When a family makes the difficult decision to place a loved one in a nursing home or skilled nursing facility, they are trusting that institution with someone who cannot fully protect themselves. California law takes that trust seriously — and when a facility betrays it through negligence, the law provides meaningful remedies.

This guide explains what legally constitutes negligence in a California nursing home, how it differs from the higher standard of recklessness that triggers enhanced remedies under EADACPA, and what families can do when a loved one has been harmed.

The Legal Framework: Two Standards, Two Different Cases

California nursing home claims can be brought under two overlapping legal theories, and the distinction between them dramatically affects what a family can recover.

Ordinary Negligence

Ordinary negligence applies when a nursing home or caregiver fails to exercise the level of care that a reasonably competent facility would provide under the same circumstances. The four elements are the same as any California negligence claim:

1. Duty — the facility owed a duty of care to the resident
2. Breach — the facility failed to meet that standard
3. Causation — the breach caused the resident’s injury
4. Damages — the resident suffered actual harm

In a standard negligence case, recoverable damages include medical expenses, lost earnings, and pain and suffering. However, pain and suffering damages do not survive death under ordinary negligence — meaning if the resident dies before the case resolves, the estate typically cannot recover for what the resident endured.

EADACPA Recklessness — A Higher Bar With Far Greater Remedies

California’s Elder Abuse and Dependent Adult Civil Protection Act goes further. Under Welfare and Institutions Code § 15610.57, recklessness is defined as a conscious choice of a course of action either with knowledge of the serious danger it creates, or with knowledge of facts that would disclose that danger to any reasonable person. This is a higher standard than carelessness, but substantially lower than intentional misconduct.

When a plaintiff proves recklessness under EADACPA by clear and convincing evidence, three enhanced remedies become available in addition to all compensatory damages. For a detailed breakdown of how these remedies affect settlement values, see Average Elder Abuse & Nursing Home Settlement in California (2026 Guide).

• Attorney’s fees and costs — the defendant pays the plaintiff’s legal fees, which can total $150,000–$500,000 or more in serious cases
• Survival of pain and suffering damages — the estate can recover the resident’s pre-death suffering even after they die, overriding the usual rule under Code of Civil Procedure § 377.34
• Punitive damages — available under Civil Code § 3294 when the conduct constitutes malice, oppression, or fraud

Common Forms of Nursing Home Negligence in California

1. Understaffing

Chronic understaffing is the single most common driver of nursing home negligence claims in California. The California Department of Public Health (CDPH) sets minimum staffing ratios for skilled nursing facilities. When a facility knowingly operates below those minimums — often to reduce labor costs — the predictable consequences include delayed responses to call lights, missed medication doses, unattended falls, and preventable infections.

Understaffing that is systemic and deliberate — where management chose to cut staffing knowing it would foreseeably cause harm — crosses from ordinary negligence into EADACPA recklessness.

2. Pressure Sores (Bedsores)

Pressure ulcers, commonly called bedsores or decubitus ulcers, are injuries to the skin and underlying tissue caused by prolonged pressure. They are almost entirely preventable with adequate staffing and care protocols: repositioning immobile residents every two hours, maintaining skin hygiene, and using pressure-relief mattresses.

A Stage III or Stage IV pressure ulcer — where the wound has penetrated to muscle or bone — in a previously mobile or modestly impaired resident is frequently evidence of neglect. Facilities are required to document skin assessments on admission and on a regular basis; missing or falsified skin assessment records are a significant red flag.

3. Medication Errors

Medication errors in nursing home settings include:

• Administering the wrong medication or wrong dose
• Giving medications at the wrong time or skipping doses entirely
• Failing to monitor for drug interactions in residents on multiple medications
• Administering chemical restraints — sedating medications — to control behavior rather than for therapeutic reasons

California Health and Safety Code § 1599.60 and Title 22 of the California Code of Regulations impose specific requirements on medication management in licensed nursing facilities. Violations of these regulations are evidence of the breach element of a negligence claim.

4. Fall Injuries

Falls are the leading cause of injury-related death among adults over 65 in the United States. Nursing home residents are at elevated risk due to cognitive impairment, polypharmacy, muscle weakness, and unfamiliar environments. Facilities are required to conduct fall risk assessments on admission and after any fall, and to implement individualized fall prevention plans.

Negligence in this context includes failure to conduct an adequate risk assessment, failure to implement the plan that was developed, leaving bed rails down on a known fall-risk resident, inadequate staffing to respond to call lights, and failure to address known environmental hazards such as wet floors or poor lighting.

5. Physical Abuse and Improper Restraint

Physical abuse of nursing home residents — hitting, slapping, rough handling, or improper use of physical restraints — is both a crime under California Penal Code § 368 and an actionable civil claim under EADACPA. California law strongly disfavors physical restraints: they may only be used when clinically necessary, with physician authorization, and with resident or family consent. Using restraints as a convenience measure or for staff convenience — rather than for the resident’s safety — constitutes abuse.

Facility liability attaches both directly through negligent hiring, training, and supervision, and vicariously through respondeat superior for employee conduct within the scope of employment.

6. Malnutrition and Dehydration

Residents who cannot feed themselves independently are entirely dependent on staff for adequate nutrition and hydration. Malnutrition and dehydration are serious medical conditions that are both preventable and documentable. Signs include unintended weight loss, dry mucous membranes, low albumin levels in lab work, and documentation of missed meals or refused feedings without documented follow-up.

Facilities are required under Title 22 regulations to maintain nutritional assessments and care plans. Unexplained weight loss or dehydration in a nursing home resident whose intake is entirely controlled by the facility is strong evidence of a care failure.

7. Elopement and Inadequate Supervision

Residents with dementia or other cognitive impairments who leave a facility unsupervised — a phenomenon called elopement — face serious risk of injury or death. Facilities are required to conduct wandering risk assessments and implement appropriate safeguards including secured units, electronic door alarms, and staff supervision protocols. Failure to do so, resulting in a resident being found outdoors, injured, or deceased, is actionable negligence.

