Articles Posted in Residents’ Rights

In June 2015, the Alameda County Courthouse ruled on a case involving Health and Safety Code §1418.8. As of January 2016, a final judgment was ordered calling the outdated health code “unconstitutional.”

The Advocates

The case, brought by statewide, non-profit advocates CANHR (California Advocates for Nursing Home Reform), is a critical first step toward nursing home reform. CANHR, through advocacy, education, and legislation (and litigation when necessary) fights to “create a unified voice for long term care reform and humane alternatives to institutionalization.”

As the holidays approach, countless San Diego residents will share the seasonable spirit alongside their family, friends, and loved ones–many of which are elder and may reside in a nursing home. For others, the holidays offer a once-a-year opportunity to check in on the health and wellbeing of the loved elders in our lives.

The best way to ensure that your elderly friend or family member is safe, happy, and healthy is to equip your self with the appropriate facts and information. The Center for Elder Abuse has compiled a helpful fact sheet to review as you venture home for the holidays and spend time with your loved elders.

Here are a few tips, signs, and questions to consider that may help you determine whether the home aid, nurse, or nursing home staff is properly caring for your elderly loved one:

• Do you notice any significant changes in how he or she is spending money?

• Does your loved one seem afraid of or hesitant around his or her caregiver, roommate, or nursing home staff member?

• Does he or she appear thin, frail, overly tired, or have any unexplained cuts, bedsores, bruises, or injuries?

• Does your loved elder appear to have poor basic hygiene; are their hair or nails overgrown, do they appear unshowered; do they wear the same clothes over the course of several days?

• Does your loved one have easy access to their everyday assistance items–such as glasses, hearing aids, dental hygiene tools, walkers or wheelchairs, medications, etc.?

• Is there evidence–mail, e-mails, or phone messages–that indicates he or she has been the target of solicitations, aggressive telemarketers, online/by-mail contests, or other scams?

• Has he or she suddenly stopped participating in a long-time activity, club, or hobby they were once devoted to?

• Does your loved one appear lonely, depressed, or otherwise withdrawn or isolated from their friends, neighbors, and/or community?

• Are your loved one’s pets nourished, clean, and cared for?

As our elderly friends and family continue to age, it is essential that loved ones take an active role in ensuring their care does not fall to the wayside. Whether your loved one lives alone, in a nursing home, or with the help of a home aid–be sure to ask these questions during your holiday visits this year.

If you suspect an elder residing in the San Diego area is the victim of a senior scam, negligence, nursing home abuse, or other forms of elder abuse, contact an experienced elder abuse attorney and discover the recourse available to you.
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One 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.

Psychological abuse, also referred to as emotional abuse, can be difficult to notice at first glance. The damage often reveals itself in the form of changed behavior, as opposed to physical bruises and marks. It’s important to know that abuse can happen anywhere the elderly person resides, even in a nursing home or other long-term care facility, and can be sustained by any type of caregiver (paid, unpaid; professional, amateur). The National Center on Elder Abuse (NCEA), directed by the U.S. Administration on Aging, states, “most cases of elder abuse are perpetrated by known and trusted others, particularly family members (including children, spouses, and others).”

Examples of psychological abuse by caregivers, friends, or even family:

• Screaming or yelling;
• Intimidation via threat of punishment;
• Isolation from family, friends, or other social activities;
• Verbal abuse such as harassment, name-calling, embarrassment, and cursing; and
• Punishment, or threat of punishment, using terror or confinement (tied to a bed/chair for long periods of time or locked in a closet).

What are some signs that an abused elderly person might display?

• Changes in sleeping or eating habits;
• Low self esteem;
• Feelings of defeat, hopelessness, or fear;
• Unusual mood swings;
• Isolation from usual groups and activities;
• Expressions of self-inflicted hurt or attempted suicide;
• Avoiding eye contact; and • Avoiding talking about possible abuse or the abusive caregiver.

Elder abuse and elder neglect often go hand in hand. Neglect can be both physical and psychological, both of which are incredibly emotionally damaging to the elderly adult. For example, an abusive caregiver might refuse to respond to calls for help, or provide routine physical care, leaving the senior feeling fearful, helpless, and abandoned. Seniors are especially vulnerable to this type of abuse and neglect due to their deteriorated mental and/or physical state, total dependence on a caregiver, fear of abandonment and the perception of a lack of resources needed to seek help. It’s this vulnerability that makes it so important for suspected psychological abuse to be reported immediately.
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According to a recent study conducted by Cornell University, 1 in 5 nursing home residents suffer abuse at the hands of their fellow residents. The study is the first of its kind in collecting data on resident-to-resident abuse. The behaviors observed in the study include physical and sexual violence, verbal aggression and hostility, invasions of privacy, and other negative and inappropriate interactions.

Using data gathered from more than 2000 nursing home residents across ten different facilities, researchers determined that those that perpetrated these abusive behaviors were often cognitively impaired, but more mobile than their fellow residents. Over a four-week period, Cornell researchers observed and interviewed elder residents, and distilled statistical data from reports and questionnaires completed by staff:

• 16% of nursing home residents have been victims of verbal abuse from other residents, including instances of swearing and yelling.
• 10.5% of elderly nursing home patients report invasive behavior from other residents, such as un-permitted room entry and rifling through the personal possessions of others.
• 6% have suffered from physical abuse, like hitting, kicking, and/or biting.
• 1.3% reported sexual abuse, including indecent exposure, inappropriate contact, and efforts to exact sexual favors.

Presenting at the Gerontological Society of America’s Annual Scientific Meeting in 2014, Dr. Karl Pillemer noted that resident-on-resident abuse is “widespread and common in everyday nursing home life,” and that elderly residents suffering from conditions like dementia may act out with “verbally or physically aggressive behavior,” resulting in “arguments, shouting matches, and pushing and shoving, particularly in such close, crowded quarters.”

A particularly troubling aspect of this study is the lack of action on the part of nursing home staff. Across the country, including in San Diego and the surrounding Southern California area, elders suffer frequent abuse of all kinds from their fellow nursing home residents, and staff reports only a fraction of these altercations. Police are sometimes called to handle instances of theft or assault between residents, but many elderly nursing home residents lack a personal advocate to ensure that justice is delivered and their best interests are served.

If you suspect that your loved one in the San Diego or Southern California area is suffering from elder abuse, either from fellow residents in his/her nursing home or from nursing home staff, take action. Get in contact with a trusted professional who can assess your case and ensure that no abuse is ever repeated. Have your concerns addressed and resolved by a knowledgeable and experienced San Diego nursing home abuse attorney.
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According to the National Center on Elder Abuse, 27% of the 1.5 million Baby Boomers who identify as lesbian, gay, bisexual, or transgender worry about discrimination as they age. Unfortunately, research from the National Center on Elder Abuse shows that LGBT elders do suffer from higher rates of abuse and neglect compared to their non-LGBT elderly peers.

In surveying nearly 500 lesbian, gay, or lesbian nursing home residents aged 60 years and older, the National Center on Elder Abuse determined, “prejudice and hostility encountered by LGBT elder persons in institutional care facilities create difficult environments” and may result in physical and verbal abuse from other residents and nursing home staff.

Statistical data from the study reveals that:

• 65% of respondents experienced victimization because of their sexual orientation, including verbal abuse, threats of violence, physical and sexual assault, and threats of their orientation being disclosed to others.

• 29% of respondents had been physically assaulted, with men three times more likely to be the victim of a physical assault.

These verbal, sexual, physical, and discriminatory attacks often cause elderly victims to experience significant declines in mental health and quality of life. The study also revealed caregivers of the elderly might not be accepting of their charge’s sexual orientation and then respond with abusive behavior.

Based on a survey of 3,500 LGBT elders 55 and older, the National Center on Elder Abuse discovered that:

• 8.3% of LGBT elders were abused or purposefully neglected because of homophobia by caregivers.

• 8.9% of LGBT elders were threatened with or experienced blackmail or financial exploitation as a result of homophobia by caregivers.

• Sometimes nursing home staff goes so far as to deny visitors for an elderly LGBT resident, or bar partners from sharing a room and/or participating in medical decision making.

The National Academy on an Aging Society reports, “many LGBT older adults are at high risk for elder abuse, neglect, and various forms of exploitation because [they are] living in isolation and fear of the discrimination they could encounter in aging setting.”

If you reside in the San Diego or surrounding Southern California area and suspect that your loved one is suffering from abuse, discrimination, or other negative treatment by nursing home staff or fellow residents, take action. You may consider contacting an Ombudsman or the Department of Public Health.
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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
Change 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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The numbers of low income elderly and/or disabled Californians who are choosing to stay in their homes rather than reside in institutions, including nursing homes, is on the rise due in part to the availability of a program called In-Home Supportive Services (IHSS).

IHSS is a program in California which pays caregivers to help low-income elderly and disabled persons in their own homes, rather than placing the elder in a nursing home. While it may sound like a terrific option for elders who do not want to live in a residential facility, such as a nursing home, the IHSS program is not without its own problems.

Low income elderly or disabled persons are almost unanimously responsible for hiring, training and supervising their own caregivers, even though the caregivers are paid by the state. Most caregivers are family members or acquaintances of the elder, but many are not. Moreover, no formal training is required of caregivers, nor is there any regulated oversight in place to ensure that the IHSS caregiver is performing the duties they are being paid to perform. Some argue that this limited oversight puts elders at greater risk for abuse including financial abuse and/or neglect.

