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Nursing Home Abuse and Neglect in California

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Posted: 1st October 2025

Lawyer Monthly

Nursing Home Abuse and Neglect in California

The decision to entrust an elderly or dependent loved one to a skilled nursing facility (SNF) is made with the fundamental trust that they will receive continuous, professional, and compassionate care.

This trust is tragically broken for thousands of California residents each year who become victims of neglect and outright abuse.

The resulting injuries from preventable falls and advanced pressure ulcers to malnutrition and fatal infections, often trigger complex legal battles that demand a deep understanding of elder abuse statutes and the rigorous framework of Medical Malpractice & Professional Negligence in California.

This article explores the legal and statutory landscape governing nursing home liability in California, detailing how negligence is defined, the critical role of the Elder Abuse Act, the limitations imposed by MICRA, and the distinct types of malpractice that endanger the state's most vulnerable population.

I. The Foundation of Liability: Abuse, Neglect, and Professional Failure

In California, legal action against a nursing home can be pursued under two primary theories: general negligence/medical malpractice, and claims brought under the state's powerful Elder Abuse and Dependent Adult Civil Protection Act (EADACPA).

Medical Malpractice in California: What Counts as Negligence

A claim of professional negligence, or Medical Malpractice in California: What Counts as Negligence, rests on the breach of the accepted standard of care.

Nursing homes, licensed as healthcare facilities, owe a high standard of care to their residents. When a facility or its professional staff (Registered Nurses, Licensed Vocational Nurses, and staff physicians) fail to meet this standard, and that failure directly causes harm, a negligence claim exists.

Examples of negligence that fall under the medical malpractice umbrella in a nursing home setting include:

Failure to Treat Pressure Ulcers: A Stage IV bedsore is a classic example of professional negligence, indicating a failure to follow the care plan by not regularly repositioning the resident.
Failure to Communicate: A nurse failing to relay critical changes in a resident’s condition (e.g., a spiking fever, signs of a stroke, or respiratory distress) to the attending physician.
Ignoring Fall Risks: Failing to conduct a proper fall risk assessment, or neglecting to use prescribed safety measures like bed alarms and chair alarms, leading to a debilitating or fatal fall.

The Elder Abuse and Dependent Adult Civil Protection Act (EADACPA)

While a standard negligence claim seeks compensatory damages for injuries, the Elder Abuse Act is designed to protect a "disadvantaged class" of Californians and provides for enhanced remedies.

To elevate a claim from simple negligence to statutory elder abuse, the plaintiff must provide clear and convincing evidence that the defendant (the facility or staff) acted with recklessness, oppression, fraud, or malice in failing to provide the care that a reasonable person in a like position would provide.

This concept of "neglect" under the Act goes beyond simple carelessness. It represents a conscious disregard for the safety and well-being of the resident. Successful EADACPA claims against nursing homes, where the higher standard of proof is met, permit the recovery of:

Attorney's Fees and Costs: This is a crucial remedy in complex nursing home litigation, as it helps families hire qualified legal counsel.
Post-Mortem General Damages (Pain and Suffering): Unlike a typical survival action (discussed later), the Act explicitly allows for the recovery of a deceased resident's pain and suffering damages, provided the "reckless" or "willful" standard of abuse is met.
Punitive Damages: In the most egregious cases of willful misconduct, a jury may award punitive damages designed to punish the defendant and deter similar conduct in the future.

II. The Financial and Procedural Constraints: MICRA's Impact

A significant factor in any lawsuit involving professional negligence against a healthcare provider in California, including skilled nursing facilities, is the Medical Injury Compensation Reform Act of 1975 (MICRA).

MICRA and Damage Caps in California Medical Malpractice Cases

MICRA fundamentally limits the amount of compensation an injured plaintiff can receive for non-economic losses. MICRA and Damage Caps in California Medical Malpractice Cases directly restrict the recovery for subjective harms like pain and suffering, emotional distress, and loss of enjoyment of life.

The 2022 legislative reforms (AB 35) introduced a phased increase to the non-economic damage cap, which had been fixed at $$250, 000$ since 1975. The cap is now subject to annual increases:

Non-Death Cases: The cap increased to $$350, 000$ in 2023, and will increase incrementally to $$750, 000$ by 2033.
Wrongful Death Cases: The cap increased to $$500, 000$ in 2023, and will increase incrementally to $$1, 000, 000$ by 2033.

It is vital to note that Economic Damages (past and future medical bills, lost wages, and life care costs) remain uncapped under MICRA.

Furthermore, experienced legal strategy is key: by successfully arguing a claim under the Elder Abuse Act's "recklessness" standard, or by proving the underlying conduct was "ordinary negligence" rather than "professional negligence," attorneys can sometimes bypass or minimize the effect of the MICRA caps.