8. Failure to Respond to Medical Emergencies

Nursing home staff are required to recognize and respond to medical emergencies — falls, strokes, cardiac events, respiratory distress — promptly. Failure to call 911 when clinically indicated, delay in notifying the attending physician, or failure to document and monitor a deteriorating resident can all constitute negligence when that failure causes or worsens injury.

Warning Signs That Negligence May Have Occurred

Family members are often the first to notice that something is wrong. Warning signs that may indicate nursing home negligence include:

• Unexplained bruises, cuts, or fractures
• Pressure sores on the heels, sacrum, hips, or other bony prominences
• Significant unintended weight loss or visible signs of dehydration
• Poor hygiene — unwashed hair, soiled clothing, unchanged briefs
• A resident who was previously mobile now confined to bed without a documented medical reason
• Sudden behavioral changes — withdrawal, fear, agitation — particularly around certain staff members
• Medication administration records showing gaps, errors, or refusals without follow-up
• A facility with recent CDPH citations or deficiency findings — searchable at the California Health and Human Services Agency website

Statute of Limitations for California Nursing Home Negligence Claims

The deadline to file a nursing home negligence or elder abuse claim in California depends on the legal theory:

• Ordinary negligence: two years from the date of the injury or the date it was (or reasonably should have been) discovered — California Code of Civil Procedure § 335.1
• EADACPA elder abuse claims: also generally two years, though the discovery rule may extend this deadline when the family could not reasonably have discovered the abuse earlier
• Wrongful death: two years from the date of death — Code of Civil Procedure § 335.1

These deadlines are unforgiving. Missing the statute of limitations permanently bars recovery regardless of how strong the underlying claim is. Contact an attorney as soon as you suspect negligence — not after the deadline has passed.

Frequently Asked Questions

Quick Summary

What Is the Average Elder Abuse or Nursing Home Settlement in California?

When a loved one enters a nursing home, assisted living facility, or skilled nursing facility, families entrust that institution with their most vulnerable family member. When that trust is violated — through neglect, physical abuse, financial exploitation, or reckless disregard for the resident’s safety — California law provides far stronger remedies than standard negligence law.

California’s Elder Abuse and Dependent Adult Civil Protection Act (EADACPA), codified at Welfare and Institutions Code § 15600 et seq., was enacted specifically because the Legislature recognized that elderly and dependent adults are uniquely vulnerable and that standard negligence remedies were insufficient deterrents against institutional abuse. The Act creates a separate, enhanced civil cause of action with remedies that go well beyond what is available in a standard personal injury case.

This guide explains how EADACPA enhanced remedies work, what settlement values are realistic across different types of elder abuse and neglect cases, and what separates a standard negligence case from an enhanced remedies case. It draws on over 30 years of experience handling elder abuse and nursing home cases throughout Los Angeles and Southern California.

(For an overview of California nursing home abuse claims and legal framework, see: California Nursing Home Abuse Claims.)

The EADACPA Framework: Why California Elder Abuse Cases Are Worth More

The most important thing to understand about California elder abuse claims is that they are not ordinary negligence cases. When the statutory requirements are met, EADACPA transforms the claim — adding remedies that can more than double the value of an otherwise ordinary care failure case.

Standard Negligence vs. EADACPA Enhanced Remedies: The Critical Distinction

A nursing home that fails to turn a bedridden patient regularly, causing a preventable pressure wound, may face a negligence claim for the cost of treating the wound, lost wages, and pain and suffering. That is a standard of care violation — ordinary negligence.

But if that same nursing home was chronically understaffed to cut costs, had been cited by the California Department of Public Health (CDPH) for the same deficiency on prior inspections, and management chose to continue the practice despite knowing it would cause serious harm — that is recklessness under EADACPA. The legal consequences are categorically different.

The Three Enhanced Remedies Under W&I Code § 15657

When a plaintiff proves by clear and convincing evidence that the defendant — a nursing home, assisted living facility, or individual caregiver — acted with recklessness, oppression, fraud, or malice, W&I Code § 15657 provides three enhanced remedies on top of all compensatory damages:

• Attorney’s fees and costs: The defendant pays the plaintiff’s attorney’s fees and litigation costs. In a serious elder abuse case, attorney’s fees alone can total $150,000 to $500,000 or more. This fee-shifting provision is one of the most powerful settlement levers in California elder abuse litigation — it turns a case the facility might otherwise fight into one they must seriously consider settling at full value.
• Survival of pain and suffering damages: Under standard California law, the decedent’s pain and suffering damages do not survive death and cannot be recovered by the estate (Code of Civil Procedure § 377.34). EADACPA overrides this limitation — when enhanced remedies are established, the estate can recover the victim’s pre-death pain and suffering even after the victim has died. For elderly nursing home residents who die before the case resolves, this is often the largest component of the recovery.
• Punitive damages: Civil Code § 3294 punitive damages are available when the defendant’s conduct constitutes malice, oppression, or fraud. In institutional elder abuse cases involving systemic understaffing, pattern violations, or deliberate cost-cutting that foreseeably causes harm, punitive damages arguments are often strong. California juries have awarded substantial punitive damages against nursing home chains in cases of egregious institutional neglect.

The Recklessness Standard — What It Takes to Trigger Enhanced Remedies

“Recklessness” under EADACPA is defined as conduct that involves a conscious choice of a course of action either with knowledge of the serious danger to others involved or with knowledge of facts that would disclose this danger to any reasonable person (W&I Code § 15610.57). This is a higher standard than ordinary negligence but substantially lower than intentional misconduct.

