Common Failures in Nursing Home Care: Understanding Elder Abuse Under California Law

Many nursing homes continue to fall short in delivering the level of care required to protect vulnerable residents. While elder abuse can take many forms, recurring patterns reveal how frequently nursing homes neglect their legal and ethical responsibilities.

In California, skilled nursing facilities (SNFs) are overseen by the Department of Public Health (DPH). The DPH enforces regulations that cover everything from patient care and facility administration to health and safety standards. These facilities must follow needs-based care rules, which include minimum staffing ratios and regular updates to individualized care plans. Nursing homes that fail to meet the obligations outlined below may face legal action - a specialized elder abuse attorney can help you navigate the legal system and determine if you have a case.

Beyond general care obligations, the California Code of Regulations (CCR) specifically addresses several scenarios that frequently appear in elder abuse cases. Here are five major care concerns that fall under state regulatory oversight:

Bedsores

Pressure sores are a serious concern for residents with limited mobility and are often the result of neglect. Contributing risk factors include incontinence, chronic health conditions, poor nutrition, and lack of movement. These injuries are a common subject of elder abuse lawsuits in California, typically due to staff failure to reposition immobile residents regularly. Regulations require facilities to take preventive steps, such as routinely changing linens and any items in contact with the resident (CCR Title 22, §72315).

Falls

Nursing homes are required to create safety plans tailored to each resident’s needs, which include strategies to reduce the risk of falls. Falls are the leading cause of injury among older adults, with one in four individuals over 65 experiencing a fall annually. While the CCR doesn’t outline a specific fall-prevention statute, the broader mandates for resident safety and care planning serve as a foundation for addressing this prevalent issue.

Infection Control

California law mandates that nursing homes implement robust infection control programs to prevent the spread of communicable diseases. Required measures include routine hand hygiene practices and proper sanitation of dishes and linens. These protocols must be reviewed at least once a year and revised when needed to ensure effectiveness.

Medication Management

Strict rules govern how medications are administered in California nursing homes, particularly concerning the use of chemical restraints. All medications must be prescribed and overseen by a licensed healthcare provider, and proper documentation is essential. Mismanagement in this area can lead to serious harm and legal consequences.

Changes in Condition

Nursing homes must closely monitor residents for any sudden or significant changes in behavior, symptoms, or overall health. When such changes occur, facilities are legally required to take prompt action—often by revising care plans or increasing supervision. Ignoring these shifts can lead to worsening conditions and is a frequent issue in elder abuse litigation.

While these five care issues are specifically addressed in state law, they are also covered by federal regulations. Both sets of standards are enforced by the California Department of Public Health, reinforcing the legal duty of nursing homes to ensure resident safety and dignity.

Federal Protections Against Elder Abuse

Californians are also protected against elder abuse by a number of federal regulations, as outlined in Title 42 of the Code of Federal Regulations (CFR). Many of these rules overlap with California’s state-level requirements. They include mandates for preventing pressure ulcers and infections, as well as ensuring proper medication management.

Federal regulations require that each resident undergo a thorough assessment to guide the development of a personalized care plan. This assessment must be completed within 14 days of admission, within 14 days of identifying any significant change in the resident’s health, and at least once every 12 months thereafter. These evaluations include detailed information about the resident’s health status, demographic data, and other relevant factors.

Federal law also governs quality of care, including individualized care planning to ensure ongoing support, and quality of life, which is established as a fundamental principle designed to maintain or improve the quality of life for each individual resident. Nursing home residents are also entitled to "a dignified existence" and the right to make choices about their own lives. Facilities are required to respect residents’ personal preferences, such as choosing when to bathe or shower, and to provide interpreter services when there is a language barrier.