Nursing home neglect is the failure of a skilled nursing facility, assisted living community, or other care facility to provide the basic care a resident needs to remain safe and healthy. California’s Elder Abuse and Dependent Adult Civil Protection Act gives families specific legal tools to hold facilities and their staff accountable when neglect causes harm — including pressure injuries, dehydration, falls, medication errors, and wrongful death.
By Paul H. Kang, Attorney · Los Angeles Bar Association Elder Law Panel Counsel · Last updated 2026
When a person enters a nursing home, the facility assumes legal responsibility for that resident’s care. State and federal regulations require nursing homes to provide enough trained staff, appropriate medical attention, sufficient food and hydration, hygiene assistance, supervision against falls and elopement, medication administration on schedule, and individualized care planning that gets updated as the resident’s condition changes.
When facilities fall short of these obligations, the harm is rarely visible immediately. A resident does not develop a Stage IV pressure injury overnight. A resident does not become severely dehydrated in a day. A resident does not lose 20 pounds in a week. These outcomes develop over time, often weeks or months, while staff fail to follow the care plan, fail to chart accurately, or fail to escalate problems to physicians.
Families are usually the first to notice. The resident seems thinner. The skin has new wounds. The clothing is dirty. The resident is afraid of certain staff members or rooms. Medications are missing or expired. The facility’s answers to questions become vague or defensive.
California’s Elder Abuse and Dependent Adult Civil Protection Act (Welfare and Institutions Code section 15600 and following) was written to address exactly this. It treats nursing home neglect not as ordinary negligence but as a distinct civil wrong, and it gives families specific remedies that go beyond what general personal injury law allows.
Failure to reposition (pressure injuries)
Bedridden and immobile residents must be repositioned on a regular schedule — typically every two hours — to prevent skin breakdown. When staff fail to follow the repositioning protocol, pressure on bony areas (heels, hips, sacrum, shoulder blades) cuts off blood flow and the tissue dies. The resulting [pressure injuries](/elder-law-litigation/pressure-injuries/) can reach muscle and bone within weeks.
Falls and fall-related injuries
Residents with cognitive impairment, mobility limitations, or medication-induced unsteadiness are at high risk for falls. Facilities are required to assess fall risk on admission and at each significant change in condition, and to put fall-prevention interventions in place. When facilities fail to implement bed alarms, scheduled toileting, supervision during transfers, or appropriate footwear, residents fall and suffer fractures, head injuries, and traumatic brain injuries.
Dehydration and malnutrition
Residents who cannot feed themselves require staff assistance and monitoring of intake. Many residents have specialized diets, swallowing precautions, or supplements ordered. When meals are rushed, when residents are not assisted, when intake is not charted, or when weight loss is not escalated to a physician, residents become severely dehydrated, lose dangerous amounts of weight, and develop infections and pressure injuries that flow from poor nutritional status.
Medication errors
Nursing homes administer dozens of medications to each resident on a strict schedule. Errors take many forms: missed doses, wrong doses, wrong medications, failure to follow the order, failure to monitor for adverse effects, and failure to discontinue medications as ordered. Medication errors can cause overdoses, undertreatment of conditions, dangerous drug interactions, and chemical restraint when sedatives are used to suppress behavior rather than treat a medical condition.
Hygiene neglect and infections
Residents who cannot toilet or bathe themselves depend on staff for hygiene care. When staff fail to provide regular bathing, brief changes, oral care, and perineal care, the results include urinary tract infections, skin infections, scabies and other transmissible conditions, and pressure injuries that develop more rapidly because of skin contamination.
Elopement and wandering
Residents with dementia or other cognitive impairment may attempt to leave the facility (elopement) or wander into dangerous areas. Facilities are required to assess elopement risk and to put appropriate supervision, monitoring, and physical safeguards in place. When residents leave undetected, the consequences range from exposure injuries to death.
Untreated medical conditions
Facilities must monitor each resident’s status and escalate changes to a physician. When staff fail to recognize early warning signs, fail to take or chart vital signs accurately, or fail to communicate with the resident’s physician, treatable conditions become severe — pneumonia becomes sepsis, a urinary tract infection becomes urosepsis, a small wound becomes osteomyelitis.
Failure to follow the resident’s care plan
Every nursing home resident must have an individualized care plan that addresses their specific needs and is updated as conditions change. When staff do not follow the plan, or when the plan is never updated to reflect the resident’s actual status, neglect results from the disconnect between what should be happening and what is.
Families who suspect neglect should document what they see. The following are common indicators:
Pressure injuries at any stage, especially on the back of the head, shoulder blades, sacrum, hips, or heels
Unexplained weight loss or visible thinness; clothing fitting loosely
Dehydration signs — dry mouth, sunken eyes, decreased urine output, confusion
Bruising or fractures that staff cannot explain or that appear in patterns inconsistent with the explanation
Soiled clothing or bedding that is not changed promptly
Strong odors of urine or feces in the resident’s room or on the resident
Untreated wounds, rashes, or infections that the family was not told about
Withdrawal, fear, or behavioral changes, especially in the presence of specific staff members
Missed medications — pills found in the room, in the bedding, or accumulated in a drawer
Repeated emergency room visits for conditions that should have been managed in the facility
Charting that does not match what you observe during visits
Documentation matters. Photographs, dated notes of conversations with staff, copies of medical records you are entitled to under HIPAA, and the names of staff present during incidents become evidence if litigation becomes necessary.
