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Elders being admitted to a long-term care facility, such as a Southern California nursing home, are granted certain rights. These rights are protected by regulations on both the State and Federal level. Specifically, these rights are guaranteed by the California Code of Regulations, the California Health and Safety Codes, the California Welfare & Institutions Code, and the Code of Federal Regulations. All California elders entering into a nursing home are granted these rights by law.

Unfortunately, this does not mean their rights are protected and upheld by the facility and staff members. It is important that anyone considering placing an elder into a long-term care facility understands these rights. Rights are granted on pre-admission, while in residence, and transfer and discharge basis.

Pre-Admission Rights
As a potential resident of a long-term care facility, such as a California nursing home, residents’ rights are granted before being admitted. Each potential resident has the right to:

•Visit the facility
•Review the license and certification of the facility
•Review the admission agreement
•Inquire into cost of care, optional services and coverage provided by Medicare or Medi-Cal
•Be informed of all rights in a language that is understandable to the resident
•Be informed of the nursing home’s rules and regulations
•Review all contracts thoroughly before signing
•Be made aware of what basic services are included in cost, and what services are optional
•Be made aware of right to apply for Medicare or Medi-Cal, and be granted assistance in applying for this coverage
•Refuse to have a cosigner
•Refuse to provide a deposit, if you are the beneficiary of Medi-Cal or Medicare
•Refuse to delay rights to receive Medicare or Medi-Cal
•Refuse to sign an arbitration agreement
•Receive the Patient’s Bill of Rights

In-Residence Rights
Federal and State laws further guarantee residents of California nursing homes certain rights while living in the facility, including:

•The right to be treated with respect and dignity
•The right to privacy during treatment
•The right to privacy during personal care
•The right to choose your personal physician
•The right to participate in one’s own treatment planning and decision making
•The right to receive care to ensure proper personal hygiene
•The right to reside in a clean, sanitary facility
•The right to receive proper nutrition in quality and quantity as per physician’s recommendations
•The right to manage your own financial affairs
•The right to refuse care/treatment
•The right to make advance directives including power of attorney, DNR
•The right to voice grievances and/or suggest policy changes to the facility without fear of repercussions
•The right to make and receive phone calls privately
•The right to privacy in visits from family members and friends
•The right to be completely free from abuse, chemical restraints and physical restraints that are not medically required to treat patient’s symptoms
•The right to a monthly itemized bill
•The right to 30 days’ notice of increase in facility rates

Transfer & Discharge Rights

Elders being discharged or transferred from one facility to another, or to return to a private residence are also granted rights under California and Federal laws. Nursing home residents transferring, or being discharged are granted the following rights:

•The right to voluntary discharge without notice
•The right to refuse involuntary transfer except in an emergency
•The right to receive a refund of security deposit within 14 days of account being closed
•The right to remain in the nursing home if insurance transfers from private pay to Medicare or Medi-Cal
•The right to remain in the nursing home if nursing home withdraws from Medicare or Medi-cal
•The right to have a bed held for 7 days if resident is transferred to a hospital

The State of California and the United States Federal Government guarantees these rights and more to all residents of Southern California nursing homes. If these rights are being in any way restricted, or violated, it is time to speak with an elder abuse attorney about your next course of action.
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Millions of elders will fracture, or break, a bone each year. Falls are the leading cause of broken bones in those over 65, and one out of three elders will fall each year. Unfortunately, falls are the leading cause of fatal and nonfatal injuries to seniors. In this post, we will focus on nonfatal injuries only.

In a best-case scenario, a fall will be nothing more than painful, but in many cases involving elders, a fall will cause a bone fracture. In fact, millions of elders suffer bone fractures each year. Hip fractures in particular are especially dangerous to those over 65. Yet according to the Centers for Disease Control, in 2010 there were 258,000 hospital admissions for hip fractures among people aged 65 and older.

As people grow older bones naturally become weaker, allowing fractures to occur from gentle movement and regular overuse. Yet, broken bones can also result from improper care, abuse and/or neglect within a Southern California nursing home.

It can be difficult to determine whether a broken bone in an elder was the result of normal activity or caused by abuse or neglect in a Southern California nursing home. That is why it is vitally important to determine the type of fracture. There are three types of fractures that elders may sustain. A stress fracture would occur naturally, as they are merely tiny cracks in bones that appear over time as the result of repetitive motion, movement, or overuse. Nursing home staff need to be aware of any stress fractures in elder residents to assure the fracture is treated properly and to prevent further injury.

Compression or spontaneous fractures can occur without trauma, and are typically caused by osteoporosis. Normal daily activities, such as walking, may cause a compression fracture in an elderly adult due to weakening bones. Common compression fractures appear in the hips and/or spine.

Traumatic fractures in elders are caused by an injury. In most cases, a traumatic fracture is the result of a fall. However, traumatic fractures may also indicate elder abuse. Neglect of a resident may be to blame for the elder falling; in cases where they were improperly medicated, and lost balance, for example. Abuse may indicate failure of the nursing home staff to properly investigate the cause of the injury, and/or failure to properly follow up with a medical visit after the fall.

It is vitally important for any nursing home resident who experiences a fall to have a thorough medical evaluation following the accident. The most common fractures that elders suffer as the result of a fall include breaks in the spine, hip, forearm, leg, ankle, upper arm, hand, and pelvis.
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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. It is unfortunate that these laws alone are not always enough to protect our elders while they are in a long term care facility such as a California nursing home.

Elder abuse in California can take many forms including physical abuse, sexual abuse, financial abuse, neglect, and a form of abuse known as chemical restraint (over-drugging). These forms of abuse may result in pain, suffering, and even death of elders. That’s why it is so important to talk with a nursing home abuse attorney if you believe that an elder is being abused or neglected while in a California nursing home.

Nursing home abuse cases in California may be very complex. However, this should not deter you from speaking with a California elder abuse attorney who specializes in nursing home abuse cases. All consultations at Walton Law, APC are free of charge. During that time, we will sit down with you and discuss your concerns, your suspicions, and your fears in regards to filing a lawsuit against a California nursing home. We will answer any and all of your questions in regards to nursing home abuse in California.

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Southern California elders – particularly those residing in nursing homes, or skilled nursing facilities – are unfortunately prone to developing life-threatening bedsores. Bedsores, which are also known as pressure ulcers, can lead to a host of health problems, particularly in elders whose health may already be compromised. Similarly, because many elders may be confined to a bed or wheelchair, their risk for developing these sores is increased.

According to the Mayo Clinic:
People are at risk of developing pressure sores if they have difficulty moving and are unable to easily change position while seated or in bed. Immobility may be due to:

•Generally poor health or weakness
•Paralysis
•Injury or illness that requires bed rest or wheelchair use
•Recovery after surgery
•Sedation
•Coma

However, more specific risk factors affecting elders which make them so susceptible to bedsores may include advanced age, which results in thinner, drier, less elastic skin, which is generally more fragile. Elders may also develop bedsores after significant weight loss, which can accompany a long-term illness. Poor nutrition and/or dehydration also make elders susceptible to developing dangerous bedsores. Illnesses such as diabetes, and vascular diseases may also lead to damaged skin tissue, making it easier for a bedsore to develop. Likewise, elders who suffer from bowel or bladder incontinence are also likely to develop bedsores if soiled clothing isn’t removed and replaced immediately.

Similarly, elders who are in a state of mental decline are typically more likely to develop dangerous bedsores. Those who have limited mental alertness may be unaware that sores are developing, leading them to progress into dangerous infections before being discovered. By the same token, any elder who has diminished sensory perception, such as those who are paralyzed, may also not discover bedsores until they have reached a dangerous stage.

The key to prevention (and treatment) of bedsores is to relieve pressure. This can be accomplished most effectively by repositioning an elder regularly, particularly once a bedsore has developed.