In nursing home cases, recklessness is established through:

• Chronic understaffing below regulatory minimums for the resident population’s acuity level
• Prior CDPH citations for the same deficiency that went uncorrected
• Management’s knowledge of the dangerous condition and deliberate failure to address it
• Policy decisions prioritizing financial returns over resident safety
• Failure to implement a known care plan for a high-risk resident
• Repeated failure to respond to family complaints about dangerous conditions

For more on the legal framework governing California nursing home abuse claims, see: Civil Claims for Elder Patient Rights Abuses in California.

Types of Elder Abuse and Neglect in California Facility Cases

Physical Neglect — Pressure Wounds, Falls, and Malnutrition

Physical neglect is the most common basis for California nursing home litigation. It encompasses the failure to provide basic care required by the resident’s condition: failure to turn and reposition bedridden residents (causing pressure injuries), failure to implement fall prevention protocols for high-risk residents, failure to provide adequate nutrition and hydration, failure to maintain hygiene, and failure to respond to medical symptoms.

Pressure injuries (also called pressure ulcers or bedsores) are a defining indicator of neglect. A stage 3 or stage 4 pressure wound — where the injury has penetrated through the skin into muscle or bone — in a nursing home resident who was admitted without such a wound is strong evidence of neglect. Pressure wounds of this severity are almost always preventable with proper repositioning and skin integrity monitoring.

Physical Abuse

Physical abuse includes hitting, slapping, pushing, inappropriate physical restraint, and any other use of physical force causing pain or injury. Physical abuse in nursing home settings is often perpetrated by overworked, undertrained, or improperly screened staff. Facility liability attaches both directly (negligent hiring, training, and supervision) and vicariously (respondeat superior for employee conduct within the scope of employment).

Sexual Abuse

Sexual abuse of nursing home and care facility residents — who are often cognitively impaired, physically dependent, or unable to communicate or report abuse — is a serious and underreported category. California Welfare and Institutions Code § 15610.63 specifically defines sexual abuse of a dependent adult as an actionable form of elder abuse. These cases involve not only the individual perpetrator but the facility’s liability for negligent hiring, failure to perform background checks, failure to investigate complaints, and failure to implement safeguards.

For more on dependent adult abuse in California care facilities, see: Dependent Adult Abuse.

Financial Abuse and Exploitation

Financial abuse — theft, fraud, undue influence over financial decisions, and exploitation of a resident’s assets — is actionable under EADACPA and can trigger the full range of enhanced remedies. W&I Code § 15610.30 defines financial abuse broadly to include taking, secreting, appropriating, or retaining property of an elder for wrongful use or with intent to defraud. Financial abuse perpetrated by facility staff or by persons using a care relationship to gain access to the elder’s finances is directly covered.

Chemical Restraint and Medication Misuse

Chemical restraint — the use of sedating medications to manage residents’ behavior rather than for legitimate medical purposes — is a form of abuse under EADACPA. Over-sedation renders residents unable to call for help, eat, participate in therapy, or communicate with family, causing rapid physical and cognitive decline. CMS (Centers for Medicare & Medicaid Services) regulations restrict the use of antipsychotic medications in nursing home residents without specific medical justification, and violations create both regulatory liability and civil EADACPA claims.

Elopement and Supervision Failures

Elopement — when a cognitively impaired resident leaves the facility unsupervised and is injured or killed — is a serious and preventable category of nursing home harm. Facilities are required to have elopement prevention programs for residents identified as elopement risks. When a resident identified as a risk wanders off and sustains a fall, is struck by a vehicle, or dies from exposure, the facility faces strong EADACPA liability.

Wrongful Death from Neglect

When nursing home neglect proximately causes a resident’s death — from sepsis from an untreated pressure wound, from a fall caused by inadequate supervision, from aspiration pneumonia from improper feeding, or from dehydration and malnutrition — the family has both a wrongful death claim and, critically, an EADACPA survival action that allows recovery of the resident’s pre-death pain and suffering. The combination of these two claims makes California nursing home wrongful death cases among the highest-value elder abuse claims.

California Elder Abuse and Nursing Home Settlement Ranges (2026)

The ranges below reflect realistic California elder abuse settlements under EADACPA. The critical distinction is whether the case meets the recklessness/malice standard for enhanced remedies — cases that do are worth substantially more than those that only support standard negligence recovery.

Important: These ranges assume identified recklessness or malice for the higher-value cases. Cases that only support standard negligence — where the facility made an isolated care error rather than a conscious choice to cut costs or ignore known risks — will fall in the lower tier. The investigation required to establish recklessness is case-specific and fact-intensive.

How California Elder Abuse Cases Are Investigated

The evidence that separates a standard negligence case from an enhanced remedies EADACPA case is almost entirely within the facility’s records — records that are often not readily accessible without formal legal process. Early and aggressive investigation is essential.

CDPH Inspection Reports and Deficiency Citations

The California Department of Public Health inspects licensed nursing facilities and issues deficiency citations when regulatory standards are violated. These inspection reports — publicly available through the CDPH website and through litigation discovery — document exactly what violations were found, when they were found, whether they were corrected, and whether the same deficiency appeared on prior inspections. A facility with a history of citations for the same deficiency that injured your family member has near-perfect recklessness evidence built into its regulatory record.

Staffing Records and Payroll Data

Chronic understaffing is the most common driver of recklessness findings in California nursing home cases. Facilities are required to maintain minimum staffing levels based on resident count and acuity. Payroll records, scheduling records, and the facility’s own staffing matrices — obtained through litigation discovery — document whether the facility was operating below minimum staffing levels on the days and shifts when the harm occurred. Expert testimony from nursing home staffing experts translates this data into recklessness evidence.

Resident Care Plans and Nursing Notes

The resident’s care plan documents what the facility knew about the resident’s risk factors — fall risk, pressure injury risk, nutrition needs, cognitive status — and what interventions were required. Nursing notes document whether those interventions were actually performed. The gap between what the care plan required and what the notes document is often the core of the negligence case, and when that gap is systematic and long-standing, it supports recklessness.