If you believe abuse or neglect is happening, you should also report it to [California Adult Protective Services](https://www.cdss.ca.gov/inforesources/county-aps-offices) and, for skilled nursing facilities, to the California Department of Public Health Licensing and Certification program. These reports trigger investigations that often produce evidence useful in a civil case.
California’s Elder Abuse Act treats neglect as a distinct civil wrong that requires specific proof. To recover under the statute’s enhanced damages provisions, plaintiffs must show:
1. The defendant had care or custody of an elder or dependent adult
2. The defendant knew of conditions that made the resident unable to provide for the resident’s own basic needs
3. The defendant denied or withheld goods or services necessary to meet those basic needs
4. The conduct was committed with recklessness, oppression, fraud, or malice — not ordinary negligence
The factual case is built from facility records and expert testimony. Records that matter include:
Nursing notes and charting — what staff documented as happening (or what they did not document, when documentation was required)
Medication administration records (MARs) — what was given, when, and by whom
Care plans and MDS assessments — what the facility committed to providing and how it assessed the resident’s needs
Incident reports — what the facility documented when something went wrong
Staffing schedules and assignments — who was working and how many residents they were responsible for
Facility policies and procedures — what the facility’s own rules required staff to do
State survey reports — what state inspectors found when they reviewed the facility
The medical case requires expert testimony connecting the facility’s conduct to the resident’s harm. Standard-of-care experts — geriatric nurse practitioners, registered nurses with long-term care experience, or geriatric physicians — establish what the facility should have done. Causation experts link the facility’s deviation from the standard to the specific injury the resident suffered.
When the elements of the statute are met, the resident or surviving family members can recover the resident’s pain and suffering damages (even after death — an exception to the general wrongful death rule), attorney’s fees, and where applicable punitive damages.
When the Elder Abuse Act applies, damages may include:
Economic damages — medical expenses for treatment of the neglect-caused condition, ambulance and hospital costs, costs of additional care needed because of the neglect
Pain and suffering damages — the resident’s own physical pain and emotional distress, recoverable by the resident if living or by the resident’s heirs if the resident has died. This survival of pain and suffering damages after death is the most distinctive feature of California’s Elder Abuse Act and is unavailable in ordinary wrongful death cases.
Attorney’s fees — Welfare and Institutions Code section 15657 authorizes attorney’s fees against defendants found liable for elder abuse by clear and convincing evidence
Punitive damages — in cases of malice, oppression, or fraud, additional damages designed to punish and deter
Wrongful death damages — when neglect causes death, surviving family members can also pursue a wrongful death claim for their own loss
The interaction between elder abuse damages, survival action damages, and wrongful death damages is technically complex and depends on the specific facts of each case. We will analyze which combination of claims fits a given situation during the initial consultation.
California’s Elder Abuse and Dependent Adult Civil Protection Act defines neglect as the negligent failure of a person having care or custody of an elder or dependent adult to exercise the degree of care that a reasonable person in a like position would exercise — including failure to provide medical care, food, water, clothing, and hygiene, and failure to protect from health and safety hazards.
Common warning signs include pressure injuries, unexplained weight loss, dehydration, bruising or fractures that staff cannot explain, soiled clothing or bedding, strong odors, untreated wounds or infections, withdrawal or behavioral changes, missed medications, and repeated emergency room visits. Document what you see, including photographs and dated notes, and request access to the facility’s records.
The facility’s own records — nursing notes, medication administration records, care plans, MDS assessments, incident reports, and staffing schedules — are the foundation of every neglect case. Photographs of injuries, the family’s contemporaneous notes, medical records from outside providers (emergency rooms, hospitals, hospice), and expert testimony about the standard of care complete the picture.
Yes. California’s Elder Abuse Act allows surviving family members to recover the resident’s pain and suffering damages even after the resident’s death — an exception to the general rule that pain and suffering damages die with the victim. A wrongful death claim may also be available to the resident’s heirs for their own loss. Both claims can typically be pursued together.
Yes. We represent residents and families harmed by neglect at skilled nursing facilities (SNFs), residential care facilities for the elderly (RCFEs), assisted living communities, board and care homes, and adult day care centers. Each facility type has its own regulatory framework, but California’s elder abuse laws apply to all of them.
Most elder abuse and neglect claims must be filed within two years of the neglect or the resulting harm. Wrongful death cases involving elder abuse generally allow two years from the date of death. Some cases involving financial elder abuse allow four years. Statutes of limitation can be easy to miss – contact an attorney as soon as you suspect neglect.
Q: What is Elder Abuse and Neglect A: Some examples of elder abuse are when someone hits, slaps, pinches, pushes, kicks, restrains, confines an elder.