For elders residing in a Southern California nursing home, inspection of the skin should be a routine part of care. Unfortunately, all too often patients suffer from bedsores due to neglect or lack of an appropriate care plan implemented in the California nursing home. If you have found a bedsore on an elder you know, a doctor needs to be notified immediately. Bedsores can often be resolved with appropriate detection and treatment.

While many long-term care facilities in California provide excellent care, others subject their patients to many forms of neglect or elder abuse. The California Welfare & Institutions Code §15610.57, addresses “neglect” in part by stating it is “the negligent failure to exercise the degree of care a reasonable person would have exercised had they had the care and custody of an elderly person.” This would include the failure to protect that elder from dehydration, bedsores, falls, other injuries caused by safety or health hazards and any type of injury that does not fit the explanation provided by the staff.
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Isolation is a form of Elder Abuse in California, per California Penal Code §15610.43. Elder abuse is a violation of the rights of elders by those charged with caring for them in facilities, such as California nursing homes. California nursing homes are required to provide reasonable care, and any intent to do otherwise constitutes a criminal action.

Elder Isolation may include:

*Any intentional actions, which prevent an elder resident from making or receiving phone calls, or having contact with family and friends outside of their residential, nursing facility.
*Any intentional actions which prevent the elder resident from speaking with their physicians, their attorneys, law enforcement or even members of their religious organization.
*Actions such as placing an elder in a locked room, or restraining them in another capacity without their consent.
*Confinement of an elder (which can also be deemed false imprisonment).

Elders are often isolated by nursing home staff as a way of dominating and/or instilling fear in the elder resident. The consequences that the elder may experience as the result can be traumatic. Elders who have been isolated often experience depression, anxiety, stress, and fear. In the worst cases, the lasting effects of isolation may result in suicide or death.
If you suspect that a loved elder may be experiencing intentional acts of isolation while in a his or her nursing home, speak up. Often elders who are being victimized in any way feel helpless to do anything about the abuse, for fear of repercussions.

If you suspect an elder you know is being abused in any capacity while residing in a California nursing home, report it to the following agencies immediately:
• Local Law Enforcement, including the Police, Sheriff, and District Attorney’s office. The San Diego County Sheriff’s department can be reached at (858) 565-5200. The San Diego County District Attorney may be reached at 619-531-4040 • Long-Term Care Ombudsman Program. They provide a 24/7 Crisis Complaint Hotline at 800-231-4024 • Adult Protective Services (APS). In San Diego County, you may contact: San Diego County Aging and Independent Services (858) 495-5660.
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Understaffing nursing homes is incredibly dangerous to adults over 65 residing in long-term care facilities such as Southern California nursing homes. That’s precisely why specific laws and regulations are in place which mandate proper staffing at long-term care facilities.

Under California law, “The facility shall employ an adequate number of qualified personnel to carry out all of the functions of the facility” Health & Safety Code § 1599.1(a). Moreover, Health & Safety Code §1276.5-1276.65 mandates that nursing homes must provide a minimum of 3.2 nursing hours per patient per day.

Unfortunately, many facilities choose to ignore the California law. Even worse, the understaffing of nursing homes has been directly correlated to abuse and neglect of elders. Indeed, understaffing in California nursing homes leads to substandard care over and over again. Substandard care in nursing homes then leads to illness, injury, and too often, death.

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For many Californians the time comes when their loved elderly parent or family member may need some help within their home. Whether they need help with meal preparation, personal health and hygiene, or just some help around the home and with errands, finding the right person to care for your elder can be stressful.

Types of in-home caregivers for elders may range from a weekly housekeeper to a certified nursing assistant, or skilled care worker. The range of services provided may be cleaning the home, dispensing medication, helping the elder with transportation, or home care workers may help with personal care such as bathing, and monitoring overall health.

Once you determine the type of care your loved elder needs, there are many places to find compassionate, qualified in-home caregivers. Consider beginning your search by asking for referrals from friends and family, or from a doctor specializing in senior care. You can also check job postings such as those found in the newspaper, or online on sites including www.Caring.com.

