Country Crest: Chronic Understaffing Enabled Elder Neglect

Elder abuse lawyer described failures of care at Oroville facility as ‘the very epitome of reckless neglect.’

When a healthy, active, mentally sharp, independent 85-year-old woman went to hospital after a choking incident, all expectations were that she would have a brief rehabilitative period before returning to normal life. Instead, she emerged from an elder care facility with an injury entirely unrelated to the choking, and with which she lived for the rest of her life. This case is a stark demonstration of how short-term rehabilitative facilities can achieve the opposite outcome of their stated purpose.

In early November 2015 – less than a year before this action was filed – the plaintiff was living independently in a mobile home community in Oroville, California. She was an active member in the community, attending church every week, playing bridge regularly with a group of friends and taking outings with family and friends. Entirely cognitively intact, she cooked meals, bathed herself, and handled her own finances. Considering her age, she was in good physical shape.

On November 10th, she was ambulanced to hospital after choking on food, which caused a stricture that temporarily limited her ability to swallow. The stricture was addressed during the hospitalization, and the plaintiff was discharged to the Country Crest Post Acute nursing facility. During her short stay, the skin on her previously-intact coccyx had developed into a stage IV pressure sore described as ‘the size of a small football’ – a painful condition that she continued to suffer with until her death in 2018.

The plaintiff had never had pressure sores before being admitted to the facility. Country Crest did note some redness on the base of her spine – a fact that should have prompted staff to remain on high alert, check her skin on a regular basis and, if necessary, reposition her every two hours in order to prevent the  development of sores – but failed to document any further interactions for the next nine days. Until the diagnosis of the pressure sore on November 27th, the facility had made no notes whatsoever on the patient.

How did an otherwise healthy person leave a short-term care facility in a worse condition than the one she’d arrived in? What kind of work setting allows nine days to pass without a single examination from a medical professional?

It’s a familiar story of corporate greed at the expense of patient care. Country Crest’s profit-seeking overseers set out to attract lucrative high acuity patients while cutting their own costs with dangerously low staffing levels. According to their own census data, over 50% of patients were on Medicare – more than double the average for skilled nursing facilities – and thus required a minimum of 6 nursing hours per patient day. Country Crest’s staffing averaged just 3.68 nursing hours during this plaintiff’s residency.

This was not an isolated case of misfortune – it was a business plan based on reckless negligence. In the two years prior to the patient’s stay, Country Crest’s net income went from $300,000 to $1.9 million. Judging by the facts of this case, this dramatic increase in profits came at the expense of patient care.