California Supreme Court Finds That Caregiver Assumes Risks with Dementia Patients
August 12, 2014 04:20 PM
The Supreme Court of California issued a very detailed ruling on the rights of health care workers who are injured in caring for patients with Alzheimer’s disease and other dementias. In its ruling, the court held that health care workers employed to care for individuals with dementia assume the risk of injury caused by their clients who suffer from a disease that manifests itself in agitation and physical aggression. The case is the first known of its kind in the nation, and it extends a fairly well-settled principle “that those hired to a hazardous condition may not sue their clients for injuries caused by the very risks they were retained to confront.”
In Gregory v. Cott, the California Supreme Court addressed the claims brought by a personal care worker employed by a home care agency against one of her clients and the client’s spouse. The worker sought damages for injuries caused the client when the client bumped into the worker as she was engaged in housekeeping tasks. Specifically, the worker lost control of a knife when she was bumped, the knife injured her hand, and she ended up with a series of injuries from the knife wound. The worker received protections under the agency’s worker compensation coverage, but also sued the client for damages.
The court applied a principle of law known as primary assumption of risk to reject the worker’s claims. Under that principle, there is no duty breached by a party when an injury occurs in a hazardous situation where risks are inherent in the nature of the employment. The court reviewed earlier cases throughout the nation where the principle was applied to firefighters, veterinarians, and health care workers in an institutional setting.
The court, in a divided opinion, held that the principle can apply equally in the home care setting as well as in nursing homes and hospitals. Also, no exceptions apply because the worker is a nonprofessional or receiving limited wages.
The court found that the extension of the general rule from institutional care to a home care setting was reasonable in light of the nation’s overall policy of encouraging home care over institutional care, demonstrated by various legal reforms including the US Supreme Court decision in Olmstead v. L.C. that held that Medicaid beneficiaries are entitled to care in the least restrictive environment under the Americans with Disabilities Act.
In this case, the worker and her employer were aware of the nature of the client’s condition and her needs. The needs were triggered by her dementia. As such, the risks of caring for the client were known and expected while the worker was employed in the client’s household specifically to deal with needs stemming from a condition that created a hazardous environment.
The case offers a few lessons to home care agencies:
First, the agency-employer should make sure that the assigned workers are fully aware of the care setting and client’s condition on all assignments. This will help manage risks and put competent workers into the care of clients.
Second, home care agencies should provide adequate training and support for workers specific to the nature of the clients they serve. For example, serving clients with a form of dementia requires directed training and support that is different than providing services to individuals with physical disabilities.
Third, agencies should take all reasonable measures to reduce foreseeable risks in the home care environment that are due to any hazardous condition related to the nature of the client and her care needs.
These steps help manage risks that a worker will be injured, clients needs will not be met , and agencies will fail to adhere to community standards of practice and/or licensing laws and accreditation standards. In addition, it will reduce the risks of litigation that involves any and all of the stakeholders involved.
The decision in Gregory v. Cott was issued by the California Supreme Court on August 4, 2014. The decision can be found here.