When interviewing a potential caregiver for your loved one, be sure to:

*Photocopy a Valid California Driver’s License
*Obtain Proof of Certifications
*Check References
*Run A Background Check
*Spend Time Getting to Know Them

After you’ve hired an in-home caregiver, make sure to stay in contact with your loved elder. In addition, be sure to schedule consultations with the caregiver at least once per week to remain current on your loved one’s wellbeing. Wherever possible make unannounced visits while their caregiver is there to make sure that the relationship between the two is one of mutual respect and care.

The decision to hire an in-home caregiver for your loved elder is a big decision and warrants time and careful screening of candidates to ensure you’ve selected the best person for the job.
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It is no secret that many people have difficulty asking others for help. Elders living in Southern California are no different. Even though physical and mental capabilities may start to diminish with aging, it is still not easy for many seniors to let others know they are struggling.
That is why it is up to all of us to keep an eye on aging family members or friends. Here is a list of warning signs that a senior you love may need help from family members or professionals.

1. Abnormal or repeated phone calls If your grandmother, mother, father, or other elder family members begin making phone calls to you repeatedly, or at peculiar times of day, it may indicate confusion. It may also be a sign of memory loss, or could indicate that the elder is feeling lonely or depressed. If you notice these types of calls, try scheduling set calls with your loved one every day to see if they stick to those times and calls. If they don’t, it may be indicative of cognitive decline.

2. Weight loss/lack of food in the home When you visit your loved one, take notice of their appearance. Are they maintaining a healthy weight? If they’ve lost a substantial amount of weight, take a look in the refrigerator to confirm that there is food, and that the food has not spoiled. If there is nothing to eat, this can indicate that your loved elder is finding it difficult to shop and/or cook, and are thereby not taking proper care of themselves. This may be a sign that they need your help in shopping, preparing meals for the week, or even that they need to see a physician.

3. Mail is piled up, unopened or has not been retrieve from the mailbox When you visit your loved senior, take notice of unopened mail piled up, or even in the mailbox. Signs that your loved elder may be overwhelmed by once routine tasks may indicate that they are feeling depressed or confused.

4. Their home is suddenly messy If your aging parents or grandparents have traditionally kept a neat home, but you find their home is cluttered or dirty, this may be a sign they need help. They may be in physical pain and unwilling to clean, or they may be too tired, or even depressed. If you notice a sudden change in the appearance of the home it can be a warning sign that your loved elder is having a hard time, and needs assistance.

5. Cooking and baking pots and pans are burnt If you see scorch marks on pots, pans, or baking sheets, it may indicate difficulty with short-term memory. Your loved one may be forgetting they have left the stove or oven on after making a dish. This is a warning sign you should never ignore, as it has safety ramifications not only for your loved elder, but also for neighbors.

6. They aren’t changing their clothes or are wearing clothing inappropriate for the weather If an elder you love seems to be wearing the same clothes over and over, or shows signs of poor personal hygiene it may be a signal that they are struggling, mentally, emotionally, or physically. They may have difficulty doing laundry because it is located on a different level of the home, or it may indicate depression, or cognitive decline wherein they are having difficulty assessing the proper clothing to wear for the weather.

7. They are missing doctor’s appointments and/or medication Missed appointments may indicate memory problems, or difficulty in securing transportation to their appointments. This can be dangerous for elders who need medication, so if you determine that they are missing their appointments and and/or are not taking their necessary medication, it may be time to consider hiring help for them.

If you notice any of these warning signs that a loved elder in Southern California may need help, don’t be afraid to speak up. Often times an elder may need something as simple as transportation a couple of days a week, or a housekeeper a few times a month. In other cases, they may need to be relocated into an assisted living facility. It’s important to realize though, that they may not ask for help, so you need to ask them questions, and ascertain as best as you can, whether or not they are still capable of living without any assistance.
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In California, financial elder abuse is defined in Welfare and Institutions Code §15610.30. The code states: “Financial abuse of an elder or dependent adult occurs when a person or entity… takes, secrets, appropriates, obtains, or retains [or assists in doing any of these] real or personal property of an elder or dependent adult for a wrongful purpose or with intent to defraud or both.”

Although financial abuse is far too prevalent, the best defense against opportunists who would seek to defraud elders out of their money, property or belongings, is preventing the abuse in the first place. Although there is no surefire way to ensure that your loved one’s finances are protected at all times, there are warning signs to look for, which can indicate that financial abuse is taking place.

In an effort to best protect a loved elder from financial abuse including a loss of their property, assets or money, be on the lookout for these warning signs that a caregiver, a family member or even a staff member at a California nursing home is victimizing elders:

*Missing items (jewelry, appliances)
*Unpaid or past due bills
*Excessive credit card charges
*Unusual bank activity (large withdrawals or checks)
*New credit cards opened in the elder’s name
*Changes to trusts, estates, wills
*Unusual investments in ventures, real estate, businesses
*Bulk sales of stocks
*Unusual charitable contributions or gifts to unknown people/organizations
*Large purchases (property, cars, electronics)

One of the best means of ascertaining that a loved one and their finances are safe is through frequent contact with the elder. Simply by calling and/or visiting them you can often pick up on cues as to their overall well-being. Volunteering to help them once or twice a month with their finances, including paying bills will also give you a good picture of their financial health at all times. Furthermore, take advantage of the opportunity to help your loved elder obtain their free annual credit report, and review it with them to make sure that all records are correct. Paying attention to the relationships your loved elder has with others will also help to illuminate any potential opportunists in their lives.

If you suspect, or confirm that your loved elder is the victim of financial abuse in California there are certain steps you should take. You may report any suspicion of abuse to the National Elder Abuse Hotline at 1-800-677-1116. In California, reports can be made to the local county Adult Protective Services Agency or to local law enforcement.
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Nearly 70% of elder abuse victims are women, according to the Bureau of Justice Statistics. It is worth noting that the population of elder women is much larger than the population of elderly men in the United States, however, that does not make these alarming statistics any less disturbing.
Why are women the victims of elder abuse more often than men? There are a few reasons most experts tend to agree upon.

1. Elderly females may be seen as easier targets for physical, financial, emotional, or even sexual abuse.
2. Women tend to live longer than men, and many live alone putting them in a position where they may be more likely to be abused.
3. Women tend to develop crippling physical diseases such as osteoporosis, which may take a long time to recover from.

Statistics conclusively show that elders who are disabled are far more likely to be abused than those who are not. As a matter of fact, according to the National Center on Elder Abuse, Administration on Aging:

“Institutionalized adult women with disabilities reported a 33% prevalence of having ever experienced interpersonal violence (IPV) versus 21% for institutionalized adult women without disabilities…when considering lifetime abuse by any perpetrator, a sample of 200 adult women with disabilities indicated that 67% had experienced physical abuse and 53% had experienced sexual abuse.”

Elderly women are far more likely to be sexually abused than men. Reports in the Journal of Elder Abuse and Neglect found that elderly women were six times more likely to be sexually abused than elderly men. Sexual abuse of elderly women occurs most often in nursing homes, or other assisted living facilities.

If you suspect that an elder –whether male or female–is being abused, it is vital to report your concerns immediately. Under California law elder abuse can be both a criminal and civil offense. The state of California has taken a firm stance and zero tolerance policy towards elder abuse in any capacity. As part of their mission to encourage all Californians to report suspected elder abuse, the state has created The Citizen’s Guide To Preventing and Reporting Elder Abuse, which can be viewed in its entirety here.

If you believe an elder you know is being abused in any capacity while residing in a California nursing home, report it to the following agencies immediately:

• Local Law Enforcement, including the Police, Sheriff, and District Attorney’s office. The San Diego County Sheriff’s department can be reached at (858) 565-5200. The San Diego County District Attorney may be reached at 619-531-4040.
• Long-Term Care Ombudsman Program provide a 24/7 Crisis Complaint Hotline at 800-231-4024.
• Adult Protective Services (APS). In San Diego County, you may contact: San Diego County Aging and Independent Services (858) 495-5660.
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