Articles Posted in Understaffing

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While it would seem to require little effort to avoid these conditions, malnutrition and dehydration are alarmingly prevalent in California long-term care facilities. They often occur together, and if left untreated can result in serious physical harm to the individual, including debilitating weakness and significant weight loss, both of which can lead to death. Malnutrition and dehydration can also indirectly lead to other conditions, such as bed sores and renal failure.


Malnutrition among the elderly is on the rise. According to one report, roughly 60% of hospitalized elderly persons, and anywhere from 35% to 85% of those in nursing homes, are suffering from malnutrition. A recent study found that 97% of elderly patients surveyed were malnourished, or were at risk of becoming malnourished, but only 19% were diagnosed, and of these a mere 7% were referred to a dietician.

While in some cases malnutrition results from a caregiver’s intentional malicious act, in many instances nursing homes are so dangerously understaffed that nurses are unable to complete daily tasks such as delivering meals to their residents’ bedsides. In many nursing homes, staff and other health care professionals are not sufficiently trained to identify the symptoms.

The risk of malnutrition is especially acute for residents who are incapable of feeding themselves. In an understaffed nursing home, the time required to feed these patients is too costly, and trays of food are sometimes delivered to a patient’s bedside, only to remain untouched because a staff member is unable to personally feed the patient.


Dehydration results when the body loses more water than it takes in. An eight percent reduction in fluid levels can cause illness, whereas a ten percent reduction can be fatal. The elderly are extremely susceptible to dehydration due to the incremental decrease in bodily fluids that accompanies aging. Compounding the problem is the fact that the aging body can make the symptoms difficult to discern. So even in those cases where a nursing home is properly staffed, dehydration may still go undetected because a nurse may not be sufficiently trained to notice the condition.

It does not take much for an elderly person to become dehydrated. Brief periods with no water, rooms with slightly elevated temperatures, and increases in body temperature can lead to dehydration. Additionally, elderly patients are often prescribed diuretic medications, such as those for heart disease, kidney disease, and liver disease, requiring that more fluids be added to their daily intake to prevent dehydration. The elderly also sometimes lose their ability to identify when they are thirsty, and thus are unable to alert a nurse of their need for water.

As with food, water is in many cases delivered to the elderly patient’s bedside, only to go untouched because the staff is too busy to administer it to patients who need assistance with drinking. In other cases, patients are left in warm rooms, causing elevated body temperatures.
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slip-and-fallOne of the most common dangers that the elderly encounter in nursing home settings is the potential for falls. According to the CDC, approximately 1,800 elderly adults die each year from fall-related injuries, while those that suffer from injuries as the result of a fall experience a long-term reduction in their quality of life or lasting handicaps and disabilities.

While 2% to 6% of elderly nursing home residents suffer fractures as the result of a fall, 10% to 20% of all elderly falls result in injuries more serious in nature–from cognitive disabilities and post-injury anxiety to an overall decline in both physical and mental health.

One way to prevent a tragic fall from occurring is to arm your self with vital information regarding the common causes that elders fall, and ways to prevent a fall from occurring altogether.

According to multiple sources, including the Center for Medicare Advocacy, for-profit nursing homes are far more likely to provide insufficient quality of care for residents than non-profit nursing homes.

The Center for Medicare Advocacy’s website, which sites numerous studies, showed:

“Extensive research finds that the type of nursing home ownership and sponsorship affects the quality of care that facilities provide to their residents.”

More specifically, the research concluded in 2011, via the first-ever analysis of the ten largest for-profit nursing home chains, reported between 2003 and 2008, “facilities owned by the top ten for-profit chains had:

• The lowest staffing levels;
• The highest number of deficiencies identified by public regulatory agencies; and
• The highest number of deficiencies causing harm or jeopardy to residents.”

In fact, after more than 80 studies were reviewed and analyzed, comparing the quality of care in for-profit and not-for-profit nursing facilities. Results conclusively showed not-for-profit facilities had better outcomes on four key measures of quality:

• More or higher quality staffing;
• Lower prevalence of pressure ulcers;
• Lower prevalence of restraints; and
• Fewer government-cited deficiencies.

When it comes to choosing a California nursing home for your loved elder, it is vital that you research the facility thoroughly. Understaffing in nursing homes is incredibly dangerous to California elders residing in long-term care facilities. That is precisely why specific laws and regulations have been put in place which mandate proper staffing of 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 nursing homes must provide a minimum of 3.2 nursing hours per patient per day.

Unfortunately, many facilities choose to ignore this California law. Even worse, understaffing at nursing homes have been directly correlated to abuse, neglect, and substandard care of elders. Before selecting a nursing home for your loved elder ask plenty of questions, and conduct your due diligence. A checklist of questions you should ask about the Southern California nursing home you’re considering for your loved elder can be found here.

If you believe that someone you know has been abused while residing in a California Nursing Home, contact an award-winning elder abuse attorney today.
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getty_rm_photo_of_blood_cells.jpgSepsis, which is also known as blood poisoning, is a potentially life-threatening illness that develops when bacteria gets into the blood stream. In elders, this bacterium often enters into the blood stream through pressure ulcers, (AKA bed sores). Sepsis may also occur from bacteria entering the blood stream via an IV, or a surgical wound, which is not properly tended to.

