COVID-19 UPDATE: Although our physical offices are closed, we are presently working remotely and open for business. For assistance with your legal matter, please do not hesitate to reach out to us via telephone, email, or video conference through Zoom, FaceTime, and Google Hangouts.

Village Square Healthcare Center, a nursing home located in San Marcos, California, received 29 citations for health and safety deficiencies in its most recent inspection, on February 14, 2019. According to Centers for Medicare and Medicaid Services records accessed on February 26, 2020, that figure numbers more than twice the statewide average of 12.8 citations, and more than three times the U.S. average of 8.0. A for-profit corporation owned by GC Holding Company LLC., Highland Springs Care Center is a Medicare and Medicaid participant with 118 certified beds and an average of 117.8 residents at the facility per day. The deficiencies described in the February 2019 citations include the following:

  1. The nursing home did not ensure residents were adequately protected from accidents. Federal code requires nursing homes to maintain a resident environment free of accident hazards and with adequate supervision to prevent accidents. An inspection found that Village Square Healthcare Center did not provide such in two capacities. According to this citation, an inspector observed water temperatures in resident bathroom sinks that exceeded safe levels. The inspector separately observed that a paraplegic resident was not provided with adaptive equipment to call facility staff. The resident stated in an interview that when he calls the facility’s main number using Alexa and his computer, these calls “go to voicemail 50% of the time,” and that he cannot use his soft touch pad call light provided by the facility “because he cannot turn his head enough to use his chin to turn it on.” The resident stated additionally that while he sends text messages to staff when he requires assistance, “in an emergency his only option would be to call 911.” A Certified Nursing Assistant stated in an interview that she did not know how to retrieve voicemails left by the resident, and that the current system for the resident to contact staff “is not safe.”
  1. The nursing home did not implement adequate measures to prevent and control infection. Federal code requires nursing homes to establish and implement infection prevention and control protocols. An inspection determined that Village Square Healthcare Center failed to do so in three capacities. In one, an inspector observed a staff member assisting residents during mealtime without conducting proper hand hygiene between residents. In another, an inspector observed a staffer moving between residents and providing them assistance without conducting proper hand hygiene. In a third, an inspector observed a resident’s urinary catheter drainage bag lying on the facility’s floor, in contravention of policy.

Meadowbrook Health Care Center, a nursing home located in Hemet, California, received 20 citations for health and safety deficiencies in its most recent inspection, on April 20, 2019. According to Centers for Medicare and Medicaid Services records accessed on February 26, 2020, that figure numbers more than the statewide average of 12.8 citations, and more than U.S. average of 8.0. A for-profit corporation owned by Johnre Care Inc., Meadowbrook Health Care Center is a Medicare and Medicaid participant with 64 certified beds and an average of 48.8 residents at the facility per day. The deficiencies described in the April 2019 citations include the following:

  1. The nursing home did not ensure residents were provided with appropriate treatment. Federal code requires nursing homes to provide residents with “appropriate treatment and care according to orders, resident’s preferences and goals.” An inspection found that Meadowbrook Health Care Center did not provide such in an instance when the facility did not “ensure signs and symptoms of bleeding were monitored” per the plan of care of a resident reviewed for side effects of blood thinner medication. The citation states further that the failure to ensure such “may have contributed” to the resident being sent to the emergency room for rectal bleeding. According to the citation, the resident was receiving an anticoagulant agent to prevent blood clots, and the plan of care stated that they should be monitored for signs and symptoms of excessive anticoagulation. A Licensed Vocational Nurse confirmed to state authorities, however, that “there was no documentation” the resident was being monitored such during the month in question, and “should have been monitored” in the period leading up to the resident being sent to the hospital.
  1. The nursing home did not ensure the competencies of food and nutrition services staff. Federal code requires nursing homes to ensure that its staff have “appropriate competencies and skills sets to carry out the functions of the food and nutrition service.” An inspection found that Meadowbrook Health Care Center failed to ensure its supervisory staff failed to carry out their key functions in an instance wherein the facility’s Dietary Manager and Registered Dietitian “did not provide management and oversight to ensure food was stored, prepared, and served according to facility and industry standards,” as well as that equipment and other food service items were maintained in good working condition. The citation goes on to state specifically that an inspector found that the facility’s RD did not ensure residents were provided with “a comparable in nutrient content alternate” when they requested one instead of the “main entrée.” The inspector also found that the RD did not “report the poor condition” of certain food service items, and that cutting boards and cooking pans were not maintained in good condition. The citation states that these deficiencies resulted in the potential for the facility’s residents to experience “food borne illness and nutritional related health complications.”

In recent years the Centers for Disease Control and Prevention has drawn attention to a source of increasing concern for nursing home residents: Candida auris, also known as C. auris, a fungus that causes “bloodstream infections and even death” in those it affects. Like many infections, C. auris infections are particularly dangerous for those who are already suffering from other conditions. Described by the CDC as “a serious global health threat,” C. auris poses a special risk for nursing home residents.

What makes C. auris so dangerous? A few things. The CDC notes that the fungus is frequently resistant to numerous antibiotic medications; that it is “difficult to identify with standard laboratory methods”; and that it is even prone to misidentification by laboratories without certain technology. This places elderly populations, especially those in nursing homes and other long-term care facilities, at heightened risk. A New York Times report published in September 2019 described a June 2019 study that found “patients and residents in long-term care settings have alarmingly high rates of drug-resistant colonization, which means they carry the germs on their skin or in their bodies, usually without knowing it, and can pass them invisibly to staff members, relatives or other patients.” The study in question “focused on Southern California,” finding that 85% of nursing home residents “harbored a drug-resistant germ.” The CDC has also found that the infection proliferates in long-term healthcare centers

The Times reported that 800 cases of C. auris infection have been identified in the US since the fungus was first reported here in 2015. In August 2019, the CDC updated that count to 806. That includes 388 confirmed cases in New York; 227 confirmed cases in Illinois; 137 confirmed cases in New Jersey; 24 confirmed cases in Florida; and five confirmed cases in California. The Times attributes C. auris’ easy spread through nursing homes to a few factors, in addition to the prevalence of nursing home patients on multiple antibiotics to which the infection has already developed a resistance. Nursing homes are frequently understaffed and under-resourced, according to the Times, and struggle to “enforce rigorous infection control.” They often cycle infected persons in and out of hospitals, putting those hospitals’ patients at risk of the infection too. One health expert told the Times, “You’ll never protect hospital patients until the nursing homes are forced to clean up.” Basic hygienic measures, such as “using disposable gowns and latex gloves,” are essential to combating the infection, yet often unfollowed by long-term care centers, according to the Times. Experts also attribute the infection’s spread in the US to healthcare economics “that push high-risk patients out of hospitals and into skilled nursing homes.” Under the US’s healthcare system, these experts told the Times, “nursing home facilities are reimbursed at a higher rate to care for these patients… providing an economic incentive for poorly staffed or equipped facilities to care for vulnerable patients.”

Each year, more than one in three seniors in San Diego sustain falls and serious injuries. In some instances, falls are the result of elder or nursing home abuse and/or neglect. But in other instances, falls are purely accidental.

More and more elders (defined by California statute as those over the age of 65) are choosing to reside in their own home versus living in an assisted living facility or with relatives. Although there are wonderful reasons to live in your own home as long as possible, it’s important to note that elders are at risk of suffering injuries from a fall, which often times could have been prevented.

Typically, falls are responsible for 60% of in-home injuries. However, statistics show that programs to help prevent falls in the home are effective.

A recent study has found that a class of drugs known as anticholinergics may increase the risk of dementia in patients aged 55 years and older. Commonly used in antidepressants, antihistamines, and antimuscarinics, the drugs have long been associated with side effects like confusion and memory issues. The new study, published in JAMA Internal Medicine, suggests more powerful side effects than medical professionals have previously understood.

As a report by the New York Times explains, anticholinergics encompass a variety of medications. Examples include clozapine, an antipsychotic; diphenhydramine, an antihistamine used in Benadryl, among other products; paroxetine, an antidepressant; tizanidine, a muscle relaxant; and scopolamine, an anti-nausea medication. Anticholinergics owe their wide range of applications to their function in blocking acetylcholine, a neurotransmitter involved in nervous system functions like muscle regulation, respiratory activity, digestion, and the opening and contraction of blood vessels. “Older adults are more likely to be prescribed many of these medications,” the Times explained, “simply because they tend to have more health issues.”

