Nursing homes today face an increasing amount of oversight as they comply with regulations from federal, state, and local governments and agencies. The trend of judicial oversight, particularly in cases involving pressure ulcers, presents a unique set of challenges to the nursing home industry. The standards of care that are increasingly applied to establish the incidence of negligence in relevant cases are dependent on an under-researched area of the clinical phenomenon of skin breakdown within a frail elderly population. As the nursing home population continues to grow and resources are further strained, finding ways to best utilize resources becomes imperative. Consideration must be given to the growing body of evidence indicating that some patients are incapable of mounting a "normal" response to the physical forces responsible for the damage observed with pressure ulcers. Pressure ulcers have evolved to the status of being a synonym for neglect and/or abuse. Clinicians must focus on establishing a realistic and far more nuanced body of knowledge regarding pressure ulcers among the frail elderly.