Signs that an elder is being abused by a caregiver include:

•Bruises, pressure marks, broken bones, scrapes, cuts, burns
•Withdrawal from normal activities
•Depression
•Weight loss
•Anxiety
•Bedsores
•Poor hygiene
•Arguments or strained relationships between the caregiver and elderly person

If you or someone you love is over 65, or disabled and needs in-home help, it is crucial to choose the caregiver carefully. Helpful tips for hiring a care worker have been provided by AARP here. You can also learn more about the IHSS program by visiting the California State Department of Social Services website.

If you suspect that an elder you know is being abused in their own home, or in a facility such as a California nursing home, it is imperative that you speak up.

You may consider contacting:

•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.
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NBC-7 San Diego recently reported a story exposing that:
“At 85 years old, Lynn Murphy’s health was failing, her memory fading fast. So, in October 2013, her daughter Kathe Murphy put her mother into the Oakmont of Roseville retirement community, near Sacramento.

While Lynn was in Oakmont’s memory care unit, Kathe said the staff wasn’t doing their job. She took photos of her mother’s dirty clothes, room and bathroom. She said the staff was supposed to be doing Lynn’s laundry and cleaning her living quarters. Kathe said her mother wasn’t being properly taken care of.

These were issues that Kathe said she knows about first-hand since she worked as a paralegal for 20 years for the Department of Social Services’ licensing division — the same state agency responsible for regulating and licensing elder care facilities in California.

“I said this is elder abuse. Nobody’s done anything,” Kathe said.

She took her mom out of the facility in April 2014 after she said her mom was put in bed and not checked on for almost 24 hours. Her mother died 3 weeks later.”

The tragedy has brought to light the question of whether or not installing cameras in nursing home residents’ rooms would help to prevent elder abuse and neglect. While many advocate for the installation of cameras, others declare that the installation of cameras would constitute a breach of privacy.

Current laws allow for video surveillance in common areas of a residential care facility. Yet the California Department of Social Services does not allow for cameras in resident’s rooms, citing privacy concerns.

According to the NBC-7 Story:

“The Department of Social Services Deputy Director of Public Affairs Michael Weston said the client’s right to privacy is a concern for the department.

“We view these as people’s homes, and we want people to have rights in their own home and balancing that between a business and a residence,” Weston said. “We want to be careful about.”

Weston said the department has developed proposed guidelines which would allow video cameras in private rooms under specific conditions. He said those guidelines are still being reviewed and expects to release them this spring.”

Click here to read the full story from NBC-7 San Diego.

Under California law, elder abuse is both a criminal and civil offense. Criminal elder abuse describes the willful infliction of physical or emotional suffering on an elder. Civil elder abuse typically includes any physical or financial abuse, neglect, or abandonment resulting in physical or mental harm.

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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Under a new bill proposed by Assemblyman Kevin McCarty, D-Sacramento, the state of California would be required to establish tighter “suitability requirements” for nursing home owners, with the goal of preventing those who have a history of poor performance from acquiring additional nursing homes.

Furthermore, under Assembly Bill 927, the Department of Public Health would also be required to make it easier for the public to ascertain who exactly owns particular nursing homes throughout the state. The California Advocates for Nursing Home Reform has called for greater transparency for years, so those contemplating placing a loved one in a California nursing home are able to easily determine who owns the nursing home they are considering.

According to a multi-part series on California nursing homes as reported by the Sacramento Bee:

“California has more nursing homes than any other state, and one of the country’s highest percentages of facilities owned by for-profit interests. Yet, as more private investment groups acquire skilled-nursing facilities, and ownership structures grow ever more layered and complex, the department has not kept pace with industry changes to help consumers evaluate chains – or even to identify the principals behind them.”

The Sacramento Bee’s lengthy investigation into ownership of California nursing homes, also revealed disturbing statistics, including:

*One nursing home chain operating in California racked up abuse complaints last year at a pace seven times the statewide rate.
*A large competitor placed one in every 15 of its long-term residents in restraints.
*Still another corporate giant whose nursing homes dominate the Sacramento region experienced high nursing staff turnover at 90 percent of its facilities.

Read more about the Sacramento Bee’s investigation here: http://www.sacbee.com/news/investigations/nursing-homes/article11316812.html#storylink=cpy

All elders in California nursing homes have the right to quality care and attention. If those rights are denied, abuse must be reported. For tips on reporting suspected neglect and/or elder abuse in a California nursing home, the Justice Department has a helpful citizen’s guide that can be found at the following website: http://ag.ca.gov/bmfea/pdfs/citizens_guide.pdf
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