Is Your Loved One Really Safe in Their Nursing Home? | Absolute Trust Talk
KEY POINTS
- Repeated falls, pressure ulcers, malnutrition/dehydration, elopement (lost residents), and even sexual abuse usually reflect system failures, not isolated mistakes.
- Non-negotiable facility duties.
Proper risk assessments, fall-prevention plans, Q2H turning and skin checks, adequate staffing/training, timely equipment (e.g., pressure-relief mattresses), post-incident reassessment, and thorough documentation are required—staffing shortages don’t excuse legal obligations. - Families must be proactive (and paper-trail everything).
Visit, ask specific questions (“Show me the turn log/weights”), and document concerns by email. Use support channels—Adult Protective Services, the Long-Term Care Ombudsman, California DPH complaints, and CANHR—while knowing agencies are overburdened. - Watch the fine print and practical limits.
Residents are a protected class in California. Do not sign arbitration agreements at admission if you can avoid it. Transfers aren’t always feasible (insurance approvals), and families may fear retaliation—be respectful but persistent. - Litigation realities & remedies.
Cases often turn on missing/weak records and impossible staffing ratios. Potential recoveries include pain and suffering, emotional distress, punitive damages, and attorney’s fees under California elder-abuse statutes. In practice, smaller facilities frequently deliver better individualized care.
Transcript:
(00:03) Hello and welcome to Absolute Trust Talk. I am Kirsten Howe, and I’m the host today. At Absolute Trust Counsel, we have many clients who have spent or will spend time in a skilled nursing facility — that’s the official legal term for what we usually call a nursing home. This might be temporary (for rehab after hospitalization) or more permanent if long-term care is needed.
(00:42) Nursing homes vary greatly in the quality of care for many reasons, so I thought it would be helpful to discuss how loved ones can ensure proper care — which is why I’ve invited my guest, Sharad Milanfar.
(01:23) Sharad Milanfar is a trial attorney and mediator specializing in catastrophic personal injury, product liability, nursing home abuse, police brutality, and truck accident cases. He became a lawyer after being a crime victim at age 12 and seeing firsthand how a prosecutor protected him. He’s now a Super Lawyer and one of the National Trial Lawyers Top 100 (2022–23).
(02:48) He’s also taught trial skills and mediation at Golden Gate University and served as a board member of Bay Area Legal Aid.
(03:34) Kirsten: As a personal injury lawyer, what are the common injuries you see in nursing home cases?
Sharad: We see issues in both residential care and skilled nursing facilities — repeated falls, bedsores, malnutrition, dehydration, even sexual abuse. In one case, a nursing home lacked an evacuation plan and literally lost a resident for some time.
(05:08) Many of these are not isolated incidents. For example, one client fell 23 times in 12 months at a single facility. Fall prevention requires proper risk assessments and follow-up after each fall — not just written protocols but enough staff to implement them.
(06:25) When someone is labeled “high fall risk,” the question becomes: what did the facility do about it? Was there reassessment after the first fall? Families should stay engaged and ask these questions.
(07:03) Kirsten: What about bedsores?
Sharad: Same principle. Facilities must conduct skin assessments, document risk factors, and take proactive measures — special mattresses, leg elevation, repositioning every two hours, and timely follow-ups. Lack of training, staff, or documentation usually leads to problems.
(09:04) Kirsten: Malnutrition and dehydration sound preventable. What goes wrong?
Sharad: Often, residents need assistance eating. Families visit and find untouched cold food hours later. Staff must monitor intake and weight fluctuations. A 25–30 pound loss in a few months is a red flag. Malnutrition and dehydration also worsen bedsores and infection risk.
(11:11) Kirsten: Is staffing part of the problem?
Sharad: Absolutely. Facilities are often short-staffed or underpaid. But legal care standards don’t change — if you can’t safely handle 40 patients, take 30 instead. Sadly, many prioritize profit over care.
(12:38) Families can now visit again post-COVID, acting as “eyes and ears.” Elderly and disabled residents are a protected class under California law, and families can hold facilities accountable by asking questions and being active.
(13:22) It’s rarely one “bad nurse.” The problem is systemic: poor leadership, overworked staff, or lack of care. Even if a patient is “difficult,” facilities accepted them knowingly and must still provide appropriate care.
(14:50) Most nursing homes are for-profit businesses, and profit motives can undermine care. Families must recognize this and stay vigilant.
(15:32) Kirsten: What should families do if they suspect neglect?
Sharad: Ask questions politely but persistently. Document concerns by email so they’re on record. Example: “Mom fell yesterday — what caused it? What’s being done to prevent another?” Don’t settle for surface-level answers.
(16:58) Be polite but persistent — your loved one’s well-being matters more than politeness.
(17:40) If problems persist, consider moving the resident — but that’s often difficult due to insurance or limited facility options. Families shouldn’t be blamed for not moving their loved one when the facility itself failed to provide required care.
(18:59) Health plan approvals are needed for transfers, so switching homes isn’t as simple as changing coffee shops.
(19:45) Families may fear retaliation after complaining. That’s real, but facilities still have legal duties. Retaliation or retribution is illegal and must be challenged.
(20:31) Families can contact Adult Protective Services, the Ombudsman, or file complaints with the California Department of Public Health (CDPH). Also, CANHR (California Advocates for Nursing Home Reform) is a great nonprofit resource.
(22:40) In Contra Costa, Alameda, and Solano counties, Ombudsman services are provided by Empowered Aging, which helps ensure fair treatment of residents.
(23:25) However, agencies are overburdened, so family involvement remains essential. Many elders with cognitive decline downplay neglect when interviewed, causing cases to be closed prematurely. Families must provide supplemental information.
(24:50) When cases escalate to litigation, Sharad notes they’re tough:
- Facilities push arbitration agreements (don’t sign them).
- Arbitration favors facilities and limits accountability.
- Winning elder abuse claims (clear and convincing standard) allows recovery of attorneys’ fees.
(26:05) Sharad advises:
- Don’t sign arbitration agreements.
- Be proactive and ask detailed questions.
- Smaller facilities often provide better care.
(27:36) Audience Q&A:
Q: Isn’t a bedsore automatic proof of neglect?
Sharad: Not always. Defense experts argue they’re unavoidable. We examine documentation — were patients repositioned every two hours? Was there proof of it? Missing records speak volumes. Many caregivers simply have too many patients to follow all protocols.
(31:06) Q: What compensation is available for nursing home abuse?
Sharad: Emotional distress, pain and suffering, punitive damages, attorney’s fees, and sometimes investigations into the facility’s financial structures. Many operate under layered corporations to obscure profits.
(32:23) These cases are about accountability and giving a voice to those who can’t speak for themselves.
(33:03) Kirsten: Thank you, Sharad, for your insights and advocacy.
Sharad: Thank you — and thank you for helping clients I’ve referred for estate planning.
(33:41) Closing:
Listeners, thank you for joining another episode of Absolute Trust Talk.
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(34:51) Join us for our next live episode in two weeks, or email questions to info@absolutetrustcounsel.com.
Thanks again for listening — see you soon.
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