The NH’s responsibility to meet the individual needs of each resident is a non-delegable duty. NME Properties v. Rudich, 2003 WL 289415 (D.C. Fla., 2003) explains the analysis.
There are several regulations which make this implicit. Under 20 CFR 483.13(c) the facility must not neglect or abuse a resident. The facility has to develop an individualized plan of care per 483.20(k) that states the services to be provided meet the resident’s needs, which means that the care plan, under the scenario that you’ve described, would specifically state that the facility will rely upon “supplemental one on one private duty nursing to be provided by the resident.” That would be pretty wild and your best dream as plaintiff’s counsel, as it would be tantamount to an admission against interest that they can’t meet the needs of the resident. Facilities cannot admit or fail to discharge residents whose needs the facility cannot meet per 483.12(a)(2). Use of outside resources to meet the facility’s obligations under 483.25 is covered under 483.75(h)(1) & (2). 483.75(h)(2) states that arrangements by the facility “pertaining to services furnished by outside resource must specify in writing that the facility assumes responsibility for” the services.