legal resources necessary to hold negligent facilities accountable.
Nursing Homes in California
There are approximately 1,240 nursing homes in California, according to Medicare.gov. Of these nursing facilities, around 882 (71%) rate average or above on the quality of care they provide, whereas 358 (29%) nursing homes fall below average or lower.
These poor levels of health care fall well below the Medicaid and Medicare acceptable standards.
Nursing homes often hire unqualified employees who fail to adequately care for residents. Sometimes they don't train their employees properly, so they don't know how to care for patients. The nursing home is also negligent when failing to provide adequate care. In other cases, a resident dies because of a nurse or caregiver error.
What is Neglect and Abuse?
Neglect is when caregivers in nursing homes fail to provide the minimum standards of care required by law. Abuse is when someone intentionally causes harm to another person.
The California Department of Public Health identifies abuse as physical or psychological violence, neglect, financial exploitation, abandonment, self-neglect, and other mistreatment.
Abuse still occurs in many California nursing homes, long-term care facilities, assisted living communities, intermediate care facilities, and rehabilitation centers. Here are only some examples of California nursing home violations:
Failure to Protect Skilled Nursing Facility Residents from All Forms of Abuse
Common symptoms of physical abuse are anxiety, depression, unexplained injuries (such as bruises), untreated infections, malnutrition, and dehydration. Nursing facilities in Arkansas often experience these issues.
The following are some common signs that a nursing facility resident is being physically neglected:
- Failing to ensure a resident was free from abuse after becoming combative with staff members who de-escalated the situation, he redirected the resident, who threw water on his roommate. (Applewood Post-Acute Nursing home and Rehabilitation)
- Failing to prevent abuse between two residents when one resident pushed a patient in the chest resulting in a fall. (Applewood Post-Acute Nursing Home and Rehabilitation)
- Failing to protect and provide a safe environment for a resident with a history of sexually inappropriate behaviors who touched another patient under her bedcovers while sleeping. (Avalon Care Center – Sonora Nursing Home and Rehabilitation)
- Failing to ensure adequate diagnostic imaging and evaluations were completed for a resident with a thighbone (femur) fracture that remained undiagnosed for 21 days. (City Creek Post-Acute Nursing Home)
- Failing to ensure a resident was free from neglect and failed to provide incontinence care. The deficiency resulted in the resident being soiled for a prolonged time, being sent to the hospital for a change of condition, and wearing multiple adult diapers with a foul urine smell. (Hayward Convalescent Hospital)
- Failing to ensure that a referral was made to the long-term care home bondsman involving an allegation of sexual abuse between residents. (Meadowbrook Post-Acute Nursing Home and Health Care Services)
- Failing to ensure one resident was free from physical abuse when a Certified Nursing Assistant hit the resident while providing care. The incident had the potential to cause emotional and physical injuries that could negatively impact the resident's mental health and psychological well-being (Oroville Hospital Post-Acute Center)
Failure to Protect Skilled Nursing Care Residents from Accident Hazards
Nursing homes in California must ensure that their skilled nursing facility residents receive appropriate care and protection from harm. Common examples of these types of issues include:
- Failing to provide supervision/assistance and ensure fall prevention equipment (bed rails and alarm) were in working order to prevent a fall that resulted in a resident falling due to an unsecured bed rail. (California Park Rehabilitation Hospital)
- Failing to assist a resident who attempted to get out of bed unsupervised and was at risk for falls with supervision and interventions to prevent a fall.. (Country Villa Belmont Heights Nursing Home)
- Failing to implement measures to avoid elopement, two residents left the facility without staff intervention on one occasion, and a resident left at least three times. One resident fell after leaving the facility and was transferred to an acute care facility. (Novato Health Care Center)
Failure to Implement and Follow Infection Protection Protocols
Infectious diseases can spread easily among residents, visitors, or staff members if the healthcare team doesn't follow proper infection control procedures; common issues associated with infections in long-term care facilities (LTCFs) and nursing homes in California include:
- Failing to follow policy and procedure for reporting scabies (a highly contagious condition involving small mites. (All Saints Healthcare Subacute Nursing Home)
- Failing to ensure infection control measures were followed in failing to ensure a Certified Nursing Assistant informed her supervisor that she was experiencing Covid-19 symptoms. (Imperial Care and Rehabilitation Center)
- Failing to follow infection control interventions to prevent the spread of Covid-19 and a severe illness caused by the virus that spread between residents. (Lakewood Health Care Center)
Is Your Loved One Being Mistreated?
It can be difficult for families to detect when their loved one is a victim of mistreatment and abuse. However, some common signs may indicate that something is wrong.
- Poor hygiene: Patients exhibiting poor hygiene, including dirty fingernails and strong odors, might not receive the care they need.
- Weight loss: Patients who have lost a significant amount of weight in a short time may not get the nutrition they need.
- Bedsores: Bed sores can form when a patient is not regularly repositioned, leading to pressure ulcers.
- Bruises or cuts: Unexplained bruises or cuts could signify abuse.
- Infections: Residents are at an increased risk for developing infections if they are not adequately cared for in a nursing facility.
- Mental decline: If a loved one seems to be deteriorating mentally, it could be a sign that they are not properly cared for in a nursing facility.
- Poor oral health: Patients with poor oral health may not receive the necessary dental care.
- Limited mobility: Patients who are not mobile may not get the necessary exercise.
- Lack of socialization: Residents with no social interaction in a skilled care facility may be at risk for isolation and depression.
- Unkempt appearance: A poorly-groomed senior care resident might not receive the necessary personal care needed to maintain their well-being in a nursing facility.
- Dirty living conditions: Residents who live in dirty conditions may not receive the necessary sanitation care.
- Noisy environment: A noisy environment in a skilled nursing facility can be disruptive and stressful for residents.
- Odors: Strong smells in a skilled nursing home can indicate that patients are not being bathed or washed properly.
Do you suspect your loved one is being abused or mistreated in a nursing facility? Talk to the skilled nursing facility staff and ask them to investigate the situation.
If they are unwilling to act, you may need to contact the police or elder protective services. Detecting and reporting mistreatment and abuse can help ensure that your loved one is safe and protected.
Residents with a High Risk of Developing Bedsores
Families should look for obvious signs of abuse and neglect when their loved one is at high risk of developing bedsores. If the resident appears to be in pain when they are moved or if they have red marks or sores on their skin, this could be a sign of neglect or abuse.
You should immediately speak to the skilled nursing facility administrator or Social Services Director if you have any concerns. According to the Department of Health Services, bedsores develop for various reasons, including:
- Limited Mobility: Skilled nursing care patients who cannot move around independently are at high risk of developing pressure ulcers. This is because they are unable to shift their weight or change positions, which can cause the pressure on their skin to increase.
- Fragile Skin: Long-term care residents have delicate skin due to age or illness, which makes them more susceptible to developing pressure ulcers. The slightest amount of pressure can cause damage to the skin and delay the healing process.
- Poor Nutrition: Residents who are not well-nourished are also at risk for developing pressure ulcers. This is because their bodies will not have the nutrients they need to heal any existing wounds.
- Inadequate Fluid Intake: A resident in a skilled nursing home who does not drink enough fluids are also at risk of developing pressure ulcers. This is because dehydration can decrease blood flow, limiting the amount of oxygen and nutrients that reach the skin.
- Incontinence: Incontinent residents receiving nursing care are at risk for developing pressure ulcers, as urine and feces can aggravate the skin and delay healing.
- Poor Hygiene: Residents who do not receive adequate hygiene and nursing care are also at risk for developing pressure ulcers. Unclean skin can provide a breeding ground for bacteria, leading to an infection that can quickly spread in the long-term care facility.
- Smoking is another risk factor for developing pressure ulcers in skilled nursing care residents. Smoking decreases blood flow and damages the collagen and elastin in the skin, making it more susceptible to injury.
- Sedentary Lifestyle: A sedentary lifestyle in a nursing home can also lead to the development of pressure ulcers in skilled nursing care residents. This is because when people do not move around often, the blood flow slows down, and oxygen levels decrease, damaging skin cells.
- Age: The older a person is, the greater their risk of developing a pressure ulcer because as people age, their skin becomes thinner and less elastic, making it more difficult for wounds to heal properly.
- Medical Conditions: Specific health problems can increase a skilled nursing care resident's risk of developing a pressure ulcer, such as diabetes, cancer, or heart disease. These conditions can make it difficult for the body to heal any existing wounds.
Abuse is Not Always Obvious in Skilled Nursing Facilities
It's difficult to spot abuse and mistreatment in skilled nursing homes in California, as many cases go undetected. However, some common signs may suggest that abuse is taking place. Families should report suspected mistreatment to the nursing home administrator, local law enforcement, and Adult Protective Services.
Nursing home abuse and mistreatment could involve:
- Physical Abuse: Incidents can involve hitting, slapping, pushing, and other forms of physical violence. This can cause serious injuries and even death.
- Verbal Abuse: Incidents often involve yelling, cursing, and verbal threats. This type of abuse can cause emotional trauma.
- Emotional Abuse: Incidents can involve humiliation, intimidation, and isolation. This type of abuse can damage a person's emotional well-being.
- Financial Abuse: Incidents can involve unauthorized use of funds, theft, and fraud. This type of abuse can leave victims penniless and vulnerable.
- Social Isolation: Incidents can involve preventing residents from socializing with family and friends. This can lead to a feeling of loneliness and isolation.
- Mental Abuse: Incidents can involve threatening residents or causing them to feel scared or helpless. This type of abuse can cause psychological trauma.
- Sexual Abuse: Incidents can involve unwanted touching, rape, and sexual exploitation, which could cause physical and emotional injuries.
- Medical Neglect: Incidents can involve failure to provide necessary medical care, leading to serious health complications or death.
- Nutrition Neglect: Incidents can involve serving insufficient or inappropriate food, leading to malnourishment or weight loss.
- Lack of Supervision: Incidents can involve staff not being present when assistance is needed, leading to falls, accidents, and injuries.
- Restraints: Incidents can involve misusing restraints, which can cause physical pain and psychological distress.
- Wrong Medications: Incidents can involve giving residents the wrong medication or the incorrect dosage, which could result in serious health complications.
- Environmental Hazards: Incidents can involve hazardous conditions such as poor lighting, dangerous staircases, and faulty wiring, which could lead to accidents and injuries.
- Abuse of Power: Incidents can involve staff members abusing their power by verbally or physically abusing residents