Sepsis is a very dangerous condition for elders, which can lead to a rapid demise in an elder living in a nursing home. Death from sepsis occurs after the levels of bacteria in the blood reach a tipping point, wherein the body’s immune system can no longer handle the infection, and organs begin to fail.

The symptoms of sepsis include fever, low blood pressure, rapid heartbeat, rash, shaking, hyperventilation, confusion, and changes in white blood cell count. Severe cases of sepsis will result in septic shock, which is an incredibly dangerous and often fatal condition for an elder.

Sepsis may be caused by coming into contact with a person with a bacterial infection, or may result from improper hygiene, or improper post-surgical care. The staff in California nursing homes must be properly trained to not only identify early symptoms of sepsis, but to ensure that all medical equipment is properly sanitized, all staff members routinely wash their hands and use gloves when tending to residents with any form of illness, and all bed sores are treated immediately.

Unfortunately, due to understaffing at many nursing homes, sepsis is a direct result of neglect of an elderly resident. Understaffing has been proven time and again to result in failure to provide proper hygiene for residents, which all too often can prove fatal.

The best defense against sepsis in a nursing home is proper prevention. This requires sufficient staff, which has received the proper training in hygienic standards, and is skilled in identifying early symptoms of both bedsores and sepsis.

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, and 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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Perhaps in response to the revelation that the California Department of Public Health has been negligent in investigating claims of elder abuse occurring in nursing homes and assisted living facilities across the state, Governor Jerry Brown’s proposed fiscal budget includes the addition of roughly 260 positions in the Licensing & Certification Division of the California Department of Public Health.

A statement issued by the California Advocates for Nursing Home Reform (CANHR) in response to the proposed budget reads:

“According to the Department’s Budget FoodInspections.jpgChange Proposals, the Department is requesting the new positions primarily because its prior methodology for assessing its staffing needs failed to consider that inspectors were needed to investigate its vast backlog of complaints or to finish complaint investigations and write reports after onsite visits were conducted.”

Unfortunately, even given the influx of a proposed $30 Million, and the addition of hundreds of jobs, CANHR also said that it is expected to take an additional four years for all pending investigations to be completed. Their statement further said:

“In other words, the Department allowed thousands of complaints involving nursing home abuse and neglect to languish for years because its leaders could not competently perform the most basic assessment of its staffing needs. Some of these failed leaders remain at the Department and should be replaced by qualified and competent managers before it is awarded any more money.

CANHR calls on Governor Brown to swiftly appoint a new leadership team at the Department of Public Health. The new leaders should have the qualifications, experience, and will to build the Licensing & Certification Division into a premier consumer protection agency that will protect the interests of nursing home residents and patients of other health facilities throughout California.”

If you suspect that an elder 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. You should report suspicions of elder abuse to:

• 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 provides 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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By law, the staff members employed by California nursing homes are required to report health changes observed in the elders residing in their facilities. Unfortunately, all too often these changes are unreported. The change in condition of a resident may not be reported for a variety of reasons, including fear that the nursing home be may fined for understaffing, or neglecting California elders residing within the facility. In other cases, a resident who has experienced a rapid deterioration in condition, may indicate that isolation, neglect, or even abuse is occurring within a facility.

Failure to report changes in condition to an elder’s doctor and family members is a violation of the law.
old woman.jpg Changes in an elder’s condition which must be reported may include, but is not limited to:

• Cracked lips, or sores in and around the mouth
• Noticeably dry skin
• Eyes which appear sunken in
• Disorientation/Confusion
• Fever and/or thirst
• Rapid weight loss
• Bed sores
• Broken bones

Elders residing within California nursing homes are granted certain rights. If they are violated, resulting in a change of condition, a crime may have been committed. It is important that all staff working in nursing homes in California report these changes in the condition of elderly residents in order to prevent serious health problems, injury, or even death to residents.

If you notice changes in the condition of your loved one while residing in a nursing home in California, report your concerns immediately. In Southern California and San Diego, you may consider reporting your suspicions to:

• Your loved one’s doctor.
• 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, or the Eldercare Locator help line at 1-800-677-1116.
• Your Department of Public Health Licensing Office.
• 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.

All elders in California nursing homes have the right to quality care and attention, regardless of their age or health. If those rights are denied, abuse must be reported. For tips on reporting suspected neglect and/or abuse in a California nursing home, the Justice Department has a helpful citizen’s guide that can be found at the following website:
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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.
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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.

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 in any form is strictly prohibited by California law. In addition to physical abuse and neglect, medication errors in nursing homes are considered a form of elder abuse. Unfortunately, due to insufficient staffing in many long term nursing facilities, errors in the type and amount of medications administered to residents occur with alarming frequency. While in many cases there may be no detrimental side effects to an elder who is given the incorrect medication, or the wrong dosage; in many other cases, the error can prove fatal.

For example, if two patients’ medications are mixed up, and incorrectly administered, the outcome can be disastrous. A diabetic who is mistakenly given a fellow patients’ heart medication may not under normal circumstances have a negative reaction. However, if that heart medication happens interacts with other medications she is taking, or causes side effects that the patient can’t sustain; the mistake can result in death.

Other medications must be taken consistently in order for them to be effective. Therefore, missing a dose of the proper medication can have devastating consequences on the elder who has missed their dosage. Other medication errors that may occur in nursing homes include: