Elder-care facilities must be on watch for neglect, abuse cases 

click to enlarge Neglect is defined under California Welfare and Institutions Code Section 15610.57 as including: "failure to protect from health and safety hazards."
  • Neglect is defined under California Welfare and Institutions Code Section 15610.57 as including: "failure to protect from health and safety hazards."

Today's question is another elder-law question from Francis P. in Marin:

Q: "I visited my mother over the holidays and could see that she had a red sore on her coccyx-tailbone. It looked red and 'angry' meaning that it was something active rather than something which was a callous. The home she is in is up north above Sacramento. This is where she wanted to be because she lived her whole life there and she has friends that come and visit her. I am unable to visit her more often since I have work, kids and my husband to take care of. I speak with her on the phone every day but I can't keep an eagle eye on her. What should I do?"

A: Francis, don't feel bad about your situation, it is one that many of us find ourselves in. My 84-year-old mother is in a nursing home in Connecticut close to my sisters. We are very fortunate that my sisters live one town away and are able to pay daily visits. We also have a nurse come in several times a week to help my mother and keep track of the staff. Have your mom's friend pay close attention to your mom's condition.

This case is one that may directly under the auspices of the California Elder and Dependent Adult Civil Protection Act (EADACPA), codified at Welfare and Institutions Code 15600, reflect the Legislature's recognition that persons age 65 and older are members of a disadvantaged class worthy of heightened protection. The EADACPA helps to meet that goal by affording heightened remedies to encourage private enforcement of the laws.

Abuse of an elder means either: a) physical abuse, neglect, financial abuse, abandonment, isolation, abduction, or other treatment resulting in physical harm or pain or mental suffering; or b) deprivation by a care custodian of goods and services necessary to avoid physical harm or mental suffering. Abuse of an elder means the negligent failure of any person having the care or custody of an elder or a dependent adult to exercise that degree of care that a reasonable person in a like position would exercise.

Neglect is defined under California Welfare and Institutions Code Section 15610.57 as including: "failure to protect from health and safety hazards." Abuse is defined as "the negligent failure of any person having the care or custody of an elder or a dependent adult to exercise that degree of care that a reasonable person in a like position would exercise."

As all organizations providing care to dependent adults must protect their patients from safety hazards (Section 15610.17). Bed sores are preventable and are often the result of neglect. They are especially prevalent in people who have no ability to ambulate and those who have to wear adult undergarments. These sores are often referred to as pressure ulcers as the pressure of the body, on any one area, buttocks, heels, etc., causes the capillaries to be compressed reducing blood supply to the affected area and skin death.

The greatest risk factors for ulcers include lack of ambulation, lack of mental clarity, poor diet, use of adult undergarments and lack of a schedule of patient movement to reduce pressure in the affected area.

My suggestion: Write a letter to the facility immediately including photographs of the affected areas and demand that they increase their vigilance and maintenance of your mother's hygiene. Demand a consultation with the dietician and a schedule for moving her within the bed, or getting her out of bed and standing, walking, etc., so that blood can flow to the area.

Demand that she be seen immediately by a physician and/or a wound care specialist. Send the letter to the facility's administrator and your mother's doctor. You may also wish to contact the county ombudsman, whose number is required by law to be posted in the facility, to make a complaint and request welfare checks. You need to act immediately as the ulcers progress through stages and can lead to infection, sepsis and death. The ulcer can be tunneling underneath the skin and be worse than appreciated. If this fails to improve the conditions immediately, contact a trial lawyer skilled in this area of law (like my firm) so we can be an advocate for you and your mom.

Christopher B. Dolan is owner of the Dolan Law Firm. Email questions to help@dolanlawfirm.com.

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