Examples and Causes of Abuse in Assisted Living Facilities

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The Los Angeles nursing home and assisted living neglect lawyers at the Law Offices of Ben Yeroushalmi have years of experience investigating the causes of abuse in assisted living facilities. For additional information, contact us at any time at (310) 623-1926 or online.

Unlike skilled nursing facilities, assisted living facilities, also called "Residential Care Facilities for the Elderly" (RCFEs), do not provide skilled nursing care. Rather, they are the intermediary between independent living and nursing homes. Assisted living facility residents are elderly individuals who are provided room and board, as well as supervision and care. These facilities are supposed to be the "humane approach to meeting the housing, social and service needs of older persons" by delivering a more homelike living environment for elderly individuals with a number of care needs. (See Health & Safety Code § 1569.1.)

Even though RCFEs do not provide the complex skilled nursing care of nursing homes, elder abuse and neglect still frequently occur in these facilities. The Commission on California State Government Organization and Economy reported that many of the problems that the elderly faced in the 1980s are still prevalent in assisted living facilities in the modern age. These issues include violation of resident rights, inadequate facility services or conditions, unlawful eviction or transfer, and abuse or neglect by facility staff. The following causes are the most common reasons that unnecessary harm occurs in assisted living facilities:

Failure to Transfer to a Higher Level of Care

The admission standards of an assisted living facility reflect their ongoing political battle with skilled nursing facilities. Each type of facility seeks to access the widest "pool" of residents in order to receive the highest monetary compensation possible. Often, an assisted living facility will intentionally misclassify current or potential residents as not needing skilled nursing care in order to improperly retain these individuals in their facility. These situations include the following:

  • Non-Ambulatory or Bed-Ridden Residents

    Under current law, assisted living facilities may only retain residents who lack mobility only if it has met fire safety requirements and have obtained non-ambulatory fire clearance from local fire authorities. (See Health & Safety Code § 13131; see also 22 Cal Code Regs § 87101(n).) A non-ambulatory elder who cannot independently turn and reposition themselves while in bed is considered "bed-ridden" (see Health & Safety Code § 1569.72(b)) and are generally not allowed to be admitted or retained by an assisted living facility (See Health & Safety Code § 1569(a)), unless the facility has obtained appropriate fire clearance, and the number of such residents is limited to a specific number. (See Health & Safety Code §§ 1569(c), 1569(h).)

  • Restricted Health Conditions

    California law prohibits assisted living facilities from admitting elderly individuals who are in need of skilled nursing care. (See Health & Safety Code § 1569.72(a); see also 22 Cal Code Regs § 87455(c).) Assisted living facilities may not admit or retain elderly persons who have the health conditions listed in 22 Cal Code Regs § 87615, which include stage III and IV pressure ulcers, gastronomy care, naso-gastric tubes, severe infections (such as staph), tracheostomies, and dependence to perform all activities of daily living as codified in 22 Cal Code Regs See Health & Safety Code § 87459. Other conditions include (as per 22 Cal Code Regs § 87455), tuberculosis, severe mental disorders, and elders who are bed-ridden or who have dementia (unless the facility meets specific requirements).

    Despite these regulations, however, assisted living facilities often intentionally fail to identify specific restricted medical conditions in order to admit or retain residents, knowing that they cannot provide the care and treatment that these individuals truly need. Facility staff will frequently turn a blind-eye to resident condition in order to maximize profits.