The Bifurcation of Claims: Wrongful Death and Survival Actions

When a resident dies due to negligence or abuse, two distinct causes of action may arise:

Wrongful Death Claim: This claim is brought by the decedent's heirs (spouse, children, etc.) for the damages they suffered as a result of the death. These damages include loss of companionship, financial support, and funeral expenses. The non-economic component of a wrongful death claim is subject to the MICRA cap. The legal process for Wrongful Death in California Nursing Homes is complex and must be initiated within a strict statute of limitations.
Survival Action: This claim is brought on behalf of the decedent's estate for the losses the decedent suffered before death. Traditionally, California Code of Civil Procedure $§377.34$ prohibited the recovery of pain and suffering damages in a survival action. However, the 2021 amendment to the statute changed this, allowing for the recovery of pain and suffering damages in survival actions—a major development in holding negligent parties accountable. Combined with the enhanced remedies under the Elder Abuse Act, the possibility of two separate, substantial recoveries exists for families.

The Arbitration Clause Hurdle

Many nursing home admission contracts contain clauses requiring the resident and their family to agree to binding arbitration for any future disputes, including malpractice and elder abuse claims.

While these clauses aim to move disputes out of the public court system, they are frequently challenged in California courts.

The California Supreme Court has been clear that a resident's arbitration agreement to resolve medical malpractice disputes may not automatically bind their heirs to arbitrate a wrongful death claim based on the facility's overall institutional neglect (custodial care) rather than purely professional medical services.

Navigating the enforceability of these pre-signed agreements is often the first critical step in a nursing home abuse lawsuit.

III. Specific Areas of Negligence and Malpractice in Care Facilities

The poor quality of care that leads to abuse and neglect often stems from severe understaffing, inadequate training, and administrative failures that prioritize profit over resident well-being. This negligence manifests in specific, harmful ways:

A. Diagnostic and Treatment Failures

Misdiagnosis and Delayed Diagnosis Claims in California are frequently at the heart of nursing home litigation. A resident relies completely on the facility staff to monitor their health, report concerning changes, and ensure physician orders are followed. Failure to:

Recognize and report early signs of stroke, heart attack, or respiratory distress.
Timely diagnose a fracture after a fall.
Monitor and treat a spreading wound infection, leading to sepsis and death.

In these cases, the legal focus shifts to whether a reasonably competent and diligent nursing home staff would have ordered the appropriate tests, called for timely medical intervention, or escalated the issue to a specialist.

When a delay allows a treatable condition to progress to a critical stage, a valid malpractice claim exists.

B. Medication and Pharmacy Errors

The administration of medication is a task with zero margin for error. Medication and Pharmacy Error Lawsuits in California may target the prescribing physician, the pharmacy, or, most commonly, the nursing staff.

See the California Medication Error Reporting (CAMER) page for state rules and reporting obligations.

Medication mistakes include:

Wrong Dosage or Wrong Patient: Administering an incorrect amount or giving a drug intended for another resident.
Omission: Failing to administer a necessary medication at the prescribed time, such as insulin or a blood thinner.
Improper Monitoring: Failing to monitor the resident for adverse drug reactions, particularly with powerful psychoactive drugs used as unauthorized "chemical restraints."

Federal and state regulations require strict protocols for drug management, and deviations from these protocols are strong evidence of professional negligence.

C. Errors in Physical and Restorative Care

Surgical Errors: Patient Rights in California are most often addressed in the hospital setting, but in a nursing home context, this category expands to include negligence surrounding wound care and post-operative recovery. A resident’s right to competent care also applies to restorative services and preventative measures.

Failure to Prevent Falls: Falls are the leading cause of injury in nursing homes. Negligence often involves the facility failing to provide assistance, neglecting to keep the floor clear of hazards, or improperly transferring a resident.
Negligent Wound Care: Improper surgical site or wound care management can lead to severe infections, and is a clear violation of professional standards.

D. The Broader Spectrum of Medical Negligence

While focused on the core issues of nursing home care, the legal framework is influenced by claims in other areas of medical malpractice:

Psychiatric Malpractice and Mental Health Provider Liability: Relevant where the facility provides inadequate mental health services, leading to self-harm, suicide, or emotional distress. This is particularly true if staff negligently misuse chemical or physical restraints to control resident behavior.
Telemedicine Malpractice: Emerging Issues in California: As many SNFs rely on remote practitioners for after-hours consultations, errors stemming from poor virtual examinations, faulty equipment, or inadequate communication protocols introduce new avenues for professional negligence claims.
Dental Malpractice Claims in California: The elderly often have complex oral health needs. Failure to provide routine or urgent dental care can lead to serious infections that endanger overall health, forming the basis of a negligence claim against the provider or facility.
Birth Injury Lawsuits in California: While not directly applicable to elder care, the high-stakes, time-sensitive nature of these claims highlights the severity of the standard of care required in all medical settings, a standard nursing homes must also uphold.

IV. The Path to Accountability

For families facing the aftermath of nursing home abuse and neglect, seeking accountability is essential, not only for compensation but to deter future negligence.

The complexity of these cases navigating the MICRA caps, proving the enhanced remedies of the Elder Abuse Act, and overcoming arbitration agreements, requires experienced legal guidance.

By leveraging medical evidence, state regulation violations (such as mandated minimum staffing ratios in Title 22), and expert testimony, victims can hold negligent facilities and their corporate owners accountable for a profound breach of trust.