Dudensing Law

A passionate elder rights champion and advocate for nursing home reform.

As hard as we fight on behalf of our clients, we believe our responsibility goes beyond legal representation. In addition to his work as a nursing home abuse attorney, Ed Dudensing is a passionate elder rights champion and advocate for nursing home reform. He has written a number of articles decrying the malfeasance of for-profit nursing home chains and calling for greater regulatory oversight of the elder care industry.

Scroll down for selected extracts from Mr. Dudensing’s recent op-eds, and links to the original publishers.

•••

Why loosening sedative rules in nursing homes would put vulnerable patients at serious risk

The federal government’s own watchdog recently confirmed what elder abuse attorneys have known for years. In a pair of reports released on March 19, the Department of Health and Human Services Office of Inspector General (OIG) found that nursing homes across this country are giving dangerous antipsychotic drugs to dementia patients to reduce staffing demands, and falsifying diagnoses to hide it. Now, the Trump administration is considering making it easier for facilities to perform this type of elder abuse.

The OIG reviewed 40 nursing home inspections and found that facilities were administering antipsychotics, drugs carrying an FDA black-box warning against use in elderly patients with dementia because of increased mortality risk, without first attempting non-pharmacological interventions. Staff told inspectors that the medications were used to quiet residents and lighten the workload. In a companion report, the OIG found that facilities were falsely diagnosing residents with schizophrenia. In at least one instance, a nurse practitioner added schizophrenia diagnoses to dozens of residents in a single day. Families were often never told.

Elder care during the Trump Administration: What’s at stake?

Elder care in America is at a crossroads. By 2030, every baby boomer will be over 65, meaning one in five people in the U.S. will be of retirement age. With a rapidly aging population, how will the political and legal landscape evolve to address the needs of seniors?

Caring for our nation’s elderly should be a bipartisan effort; however, elder care policies often fluctuate with changing political priorities. The new Trump Administration has indicated an approach to elder care that could jeopardize the safety of millions of aging Americans if implemented carelessly and hastily.

Longstanding systemic issues in elder care – such as chronic understaffing and cost-cutting measures – have contributed to a troubling rise in elder abuse and neglect across the country. In response, the Biden Administration took significant steps to address these challenges. In April 2024, the former Administration proposed new regulations requiring nursing homes to meet nationwide minimum staffing levels, mandating 3.48 nursing hours per patient per day. In tandem with these efforts, Senators Elizabeth Warren and Bernie Sanders later demanded that for-profit nursing homes prioritize patient care over executive payouts.

Preparing for C-TAPP Phase 2: What California lawyers need to know

The State Bar of California’s Client Trust Account Protection Program (C-TAPP) is moving into Phase 2, and attorneys should prepare for significant new compliance obligations. By the end of this year or early next year, law firms will face mandatory audits of their client trust accounts. These reviews will be initiated by the State Bar, but the responsibility for compliance rests squarely with the firm, which must select a State Bar-Approved CPA to conduct the audit. The projected cost ranges from $3,000 to $15,000, with some estimates of up to $25,000 — an unwelcome expense for many small and midsize firms.

Solo and small firms will face significant financial and administrative effects. But beyond the expense, the program signals a shift in the State Bar’s oversight approach: maintaining minimal records is no longer enough.

California needs to take ‘walkaway deaths’ and senior care oversight more seriously

Earlier this year, the U.S. Senate Special Committee on Aging announced it would be investigating “walkaway deaths” at assisted living facilities across the country. Walkaway deaths occur when a resident wanders away from a facility or is left unattended, resulting in death. Deaths can be caused by exposure to inclement weather, pedestrian accidents, lack of access to vital medicine, and other situations where elderly people are especially vulnerable.

Committee chairman Sen. Bob Casey, a Pennsylvania Democrat, sent letters to three of the largest corporate owners of American assisted living facilities, requesting their response to reports of “workforce shortages and expensive and inadequate care.” Each of these CEOs oversees numerous facilities in California.

The oft-overlooked issue of walkaway deaths, tied to dangerous staffing shortages, should be of great importance for Californians. There are more than 6.1 million residents over the age of 65, and the so-called gray wave is just beginning.

The Senate can protect the elderly by supporting nursing home staffing regulations — not overturning them

In April, the Biden administration unveiled a set of regulations to establish minimum staffing requirements for nursing homes nationwide. Under these new guidelines, nursing facilities must maintain staffing levels of 3.48 nursing hours per patient per day, including 0.55 registered nursing hours per patient per day and 2.45 nurse assistant hours per patient per day.  

The introduction of these regulations is a significant stride in the right direction. In fact, these minimum requirements should serve as a baseline, rather than a ceiling, for staffing levels in nursing homes. Each resident’s needs are unique, and staffing must be tailored to meet these individual requirements to ensure the highest quality of care.  

However, senators appear to have succumbed to heavy lobbying influence aimed at reversing these new regulations. Such efforts could significantly endanger healthcare access for our most vulnerable citizens.

Why litigation is necessary to hold private equity accountable for elder abuse care

Private equity firms have increasingly infiltrated the healthcare sector, particularly within the nursing home and assisted living industry. This shift has raised serious concerns about the quality of care available to our elderly population. Private equity firms are judged solely by return on investment, a direct contrast to nursing homes and assisted living facilities, which should be judged on the quality of care they provide. This dichotomy of interests poses a significant risk to elder care, as private equity firms are motivated more by financial gain than by the well-being of their vulnerable residents.

Evidence shows that the involvement of private equity firms in nursing homes is correlated with a decline in care. According to a 2023 study published by the British Medical Journal, residents in private equity-owned nursing homes experience higher death rates and adverse health events, including falls and infections, than residents in independently owned nursing homes. In fact, the study’s conclusion states: “Such [private equity] ownership is often associated with harmful impacts on costs to patients or payers and mixed to harmful impacts on quality.”

Over 350 COVID-19 deaths expose California assisted-living homes

Problems in California’s nursing homes are no secret. For years, the sprawling industry has attracted attention and lawsuits. Meanwhile, the separate assisted living business has largely flown under the radar, quietly gaining broad popularity as baby boomers continue to age.

With the spreading COVID-19 pandemic, however, the dangers that assisted living centers pose to the health of elderly Californians are coming into focus. Inadequate staffing, lack of trained medical personnel, lax infection control, and the use of dangerous psychotropic drugs to control behavior have for too long been systemic problems for the industry.

•••

The State of Elder Care

When a confused and distressed Roger Curry was abandoned outside a hospital in Herefordshire in 2015, he had no recollection of how he got there or where he was from. He spent the next several months in a nursing home, while British police worked with Interpol to identify him. It emerged that Mr. Curry had been a victim of abuse: abandoned by a son who thought his father would receive better care in another country.

And, despite his cruel actions, he wasn’t wrong.

A Guardian report from last year noted how well looked-after Mr. Curry was in the nursing home, where no money changed hands in return for his care. No fees, insurance, or co-pays. No price gouging on his dementia medication. The only source of funding that contributed to Mr. Curry’s good standard of care was the British taxpayer.

How does this sad situation speak to the state of elder care in the US? Why would someone prefer to abandon his father across an ocean rather than just, say, in a far flung corner of his own country?

The overwhelming cost of healthcare across the US is the reason Mr. Curry ended up in the UK — though it could just as easily have been Canada. Or Japan. Or Norway, Sweden, Denmark, New Zealand, Switzerland, Vietnam, China, Singapore… the list of countries, from Albania to Zambia, where you can walk in off the street and receive healthcare at low or no cost is long and varied. The US is conspicuous by its absence.

•••

Assisted Living is Health Care, Not Just Simple Housing

“California’s rapidly aging population, and the challenges posed by this so-called “gray wave,” have sparked much discussion among health care experts and policymakers. Gov. Gavin Newsom’s Master Plan for Aging, scheduled to be unveiled next year, affirms the need for decisive and strategic action. Reforming the assisted living industry must be a part of this strategy. The graying of California has been a boon for assisted living programs, as families look for alternatives to traditional nursing homes for loved ones who are living longer. Assisted living centers appear attractive because they more closely resemble homes than hospitals, with comfortable living spaces, social programs and other amenities. But as the popularity of assisted living continues to grow – and with it the economic clout of corporate owners – oversight and sound health care standards and practices have lagged, imperiling vulnerable people. We can attest to this firsthand: Recently, one of us represented the family of a 77-year-old resident of the long-term care mega-provider Eskaton, who choked to death after she was given powerful sedatives to chemically restrain her.”

•••

Coronavirus pandemic requires renewed focus by California policymakers on elder care

For California’s seniors, the coronavirus pandemic is an especially terrifying crisis. For the state, it is also a powerful signal that gaping loopholes in protections for this vulnerable and growing population must change.

As a population, people over 70 tend to have weaker immune systems and more underlying conditions that impede their ability to fight the virus. They are also more likely to reside in group living situations, in close quarters. Waves of COVID-19 deaths in nursing homes — first in the Seattle area, then near Sacramento and now throughout the nation — have underscored this grim reality. So far, Californians over 65 have made up at least a quarter of the state’s confirmed cases of COVID-19.

But regulations, particularly for assisted living facilities, are perilously behind the curve in safeguarding California’s elders from this virus. Fortunately, Gov. Gavin Newsom’s Master Plan on Aging initiative, currently underway, presents an opportunity to aggressively address this danger and take steps to protect millions of older Americans.

•••

The Eldercare Industrial Complex: Favoring Corporations Over Care

“Who owns nursing homes? The answer often depends upon who is asking. If a family caregiver is being shown around a leafy facility with the intention of shelling out thousands of dollars each month for their older loved one to reside there, corporate owners spare no expense in flaunting untrammeled devotion to their residents’ comfort, health and well-being. If, like me, you’re an elder abuse attorney with questions about a fatal abdication of care, the red carpet is rolled back up, the owners recede into the shadows and the facility claims to be barely keeping its head above water.

Eldercare facilities being gobbled up by private equity is nothing new. Proprietary chains have been owning and operating nursing homes since at least the 1960s, and the corporatized model of eldercare has been dominant for 40 years. A 1986 paper showed that more than 75 percent of nursing homes nationwide were owned by for-profit interests, a trend that has continued unabated.

But big money and remote management have not translated into greater accountability or higher standards of care. Quite the opposite.”

•••

California is Facing an Elder Abuse Crisis

“As an elder abuse lawyer, I’ve seen firsthand what happens when powerful corporations fail vulnerable people by putting profits before care. I recently represented the family of a 77-year-old woman who choked to death while under the care of Eskaton, a mega-provider with long-term-care facilities throughout Northern California. Her death was attributed to the improper administration of Ativan, a powerful sedative used as a chemical restraint. A Sacramento jury later awarded a record $42.5-million verdict against Eskaton. The case raised serious questions about inadequate training and insufficient staffing levels. It also highlighted wider concerns about subpar corporate oversight and regulations.”

•••

The eldercare industrial complex: favoring corporations over care

The increasing corporatization of skilled nursing facilities is a root cause of the hidden national scandal of elder abuse.

Who owns nursing homes? The answer often depends upon who is asking. If a family caregiver is being shown around a leafy facility with the intention of shelling out thousands of dollars each month for their older loved one to reside there, corporate owners spare no expense in flaunting untrammeled devotion to their residents’ comfort, health and well-being. If, like me, you’re an elder abuse attorney with questions about a fatal abdication of care, the red carpet is rolled back up, the owners recede into the shadows and the facility claims to be barely keeping its head above water.

Call 916-448-6400 to receive a free case evaluation from an elder abuse lawyer in Los Angeles, San Francisco, or Sacramento.