Corporate Ownership and Management Records

Many California nursing homes are operated by large corporate chains. When systemic understaffing or cost-cutting policies are traceable to corporate management decisions — rather than isolated facility-level failures — the corporate parent faces direct liability in addition to the operating facility. Corporate financial records showing that cost-cutting targets were set and implemented at the expense of staffing levels are powerful evidence of institutional recklessness.

Insurance Coverage in California Elder Abuse Cases

California nursing homes and assisted living facilities are required to carry professional liability insurance (also called medical malpractice insurance in this context) and general liability insurance. Coverage amounts vary significantly by facility size and corporate structure:

• Independent nursing homes: Typically carry $1,000,000–$3,000,000 in professional liability coverage per occurrence.
• Large corporate nursing home chains: May carry $5,000,000–$25,000,000 in combined coverage, often structured through captive insurance arrangements or self-insurance programs.
• Assisted living facilities: Coverage varies more widely — some carry as little as $1,000,000; large corporate chains carry substantially more.
• Home care agencies: Typically carry $1,000,000–$3,000,000 in general liability coverage.

The attorney’s fees provision of EADACPA creates a specific coverage dynamic: when a plaintiff makes a well-documented demand that includes the potential attorney’s fee award, facilities and their insurers must account for the total exposure — compensatory damages plus attorney’s fees plus potential punitive damages — in their settlement analysis. This total exposure often substantially exceeds the compensatory damages alone and creates strong pressure to settle at or near policy limits in cases with strong recklessness evidence.

An important caveat: punitive damages are generally not covered by liability insurance policies under California law (Ins. Code § 533). When punitive damages are legitimately in play, the defendant faces out-of-pocket exposure that is separate from the insurer’s coverage — creating additional settlement pressure, particularly for corporate defendants with substantial assets.

Factors That Determine California Elder Abuse Settlement Value

1. Whether Enhanced Remedies Are Established

This is the single most important variable. A case that establishes recklessness under EADACPA is worth substantially more than a case that only supports standard negligence — because it adds attorney’s fees (removing the economic disincentive for full litigation), survival of pain and suffering (adding a major damages category in wrongful death cases), and potential punitive damages. The investigation required to establish recklessness — CDPH records, staffing data, corporate documents — is the foundation of maximum value recovery.

2. Injury Severity and Duration of Suffering

The severity of the physical injuries and the duration of the resident’s suffering directly drive non-economic damages. A stage 4 pressure wound that went undetected for weeks — causing osteomyelitis, sepsis, and months of painful treatment — produces higher non-economic damages than a stage 2 wound caught early. When the EADACPA survival of pain and suffering provision applies, the resident’s documented suffering — even after death — becomes recoverable by the estate.

3. Wrongful Death Component

When neglect or abuse causes death, the family has two parallel claims: the wrongful death claim (CCP § 377.60) compensating the family’s own losses, and the survival action (CCP § 377.30) compensating the estate for the decedent’s pre-death losses. Under EADACPA, the survival action includes the decedent’s pain and suffering — normally excluded from post-death recovery under CCP § 377.34. The combination of both claims in an EADACPA wrongful death case produces the highest total recovery in this category.

4. Prior CDPH Violations and Pattern Evidence

Prior deficiency citations for the same issue that caused the current harm are the strongest available recklessness evidence. When a facility has been cited multiple times for inadequate pressure injury prevention, failed to correct the deficiency, and a resident develops a catastrophic pressure wound, the citation history converts an otherwise standard negligence case into a strong enhanced remedies case. Facilities with pattern violations face settlement pressure that facilities without such histories do not.

5. Corporate vs. Individual Facility Defendant

When systemic cost-cutting or understaffing policies are traceable to corporate management, the corporate parent is a defendant with substantially larger coverage and assets than the individual facility. Corporate chain defendants face higher reputational exposure, higher punitive damages exposure, and more sophisticated settlement analysis than independent facility operators. Cases against large nursing home chains regularly produce higher settlements than comparable cases against small independent operators.

What to Do If You Suspect Elder Abuse or Nursing Home Neglect in California

1. Document everything immediately. Photograph pressure wounds, bruises, injuries, and the resident’s condition. Note dates, times, and the names of staff present. Request copies of the resident’s care plan and recent nursing notes. This documentation should begin as soon as abuse or neglect is suspected — before the facility has an opportunity to remediate or modify records.
2. Report to regulatory authorities. File a complaint with the California Department of Public Health (CDPH) at 1-800-236-9747 for nursing homes, and with the California Department of Social Services (CDSS) for residential care facilities for the elderly. An ombudsman complaint can also be filed through the Long-Term Care Ombudsman Program. These reports trigger investigations that produce official records usable in civil litigation.
3. Request all facility records. Under California law, a patient or their authorized representative has the right to access medical records within 5–15 days of request (Health & Safety Code § 123111). Request the complete medical record, incident reports, staffing records, and care plans. Facilities sometimes resist; an attorney can enforce these rights through formal legal process.
4. Check CDPH inspection history. The CDPH publishes inspection reports and deficiency citations for all licensed nursing facilities on its website. Reviewing the facility’s recent inspection history before or immediately after placing a complaint can reveal prior violations that establish the recklessness pattern needed for enhanced remedies.
5. Contact an elder abuse attorney immediately. Evidence in nursing home abuse cases — electronic medical records, surveillance footage, staffing records — can be altered or destroyed if not preserved promptly through a legal hold letter. The statute of limitations for EADACPA claims is two years from the date of the abuse or neglect (or within two years of the date the plaintiff discovered or should have discovered the abuse). For wrongful death, two years from the date of death.
6. Consider a facility transfer if the resident is still living. If the resident is still in the facility where abuse occurred, discuss a transfer to a different facility with the treating physician. Continuing to reside in the abusive facility is a safety risk, and transferring does not waive any legal claims.

Frequently Asked Questions: Elder Abuse and Nursing Home Settlements in California

Related Guides on victimslawyer.com

• Elder Abuse and Neglect Attorney Los Angeles
• California Nursing Home Abuse Claims
• Civil Claims for Elder Patient Rights Abuses in California
• Dependent Adult Abuse
• Understanding Nursing Home Abuse in Los Angeles: Legal Protections and Remedies for Victims
• Average Hip Fracture Settlement in California (2026 Guide)
• Average Personal Injury Settlement in California (2026): Real Data by Injury Type, Severity, and Insurer
• Average Wrongful Death Settlement Values in California
• Recent Case Results

Disclaimer: This article is intended for general informational purposes only and does not constitute legal advice. Settlement ranges discussed are illustrative composites drawn from firm experience and publicly available California verdict and settlement data. They are not promises or guarantees of any specific result. Past results do not guarantee future outcomes. Individual case values depend on the specific facts, injuries, insurance coverage, and applicable law. If you believe a loved one has been the victim of elder abuse or nursing home neglect, consult a licensed California personal injury attorney regarding your specific situation.

What Constitutes Nursing Home Abuse?

Nursing home abuse can manifest in various ways:

• Physical Abuse: The intentional use of force that causes pain, injury, or impairment (e.g., hitting, slapping, or using physical restraints).
• Emotional Abuse: Verbal threats, insults, humiliation, and isolation intended to cause emotional distress.
• Sexual Abuse: Non-consensual sexual contact or exploitation of an elderly resident.
• Neglect: Failure to provide adequate care, including withholding food, medical attention, or hygiene assistance.
• Financial Abuse: Unauthorized use of an elderly person’s funds, property, or assets.

The emotional and physical toll on victims and their families can be devastating, which is why the law provides avenues for justice and compensation.

Legal Protections Under California Law

California takes elder abuse seriously. The Elder Abuse and Dependent Adult Civil Protection Act (EADACPA) is a critical piece of legislation that protects residents of nursing homes and other long-term care facilities. Enacted under California Welfare and Institutions Code § 15600 et seq., EADACPA provides civil and criminal penalties for those who commit elder abuse or neglect.

Key Provisions of EADACPA

1. Definition of Elder Abuse: Elder abuse is defined as the physical, emotional, or financial abuse of anyone aged 65 or older. The statute also protects dependent adults aged 18 to 64 who suffer from physical or mental limitations.
2. Neglect and Care Violations: Nursing homes and caregivers can be held liable for failing to provide the necessary care, which includes not attending to a resident’s basic needs or medical requirements.
3. Civil Remedies: Under EADACPA, victims or their families can file civil lawsuits for damages, including medical costs, pain and suffering, and in cases of egregious abuse, punitive damages. The statute allows for the recovery of attorney’s fees and costs, making it easier for victims to pursue claims.
4. Criminal Penalties: Those found guilty of elder abuse can face criminal charges ranging from misdemeanors to felonies, depending on the severity of the harm inflicted on the victim. Penalties may include imprisonment, fines, or both.

How to Identify Signs of Nursing Home Abuse

Recognizing the signs of nursing home abuse is crucial to stopping it early. Common warning signs include:

• Unexplained injuries such as bruises, cuts, or broken bones.
• Sudden changes in behavior, including depression, anxiety, or withdrawal.
• Poor hygiene, malnutrition, or dehydration.
• Bedsores or other medical conditions that have not been properly treated.
• Unexplained financial transactions or changes in legal documents such as wills or powers of attorney.

If you notice any of these signs, take action immediately.

What to Do If You Suspect Abuse

If you believe that your loved one is a victim of nursing home abuse, it is important to act quickly. Here are the steps you can take:

1. Report the Abuse: In California, you can report suspected abuse to Adult Protective Services (APS) or the Long-Term Care Ombudsman Program. In cases of immediate danger, call 911.
2. Document the Evidence: Keep detailed records of your observations, including dates, names, photographs of injuries, and any conversations with staff or administrators.
3. Consult a Nursing Home Abuse Attorney: Navigating the legal complexities of nursing home abuse claims requires expertise. An experienced attorney can help you gather evidence, file claims, and pursue compensation on behalf of your loved one.

Filing a Lawsuit: Holding Nursing Homes Accountable

In addition to reporting the abuse, filing a civil lawsuit is one of the most effective ways to hold nursing homes and caregivers accountable. A nursing home abuse attorney will help you build a case by:

• Investigating the facility’s history of care violations or past abuse claims.
• Interviewing staff, residents, and other witnesses.
• Working with medical experts to document the extent of the injuries and the standard of care that should have been provided.

Conclusion

Nursing home abuse is a tragic reality that affects thousands of elderly individuals across Los Angeles and California. However, the law offers powerful tools to protect victims and their families. If your loved one has suffered abuse or neglect in a nursing home, it is important to understand your rights under the Elder Abuse and Dependent Adult Civil Protection Act and seek legal assistance.

At Steven M. Sweat, Personal Injury Attorneys, APC, we are dedicated to helping families pursue justice for their elderly loved ones. Contact us today to schedule a free consultation and learn how we can assist you in holding negligent nursing homes accountable. Call 24/7 at 866-966-5240

Sources:

• California Welfare and Institutions Code § 15600 et seq. (Elder Abuse and Dependent Adult Civil Protection Act)

Factual and procedural background

Brandon Nelson was a 26-year-old engineering graduate who developed acute psychosis in Jan. 2018. He told a police officer friend that he needed to borrow a handgun to kill himself because he felt evil and animal-like. The friend called the police, and Brandon was placed on a psychiatric hold for 72 hours in an inpatient psychiatric facility. He was subsequently treated for six weeks, first in Pasadena at Las Encinas Mental Hospital (LEMH) and subsequently in Laguna Beach at Mission Hospital. The hospital records at LEMH noted that Brandon was delusional, paranoid, believed he was being recorded, was fearful, and was considered gravely disabled. LEMH discharged him on Feb. 23rd. He was then admitted to Mission Hospital three days later on Feb. 26 on a new psychiatric hold after he again threatened to commit suicide. Brandon signed a durable power of attorney (POA) on Feb. 27, granting his father, Allen Nelson, power of attorney to handle Brandon’s financial affairs and personal care, including the ability to use Brandon’s resources for placement in a residential care or skilled nursing facility.

Mission Hospital completed a certification review on March 1 and found that Brandon was still gravely disabled and in danger of self-harm and recommended that his hold be extended for 14 days. However, he was discharged from Mission Hospital on March 7. On March 6, one doctor found that Brandon required ongoing inpatient care. On March 7, however, a second doctor found that he should be released to the care of his parents so that they could find a residential placement with appropriate licensing to handle his psychiatric needs. Instead of notifying his parents, Mission Hospital instead released him to the care of Sovereign Health of San Clemente, a dual diagnosis and sober living facility that was not licensed to provide the type of care Brandon required.

Upon his arrival at Sovereign Health, Brandon signed an arbitration agreement as a part of his intake paperwork. The Sovereign employee who did his intake testified that she didn’t recall doing it but also testified that Brandon was agitated, so she requested that he be seen by a licensed clinician. He was seen by a licensed clinical social worker on the evening of March 7, and she performed a biopsychosocial assessment and found that he came without his psychotropic medication, which was precipitating his crisis. The assessment stated that he had been without his psychotropic medication for 24 hours and also noted that Brandon was experiencing auditory hallucinations, thought that people on television were talking to him, and knew that his thinking was impaired. She stated that he was lying in a fetal position and howling. He also yelled for the voices in his head to stop telling him negative things. She wrote that his symptoms decreased after he took his medication. The social worker wrote that he needed to be supervised 24 hours per day because of his high risk of decompensation without medication.

The following day, Sovereign waited until 6:20 pm to give Brandon his medication while they waited for his prescription to be transferred to one of Sovereign’s own pharmacies. At 7 pm, Brandon again began screaming. However, the facility allowed him to return to his room unsupervised at 7:45 pm, where he hung himself from a sprinkler with the drawstring from his pants.

Brandon’s parents, Allen and Rose Nelson, filed a lawsuit against Sovereign for wrongful death. They also included causes of action on Brandon’s behalf for negligence, dependent adult neglect or abuse, negligence per se, fraud, and negligent misrepresentation. Sovereign filed a motion to compel arbitration based on the arbitration agreement that Brandon allegedly signed. The motion was denied. The court found that the defendant had not properly authenticated Brandon’s signature and that the agreement was unconscionable and unenforceable. Sovereign filed an appeal.

Issue: Whether the trial court erred when it denied Sovereign’s motion to compel arbitration?

Sovereign argued that the trial court erred when it denied Sovereign’s motion to compel arbitration and in its finding that Sovereign had not properly authenticated Brandon’s signature. It also argued that an arbitrator instead of a court should have decided the preliminary matters, including the case’s arbitrability.

Rule: The party arguing for arbitration must prove the agreement existed, and the party opposing arbitration must present evidence of a defense such as its unconscionability.

The California Arbitration Act is meant to ensure that arbitration agreements are enforced according to their terms. However, the party moving to compel arbitration must present evidence showing an arbitration agreement exists by a preponderance of the evidence. The party opposing a motion to arbitrate must then present evidence showing that the agreement is unconscionable or that another defense applies.

Analysis

Parties can agree for an arbitrator to resolve their disputes over preliminary matters instead of the court when a motion to compel arbitration is filed or agree to delegate the authority to determine an arbitration agreement’s enforceability to an arbitrator. Sovereign argued that the arbitration agreement purportedly signed by Brandon included a delegation clause, so the court should not have determined whether the agreement was enforceable and should have instead granted the motion to compel arbitration. Under California law, there is a presumption that the arbitrability of an agreement should be initially determined by the court unless there is clear language agreeing for the decision to be delegated to an arbitrator.

Sovereign also argued that the Federal Arbitration Act applied instead of the California Arbitration Act and said that its agreement with Brandon involved interstate commerce. The defendant relied on the testimony of the intake worker, who testified that Sovereign obtained supplies and food from out-of-state vendors for the use of its residents. The appeals court noted that there is little difference between the FAA and the CAA since both presume that the arbitrability of an agreement should be initially decided by a court unless the parties clearly and unmistakably agreed to delegate the duty to an arbitrator. Sovereign argued that the parties implicitly agreed to delegate the determination of the scope and enforceability of the arbitration agreement by a statement that said that the parties desired to have disputes resolved by an arbitrator.

The Court of Appeal found that this was not clear and unmistakable and did not mention the determination of arbitrability. Sovereign also argued that the rules of the American Arbitration Association (AAA) should apply but admitted that those rules had not been given to Brandon at the time the contract was signed even though the agreement stated that they were incorporated by reference. It argued that the AAA rules would bind Brandon and his parents to arbitrate the arbitrability of the contract. However, Sovereign did not present any precedent holding that a reference to those rules would bind a party who was unsophisticated. The Court of Appeal found that the trial court judge did not err by making the decision about arbitrability.

Next, the court considered whether the agreement was unconscionable and unenforceable. The court noted that unconscionability includes both procedural and substantive components. Determining whether a contract is procedurally unconscionable involves considering whether the bargaining parties were roughly equal or if they instead were unequal, making the contract a contract of adhesion.

A contract is substantively unconscionable when it is substantially unfair and oppressive to the party that did not draft it. A court cannot refuse to enforce an agreement unless it finds that it is both procedurally and substantively unconscionable. The Court of Appeal found that the contract was a contract of adhesion and that there was no evidence that Brandon had equal bargaining power. It noted that Brandon was not provided a copy of the AAA rules, which amounted to oppression and a surprise. The court also noted that the biopsychosocial assessment indicated that Brandon had an impaired mental state, so it would be unlikely he would have been able to understand or comprehended what he signed because he was a mentally impaired dependent adult. The Court of Appeal thus found that it was procedurally unconscionable.

