Alzheimer's Patient Not Liable for Injuries To Home Caregiver

A man contracted with a home health care agency to assist with his 85-year-old wife, who suffered from Alzheimer's disease. The agency assigned a caregiver to work in their home. The caregiver was trained to care for Alzheimer's patients and had done so in other assignments. She knew they could be violent. The husband told her that his wife was combative and would bite, kick, scratch, and flail. The caregiver's duties included supervising, bathing, dressing, and transporting the wife, as well as some housekeeping.


About three years after she was assigned to their home, the caregiver was washing dishes while the wife sat at the kitchen table. The husband was not at home. As the caregiver was washing a large knife, the wife approached her from behind, bumped into her, and reached toward the sink. When the caregiver attempted to restrain the wife, she dropped the knife, which struck her wrist. As a result, the caregiver lost feeling in several fingers and experienced recurring pain.


The caregiver sued the couple for negligence and premises liability, with a claim against the wife for battery. The Los Angeles County Superior Court granted summary judgment to the couple. A divided Court of Appeal affirmed, holding that the caregiver's claims were barred by the primary assumption of risk doctrine.


The Supreme Court of California affirmed. The court held that, under the doctrine of primary assumption of risk, the Alzheimer's patient and her husband were not subject to tort liability for an injury that the wife allegedly caused to her in-home caregiver, even if the wife’s conduct was intentional, regardless of the fact the care was provided in the couple’s home, even though the caregiver was not a certified health care professional, even though the caregiver's duties included housekeeping, and the husband’s disclosure that his wife had violent tendencies was sufficient.


The court explained that primary assumption of risk was a complete bar to recovery that applied when, as a matter of law, the defendant owed no duty to guard against a particular risk of harm. The doctrine of assumption of risk applied in favor of those who hired workers to handle a dangerous situation, in both the public and the private sectors, since such a worker, as a matter of fairness, should not be heard to complain of the negligence that was the cause of his or her employment. Primary assumption of risk in its occupational aspect was readily applicable to the relationship between hired caregivers and Alzheimer's patients. The court found that violent behavior was a common symptom of the disease as shown by medical texts, legal commentary, and the facts of reported cases. The court reasoned that the risk of violent injury was inherent in the occupation of caring for Alzheimer's patients. Therefore, Alzheimer's patients owe no duty of care to protect hired caregivers from the risk of injury.


The court held that primary assumption of risk barred recovery, even if the wife's violent conduct was intentional. Whether “intentional” or not, violent conduct by Alzheimer's patients was an inherent aspect of the caregiving function of an aide trained and employed by a home health care agency specifically to assist the patient, and therefore within the scope of the risk assumed by the aide.


Alzheimer's patients owed no duty of care to protect home health care workers just as they owed no duty to health care workers employed in institutions. In each setting, caring for patients with Alzheimer's dementia was the “nature of the activity.” Caregivers were hired to protect the patients from harming themselves or others. If a patient injured a caregiver by engaging in the combative behavior symptomatic of Alzheimer's disease, the “particular risk of harm that caused the injury” was among the very risks the caregiver was hired to prevent.


The court held that primary assumption of risk barred recovery even though the caregiver was not a certified health care professional where the caregiver was employed specifically to assist the wife, and the caregiver was trained and employed by a home health care agency. The court expressly stated that it did not hold that anyone who helps with such patients assumed the risk of injury; rather the rule the court adopted was limited to professional home health care workers who were trained and employed by an agency.


The court held that primary assumption of risk barred recovery even though the caregiver's duties included housekeeping. The court reasoned that the circumstance that her duties included some housekeeping did not alter the central reason for her employment: the wife's inability to care for herself due to Alzheimer's disease. This fact established their relationship as caregiver and patient, and supported the application of primary assumption of risk.


Having hired the caregiver to care for his wife, the husband owed the caregiver no duty to protect her from the ordinary risks that arose in the course of that employment. The husband informed her of his wife's combative tendencies. He was not required to warn her that his wife might approach her from behind while she was washing dishes. No advisement can reasonably be required to anticipate every variation of circumstance in which a disclosed risk might develop.


The court expressly stated that its holding did not preclude liability in situations where caregivers were not warned of a known risk, where defendants otherwise increased the level of risk beyond that inherent in providing care, or where the cause of injury was unrelated to the symptoms of the disease.


The Supreme Court of California affirmed the trial court’s grant of summary judgment to the Alzheimer’s patient and her husband.


See: Gregory v. Cott, 2014 WL 3805478, 14 Cal. Daily Op. Serv. 8780 (Cal., August 4, 2014) (not designated for publication).