable and no later than 24 hours. Federal rules separately require the facility to immediately inform the resident, consult the resident's physician and notify the resident's representative when there is an accident involving the resident which results in injury and has the potential for requiring physician intervention; a significant change in the resident's physical, mental or psychosocial status; a need to alter treatment significantly; or a decision to transfer or discharge the resident from the facility (42 CFR 483.10(g)(14)). Whether those things happened, and when, is often worth establishing.

What a family should do now

1. Have the burn seen and documented outside the facility. An emergency department or burn service will stage the injury independently and create a record the facility does not control.
2. Photograph it early and repeatedly. Depth and pattern change quickly once treatment begins.
3. Request records in writing. Ask for the nursing notes, the bathing and shower records, the incident report, the assignment sheet for that shift, the resident's care plan, and the water temperature logs and maintenance records for that fixture.
4. Do not sign anything that resolves the incident. That includes documents presented as routine paperwork or as a condition of continued care.
5. Write down what you were told and by whom. Explanations can change; contemporaneous notes are useful.

If you would like help doing this, call 702-382-2500. We can discuss what the records show before you commit to anything.

O'Reilly Law Group, 325 South Maryland Parkway, Las Vegas, Nevada 89101; 702-382-2500. Nothing on this page is legal advice about your particular situation, and no result can be promised.

Terms you may hear

Scald burn

A burn caused by hot liquid or steam rather than flame or a hot solid surface. In care facilities, most scalds involve tap water during bathing, showering or washing.

Thermostatic mixing valve

A plumbing device that blends hot and cold water to hold the temperature at an outlet below a set maximum, so a rise in tank temperature does not reach the resident. A failed, misadjusted, bypassed or absent valve is a recurring issue in scald cases.

Peripheral neuropathy

Nerve damage, most often affecting the feet and hands, that dulls or removes the sensation of heat and pain. Common in long-standing diabetes. A resident who has it may not feel water hot enough to injure them.

Full-thickness burn

Formerly called a third-degree burn. It destroys the epidermis and dermis and extends into the tissue beneath. The skin is leathery, stiff and dry, does not blanch, and is typically painless at the burn because nerve endings have been destroyed. Surgical treatment is generally required.

Water temperature log

The dated record of temperature checks at resident-accessible fixtures, usually kept by maintenance or environmental services. Missing entries, long gaps, or readings that were out of range without follow-up are among the first things to look for.