The JAMA Internal Medicine study examined 58,769 patients who had been diagnosed with dementia, with 225,574 matched control patients. Researchers examined dementia patients’ medical records, scrutinizing what medications doctor prescribed them between eleven years and one year before they were diagnosed with dementia. The study took into account 56 separate anticholinergic drugs, accounting for the dosage patients were prescribed and the length they were prescribed the drugs in question. What researchers ultimately discovered was a 50% increase in the risk of dementia in patients “who used a strong anticholinergic drug daily for about three years within that 10-year period,” according to the Times. This risk was strongest in patients who used anticholinergics to treat depression, psychosis, epilepsy, and bladder regulation issues. The study also found a stronger association between anticholinergics and dementia in patients who received their dementia diagnoses before they reached 80 years of age, and in patients with vascular dementia in comparison to those with Alzheimer’s disease.

According to the World Health Organization, dementia is one of the major causes of disability and dependency among older people. Dementia, which is a syndrome in which there is a deterioration in memory, behavior and thinking, causes many who suffer from it to lose the ability to perform their regular activities.

Elders are stricken with dementia far more than any other age group. In many cases, dementia is the reason an elder moves into a nursing home. Dementia is also often to blame for what is known as “elopement” or in layman’s terms, wandering. Elders with dementia may develop wandering tendencies, wherein due to cognitive impairment, they begin to wander around their nursing home unsupervised and without an escort.

Wandering may lead to serious injury as the result of falling. In some cases wandering has even led to death, in cases where residents have wandered outside of their residential facility. Though rare, wandering is dangerous enough that lawmakers included provisions to protect against it in the 1987 Nursing Home Reform Act. The law required that nursing homes must provide residents with adequate supervision in effort to prevent elderly patients from wandering. That means of course, that nursing homes must be properly staffed.

Elder abuse typically refers to the knowing, intentional, or negligent act by a custodial care provider, caregiver, or any other person that causes harm to a vulnerable adult. In California, anyone aged 65 and older is protected by the Elder Abuse and Dependent Adult Civil Protection Act. The laws are designed to help prevent neglect and abuse to California seniors. Neglect falls within the definition of elder abuse, and unfortunately may have dire consequences to the victim.

In broadest terms, neglect is a type of elder abuse wherein a caregiver fails to provide the elder with basic needs including water, food, shelter, heat/air-conditioning, personal hygiene products and medical assistance. Failure to adequately move or reposition a bedridden elder, for example constitutes neglect, just as failing to keep elders properly nourished and hydrated constitutes neglect.

Neglect is particularly dangerous for elders, as it can lead to life-threatening consequences. Such consequences of neglect include:

The Elder Abuse and Dependent Adult Civil Protection Act (Act) was strengthened in 1991, when California legislature added Welfare & Institutions Code §15657 to the Act. This was done to specifically address the needs of California elders and the unique struggles they face, to include elder abuse, neglect, and abandonment.

Because elders may be seen as a disadvantaged class, California elder abuse attorneys who advocate for elders who have been abused, or the families of those who have passed away, are able to charge attorney’s fees and costs to the defendant (abuser). This helps those whose loved elders were mistreated by others who intentionally acted in a reckless, malicious, fraudulent, or oppressive manner to recover damages for the elder, or the family if the elder is deceased.

As such, those who can sue for Elder Abuse in Southern California will include both the family members of the abused elder (if the elder is deceased), or the elders themselves. If the suspected victim has died as the result of abuse or neglect while residing in a California nursing home, the family has the right to file a lawsuit on behalf of their deceased elder, and the court proceedings will ensue as if the elder were still living.

In many cases, where the elder has died, and the family believes the death was caused by misconduct, negligence, or abuse by the hands of another, two cases will evolve. One case will directly address the abuse, and proceed as if the elder were still alive. The second will be a wrongful death case filed on behalf of the survivors. The cases are very different. The injury/abuse case will take into account the injuries sustained by the elder, which will then be granted to the deceased elder’s estate. The wrongful death suit will serve to compensate the family and heirs of the elder who has passed away.

If you are unsure as to whether or not you have a case for an elder abuse lawsuit, contact Chris Walton today for a free consultation. Chris is an award winning elder abuse attorney who is based in San Diego, CA. Walton Law, APC focuses their entire practice on advocacy for elders who have been abused, or those who have suffered grave personal injury. Click here to schedule a consultation.
Continue reading

Making the transition from an independent life to living in a nursing home is rarely easy for an elderly person.  Fear, anger, anxiety, and many more emotions can make the anticipation of this lifestyle change dangerous.  What are the risk factors and methods of mitigation that can be used to prevent a tragedy?

Transitioning from Home to Nursing Home

The time period between when the decision is made to move to a nursing home and the actual move-in date is critical.  In some cases, the prospect of this lifestyle change is enough to make an elderly person consider suicide as an option.  Some of the reasons for this include: