The California Supreme Court in San Francisco ruled on Monday that a home health care worker could not sue a patient with Alzheimer’s disease and her husband because of an injury the worker sustained while caring for the patient. The Court arrived at a 5-2 decision in the matter.

While the decision relies on a precedent set in 1994, involving a staff member in a nursing home sustaining a similar injury, the Court issued a new ruling that extends protection into the home. In the later stages of Alzheimer’s, agitation and flailing movements are common, and workers who choose to enter these patients’ homes should already be aware of the risks they assume, the Court claimed. To give legal preference to home aides over nursing home staff would give families a financial incentive to put a relative with Alzheimer’s into a nursing home — a side effect Justice Carole Corrigan said was unfair.

"It is a settled principle that those hired to manage a hazardous condition may not sue their clients for injuries caused by the very risks they were retained to confront," Corrigan wrote for the majority.

In 2005, Bernard Cott hired Carolyn Gregory as a home health care worker. Cott’s wife, Lorraine, suffered from Alzheimer’s. Bernard Cott says he informed Gregory from the beginning that his wife was prone to erratic movement and jerking limbs. In 2008, then 85 years old and weighing only 100 pounds, Lorraine Cott pushed into Gregory as she was washing dishes. Gregory was holding a knife at the time, and as Cott grabbed for the knife she caused the blade to fall onto Gregory’s wrist. Gregory says the incident took away sensation from two fingers and her thumb and caused her recurring pain.

Gregory sued the Cott family for negligence and battery, though her case was dismissed in the lower courts for the same reason the Supreme Court cited. (An important distinction lies in Gregory’s employment status. She was hired through an agency; families who hire the workers directly could still be liable.) Future lawsuits may still reach the Court, even with Monday’s ruling, provided plaintiffs can prove the job’s risks weren’t laid out before starting.

The two minority justices, Justice Laurence Rubin and Justice Kathryn Werdegar, argued in their dissent that home aides shouldn’t be treated like police officers or firefighters — professions where the risk of injury is inherent in the job. And the research may support their claims: Early stages of Alzheimer’s don’t carry the same risk as late stages. Out of the seven stages typically observed in Alzheimer’s, violence tends to emerge no earlier than the sixth stage.

"Not every patient with advanced Alzheimer's is violent, and violence is not common during the disease's early stages," Rubin wrote. “Thus, exposure to violence is not inherent in caring for all Alzheimer's patients.” Rubin and Werdegar also argued families tend to have a great deal of control over what goes on in their homes, lifting some of the risk assumed by the health worker. Since nursing homes, not the family of the patient, employ the staff member, the employee would be held responsible for injury.

Rubin added in his dissent that caring for Alzheimer’s patients remains the top priority. The World Health Organization projects dementia cases will triple by 2050, making preventive efforts all the more critical. In this, Rubin sympathized with the average home health care worker.

“Whatever the solutions to those problems, I do not believe they should be at the expense of in-home caregivers,” he said, “who risk a physical injury by working on the front line, typically for low pay and few benefits.”