5 Common Nursing Home Care Issues Governed by California Law
Too many nursing homes are failing to provide acceptable standards of care for vulnerable residents. And while the nature of elder abuse varies from case to case, there are a number of common fact patterns that can help us understand how the nursing home industry routinely abrogates its duty of care.
In California, skilled nursing facilities (SNFs) are regulated by the Department of Public Health. DPH regulations cover resident care requirements, administration, and health and safety. SNFs are subject to needs-based care standards, including minimum staffing ratios and regular updates to patient care plans.
In addition to governing overall care standards, the California Code of Regulations (CCR) directly addresses several specific scenarios commonly found in cases of elder abuse in nursing homes. Let’s look at five common care issues governed by state law.
Falls. Nursing homes are obligated to develop safety plans for residents — which implicitly includes strategies for preventing falls. According to CDC data, falls are the leading cause of injury for older adults, with one in four over-65s reporting a fall every year. While there is no specific regulation addressing fall prevention and intervention, the general care planning and safety requirements do provide a legal framework for one of the most common preventable risks facing nursing home residents.
Infection. California law outlines specific requirements for facilities to implement infection control policies and procedures to prevent the spread of communicable diseases. Infection control measures named in the CCR include regular hand hygiene, and cleaning protocols for dishes and linen. These measures must be ‘reviewed at least annually and revised as necessary.’
Pressure Sores. Commonly known as bedsores, pressure sores are a scourge on nursing home residents, especially those with mobility issues. Other common risk factors include incontinence, poor sensory perception, underlying medical conditions, and poor nutrition and hydration. Pressure sores represent a significant percentage of elder abuse lawsuits filed in California — usually involving the development of a pressure injury due to staff failing to provide basic care in the form of frequent repositioning.
Nursing homes are required to take preventative measures against the risk of pressure sores, including the ‘changing of linens and other items in contact with the patient’ (CCR tit. 22, §72315).
Changes of Condition. Nursing homes are required to monitor residents for ‘any sudden and/or marked adverse change in signs, symptoms or behavior’ and take immediate steps to modify the care plan accordingly. Untreated changes in a resident’s physical or mental health often lead to further health complications – a common cause of contention in elder abuse lawsuits in California. Interventions may include updating care plans and adjusting staffing levels.
Medication. California nursing homes are subject to strict regulations regarding the use of chemical restraints and other forms of medication management. Medication must be administered with the supervision of a licensed healthcare provider, and with all necessary documentation present and correct.
In addition to the obligations set down in the CCR, the common care issues discussed here are covered by federal regulations, which are enforced by the California Department of Public Health. We will look at federal regulations in next week’s blog.
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