It next considered whether the agreement was also substantively unconscionable, which occurs when an agreement is unfairly one-sided. The Court of Appeal pointed out that the arbitration agreement expressly waived Brandon’s right to sue Sovereign for anything related to his stay while the agreement did not waive Sovereign’s ability to sue Brandon. The release also waived Sovereign’s liability for any negligence that might occur, including dependent abuse or neglect. The waivers also purportedly extended to the rights of third parties to pursue claims against Sovereign or hold the company liable for negligence and that Brandon agreed to reimburse the company for any legal fees and costs it might have to pay to defend itself against a third-party claim related to his stay. The Court of Appeal found that the arbitration agreement was unconscionable and unenforceable.

Conclusion

The Court of Appeal affirmed the trial court’s ruling and returned the case for further proceedings. It also awarded the plaintiffs their costs on appeal.

Consult an injury attorney

If your loved one was forced to sign an arbitration agreement when he or she entered a nursing home or residential care facility that purported to waive his or her rights to pursue claims against the facility for dependent adult abuse or neglect, you should speak to an attorney if your loved one was abused or neglected in the facility. Contact the Steven M. Sweat, Personal Injury Lawyers, APC for a free case evaluation by calling 866-966-5240.

Factual and Procedural Background

In the case of Samantha B., et. al. v. Aurora Vista Del Mar, LLC, et. al., Cal. Ct. App. Case No. B30231, several women who were patients of a mental health hospital alleged that they were repeatedly sexually abused by an unlicensed attendant. Samantha B., Danielle W., and C. F. were patients at Aurora Vista Del Mar, a licensed psychiatric hospital. The facility was owned by Signature Healthcare Services.

In 2011, Aurora hired Juan Valencia to work in the hospital as an unlicensed mental health worker. At the time he was hired, Valencia was presented with a form in which he was asked if he had ever been arrested for an offense that would require sex offender registration, and he answered no. The hospital hired a third-party consumer reporting agency to conduct a background check on Mr. Valencia that only went back seven years before his hiring date. Consumer reporting agencies are not allowed to report arrests not leading to convictions that are older than seven years.

Valencia had a misdemeanor conviction 11 years before his hiring date. He had originally been charged with sexual abuse of a minor, which would have required him to register as a sex offender. However, he pleaded that charge down to the misdemeanor for which he was convicted, and the misdemeanor conviction did not require sex offender registration.

Since Valencia was hired to work as an unlicensed mental health worker, the hospital’s background check did not include fingerprint checks. If the hospital had instead hired licensed certified nurse’s aides (CNAs), the background check would have revealed Valencia’s past arrest and conviction. The hospital’s unlicensed mental health worker positions did not require that employees have any previous experience, training, or education. Upon being hired, Valencia completed a two-day orientation. During the orientation, he received around five minutes of training about countertransference, which occurs when caregivers form emotional bonds with their patients.

After his initial orientation, Valencia was only required to sign forms annually about relationships between patients and staff. Aurora did not test him or other mental health workers about their understanding of patient boundaries.

Aurora’s policy allowed male mental health workers to be in the rooms of female patients unsupervised for up to 20 minutes at a time as long as the doors were kept open. However, the charge nurse remained at the nurse’s station for much of the time and could not see into the rooms from that vantage point.

In 2013, while Valencia was still working at the hospital, Samantha B., Danielle W., and one other woman were patients. All three were suffering from psychosis and could not consent to sex. Valencia allegedly engaged in sexual relations with all three women while they were patients in the facility. Other workers in the hospital called Valencia “Rapey Juan.” When one staff reported this nickname to the charge nurse, she only rolled her eyes.

Earlier, in 2004, a former employee had raped a 17-year-old patient in the same hospital. At that time, the clinical director recommended that Aurora increase its education to improve the ability of workers to set boundaries with patients. However, the chief executive officer (CEO) told the clinical director that Signature Healthcare Services would not pay for the additional training and education component on boundaries.

On Nov. 29, 2013, Danielle W. was discharged from Aurora. The following day, a student nurse encountered Danielle W. together with Valencia at a party and reported that they appeared to be involved romantically. Valencia was suspended and subsequently terminated on Dec. 12, 2013, following a two-day investigation. Even though the investigation revealed that the relationship between Valencia and Danielle B. was sexual, the facility failed to report it to the state for a year. Instead, the hospital only reported the sexual relationship after it became public knowledge.

Samantha B. was discharged from Aurora on March 6, 2013. She filed a lawsuit against Aurora in Feb. 2015 and subsequently added Signature Healthcare Services as a defendant in June 2015. Danielle W. filed a similar lawsuit against Aurora in Aug. 2015, and the third patient, C.F., was discharged on April 29, 2013, and filed a lawsuit in June 2015.

The lawsuits were consolidated into a single action, and the case went to a jury trial. The jury returned verdicts in favor of all three plaintiffs. The jury awarded $3 million to Danielle W., $3.75 million to Samantha B., and $6.5 million to C. F. All of the damages awarded were noneconomic. Each plaintiff was also awarded $50,000 in punitive damages. The jury found that Signature was 30% at fault, Aurora was 35% at fault, and Valencia was 35% at fault. Aurora and Signature appealed.

Issue: Whether the court erred by not reducing the noneconomic damages award to the plaintiffs to $250,000?

Both Aurora and Signature argued that all three plaintiffs’ actions were time-barred and that even if they were not, their noneconomic damages should have been capped at $250,000 under MICRA. The plaintiffs argued that the time limitation and damages cap under MICRA did not apply and instead, the rules under the Elder Abuse Act should apply.