  • Terminally-Ill Residents

    "Terminally-ill" is defined as having a prognosis by an attending physician of a life expectancy of six months or less. (22 Cal Code Regs § 87101(t).) An assisted living facility may only admit or retain elderly persons who are deemed "terminally-ill" if all of the following is met (according to Health & Safety Code § 1569 and 22 Cal Code Regs §§ 87632, 87633):

    • The facility agrees to accept/retain the person and to seek a waiver, and the person has requested the waiver and has the capacity to understand the waiver;
    • The person has obtained the services of a hospice program licensed by California and certified by Medicare;
    • The facility can provide appropriate care and supervision;
    • The hospice has agreed to provide necessary services to supplement facility care and supervision;
    • The facility and hospice prepare and sign a care plan for the person; and
    • The facility has obtained permission by any resident sharing a room with the person to allow hospice into the room.
  • Dementia

    An assisted living facility may only admit or retain elderly individuals with dementia if it complies with specific regulations regarding staffing, training, fire safety, and other measures set forth in 22 Cal Code Regs §§ 87705 and 87455. These regulations focus on the necessary safeguards for potential and current residents living with dementia.

    For example, assisted living facilities that advertise dementia care must also include in their plan of operation a narrative description regarding the dementia-related services. The facility admission agreements must inform the resident or responsible parties of the services described in the plan of operation. The facility must also ensure that staff who care for elders with dementia meet the applicable training requirements.


According to 22 Cal Code Regs § 87608, restraining devices other than postural supports approved in writing by a physician may not be used by assisted living facilities on residents. Restraints do not only include physical restraints, such as the use of full-length bed rails, but also chemical restraints, such as sedation by medication. Misuse of psychoactive medications to sedate residents is also a sign of abuse and gives rise to punitive damage liability. (See Welfare and Institutions Code §§ 15610, 15657.)

Facility staff may employ the use of restraints because they feel overworked or understaffed. If a resident is restrained, staff may feel they do not need to monitor or supervise the resident as frequently. However, use of restraints not only violates the rights of assisted living residents, but also leads to harm, such as through pressure ulcers from being left in one position for long periods of time, or through wandering and elopement which leads to a greater risk of falls.

Medication Error

Although regulations require that assisted living residents be capable of administering their own medications (22 Cal Code Regs § 87455(b)), in reality a high number of elderly residents are simply not capable, either physically or mentally, to do so. As a result, a large percentage of elderly residents that take and need medication are admitted to residential facilities with no medical staff to help them.

Although assisted living staff may assist residents in administering and storing medications, these employees are not skilled medical personnel like those in skilled nursing facilities. Severe harm can and does result as a consequence of undereducated and untrained staff assisting with medications.


Like skilled nursing facilities, understaffing in assisted living facilities is a sign of substandard care and contributes to avoidable injury to residents. Although staffing in assisted living facilities is not as heavily regulated as skilled nursing facilities, low staffing negatively affects the overall quality of care in assisted living facilities and leads to elder abuse and neglect. Assisted living facilities are often understaffed, both in terms of number and in training, to properly provide the care and supervision that residents at these facilities require.

Similar to those working in skilled nursing facilities, most of the employees in assisted living facilities are paid extremely low wages. Payroll is often the highest cost to assisted living owners and operators. This leads to exceptionally high turnover of assisted living staff.

Residents of assisted living facilities are admitted for care and supervision. When assisted living facilities are understaffed, less employees are available to monitor each resident to prevent against unnecessary harm. Elderly individuals who need assistance with medication and activities of daily living, as well as those with dementia or cognitive issues, are especially susceptible to the issues that result from an understaffed assisted living facility.

Despite this, however, similar to many nursing homes, managers, directors, and administrators of assisted living facilities consciously decide to understaff their facilities specifically in order to save on costs and make a higher profit. California law states that a facility's conscious decision to understaff its facility is elder abuse, not just mere negligence. (See, e.g., Merron v. Superior Court (2003) 108 Cal App. 4th 1049, 1067.) These facts are often used to impose punitive damage and enhanced remedy liability by experienced elder abuse attorneys.

Need Additional Information?

For additional information for examples and causes of abuse in assisted living facilities, get in touch with an experienced attorney. The nursing home and assisted living neglect lawyers of the Law Offices of Ben Yeroushalmi in Los Angeles are dedicated to elder abuse and neglect cases and can be contacted online or at (310) 623-1926.

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