Rule: Lawsuits alleging professional medical negligence must be filed within one year of when the injury occurred or within one year of when it reasonably should have been discovered. Under MICRA, non-economic damages are capped at $250,000.

Under Cal. Civ. Code Proc. § 340.5, claims that allege medical malpractice must be filed within one year of the date of the injury or one year from the date the injury should reasonably have been discovered. This statute of limitations is included in MICRA. The defendants argued that it barred all three plaintiffs’ lawsuits against Aurora and Signature. The defendants also argued that non-economic damages are limited in medical malpractice actions under Cal. Code Civ. Proc. § 3333.2 to no more than $250,000.

The plaintiffs argued that MICRA did not apply and that instead, the Elder Abuse Act did. They argued that under the Elder Abuse Act, their complaints were not time-barred and that their non-economic damages should not be capped.

Analysis

The court began by looking at the time limitations for filing claims under MICRA. While it noted that complaints alleging professional negligence under MICRA are subject to the one-year statute of limitations, there is a four-year statute of limitations when the Elder Abuse Act applies. It then considered whether MICRA or the Elder Abuse Act applied to the plaintiffs’ case.

Unlike MICRA, which only applies in situations involving professional negligence, the Elder Abuse Act applies when the professional conduct is reckless, fraudulent, malicious, or oppressive in failing to prevent the abuse or neglect of elderly or dependent adults. The court noted that claims under the Elder Abuse Act are distinct and separate from claims under MICRA.

In Delaney v. Baker, 20 Cal.4th 23 (1999), the California Supreme Court rejected a defendant’s argument that the meaning of professional negligence applies to any situation involving a provider’s services and instead found that the heightened legal remedies under the Elder Abuse Act apply when a plaintiff proves the conduct was reckless.[5]

The court then considered whether the Elder Abuse Act or MICRA applied to the plaintiffs’ case. It noted that the hospital and its parent company had previous knowledge that a patient could be sexually abused by a male mental health worker because of the 2004 incident but failed to institute any additional education or training about boundaries. It also noted that failing to require employees who work with vulnerable adults to have licensure and more thorough background checks was also reckless.

Conclusion

The court found that the Elder Abuse Act applied. This meant that the claims were not filed beyond the statute of limitations, and the damages awards were not excessive. The trial court was affirmed, and the defendants were ordered to pay the plaintiffs’ costs on appeal.

Talk to an Experienced Attorney

If you were abused as a dependent adult while you were under the care of a hospital or other facility, you should consult an experienced injury and abuse lawyer. The attorneys at the law firm of Steven M. Sweat, Personal Injury Lawyers, APC can review your situation and explain the potential remedies that might be available. Call us today at 866-966.5240 for a free and confidential consultation.

Nursing home abuse in California is still a huge problem. By way of example: The case of an 88-year-old Sacramento, California woman found dead in 2013 after living in a residential nursing home was unbelievably tragic. According to press reports, the elderly woman had developed severe bedsores, triggering sepsis–a life-threatening bacterial infection–and ultimately her death.

Who was to blame for this terrible neglect of an elderly Californian?

To the Department of Justice, it was the owner of the elder-care facility in which she had lived for many years. The federal government lodged felony charges, including manslaughter, against the operator. Local media called it one of the first prosecutions of its kind.

The ultimate resolution of this nursing home neglect case wasn’t immediately available, but the attention paid to such a high-profile case serves to highlight that elder abuse and elder neglect are serious crimes and severely punishable by law. In California, the state’s Welfare and Institutions Code Section 15610.57 requires that anyone caring for an adult exercise a “degree of care” that a reasonable person “in a like position” would exercise.

The statute defines neglect by the following (but is not limited to):

• Lack of medical care for physical or medical needs.
• Failure to protect from “health and safety hazards” and to “prevent malnutrition or dehydration.”
• Not assisting in personal hygiene or the “provision of food, clothing or shelter” and more.

Advocates with the Elder Justice Now initiative say the elderly deserve to be free from “abuse, neglect and exploitation.”

According to the National Center on Elder Abuse, as many as 10 percent of respondents in one major study said they experienced elder abuse within the previous year. Another study highlighted by the organization says “only one in 14 cases of elder abuse ever comes to the attention of authorities.”

Who abuses elders?

While the vast majority of abusers are family members according to the NCEA, many U.S. elderly have their care coordinated by supposedly trusted and regulated caregivers.

The federal Centers for Disease Control estimates that in 2012 approximately 8 million U.S. residents were under the care of about 58,500 “paid, regulated long-term care services providers.”

So how can you tell if something is going wrong with the care you’ve coordinated? Advocates with Elder Justice Now say the signs and symptoms of abuse can come in many forms and are not limited to the following:

• Bruising or other obvious signs of physical abuse
• Signs of poor attention or hygiene, including bedsores and sudden weight loss
• Issues with caregivers, such as belittling behavior or anger
• Sudden changes in finances

For bedsores, it’s important to be armed with information about how they form and the different stages.

• Bedsores form from prolonged pressure on the skin, according to the Mayo Clinic.
• They can be “very difficult” to treat.
• The four stages outlined by Mayo Clinic experts can run from simply: “tender” skin to “exposed muscle, bone or tendons” and even dead tissue.
• The sores can form in different areas depending on mobility. For people in wheelchairs, bedsores may appear on the tailbone or backs of arms. Individuals who are confined to their beds may develop sores on their hips, backs of shoulders, the tailbone and other areas.

How can I learn more?

Government experts with the Administration on Aging have described bedsores as “indicators of possible neglect” and urge those who suspect abuse to seek out resources, which they list by state. If someone’s life is in danger, call 9-1-1.

For a free consultation with California nursing home abuse and neglect attorney or on any accident or injury claim call Steven M. Sweat, Personal Injury Lawyers, APC, APC toll free at 866-966-5240.

Additional Resources

Nursing Home Abuse and Neglect – Laws of California