Written by attorney Scott Jason Vold

Detecting and Preventing Nursing Home Abuse

Watching our grandparents and parents grow older can be difficult. As those we love fall victim to the ailments of aging, we look to medicines, doctors, diets, vitamins—anything we can find—in hopes of keeping them healthy and able to live as independently as they wish to. When finally the complications get too great, we turn to an assisted living, nursing home, or other long-term care facilities to continue the thoughtful and conscientious care we are no longer able to provide.

While many of these facilities provide excellent care, far too many do not. More concerned with profitability than the wellbeing of our loved ones, nursing homes are often understaffed with underpaid or poorly-trained employees. Neglected and abused, nursing home residents may suffer physically and emotionally.

It is difficult to say how many older Americans are abused or neglected each year, largely because surveillance is limited and the problem remains greatly hidden. The National Elder Abuse Incidence Study suggest that more than 500,000 Americans aged 60 and over were victims of abuse in 1996. This number has likely increased greatly in the last several years. Indeed, the Senate Special Committee on Aging estimates that there may be as many as 5,000,000 victims of elder abuse every year.

What is Nursing Home Abuse?

Elder abuse can take many forms, but the four below are the most common, particularly in the nursing home, assisted living, and long-term care facility settings.

  • Physical abuse: the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include acts of violence, such as beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. It may also include inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind also are examples of physical abuse.
  • Sexual abuse: any non-consensual sexual contact of any kind with an elderly person. It includes, but is not limited to, unwanted touching, all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing.
  • Emotional or psychological abuse: the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse includes insults, threats, intimidation, humiliation, and harassment. In addition, treating an older person like an infant; isolating an elderly person from his/her family, friends, or regular activities; giving an older person the "silent treatment;" and enforced social isolation are examples of emotional/psychological abuse.
  • Neglect: the refusal or failure to fulfill any part of a person's obligations or duties to an elder. Neglect typically means the refusal or failure to provide an elderly person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide necessary care.

Unfortunately, incidents of nursing home abuse are rarely reported to the proper authorities. Residents may be reluctant to complain for fear of retaliation or embarrassment, and family and friends of the victim might be unaware of the common signs of abuse.

Know the Warning Signs of Abuse

By learning the signs of nursing home abuse and neglect, you may be able to quickly identify and respond to elder abuse. Rampant neglect or obvious physical abuse is rare. While the warning signs of elder abuse can be subtle, awareness can increase your chances of early intervention. To stop nursing home abuse, you need to know what it looks like. If you notice that your loved one exhibits warning signs of abuse, take immediate action.

The first questions to ask when identifying nursing home abuse are:

  1. Does your loved one have injuries or show physical signs of abuse or neglect?
  2. Are your loved one’s complaints insistent and frequent?
  3. Are objections directed at a particular nursing home staff member?
  4. Has your loved one displayed unusual behavioral changes?

Warning signs of physical and sexual abuse may include:

  • Broken bones
  • Bed sores and bruises
  • Medication overdose
  • Head injury
  • Dirty, bloody, or stained clothing or bedding.

Warning signs of neglect may include:

  • Complaints about painful blisters or abrasions
  • Bedsores
  • Poor hygiene
  • Weakness or inexplicable weight loss
  • Soiled bedding
  • Constant thirst or extremely dry skin
  • Hazardous or unsafe living conditions
  • Over-medication

Your loved one may also display several behavioral changes. These changes may include:

  • Sudden personality changes
  • Uncharacteristic anger, lack of interest, or anxiety
  • Fear of being alone
  • Overwhelming sadness and frequent crying
  • Change in alertness
  • Outright complaint
  • Rude or humiliating comments by staff

You must also be aware of more nuanced evidence of nursing home abuse, which include:

  • Staff refuses to allow visitors to see resident, or delays in allowing visitors to see resident
  • Staff does not allow visitors to be alone with resident
  • Frequent arguments or tension between the caregiver and resident

Causes of Nursing Home Abuse

Caregiver burnout is considered to be the primary cause of nursing home abuse and negligence, but nursing homes with the following put all patients at an increased risk of abuse:

  • No abuse prevention policy in place
  • Inadequate staffing levels
  • Inadequate staff training
  • Insufficient employee background checks
  • High staff turnover rate
  • A history of complaints

Who's At the Greatest Risk?

Tragically, those elderly patients most at risk for abuse and neglect in nursing homes are the ones most in need of skilled care and compassion: those who are no longer able to care for themselves because of dementia, disruptive behaviors, or with significant need for assistance; those who are socially isolated.

Elder Abuse Is Illegal

No matter what the causes are for the abuse, elder abuse is illegal. In 1987, the U.S. Congress passed the Nursing Home Reform Act (NHRA), which includes the Nursing Home Residents' Bill of Rights. It is the foundation of elder law, the legal practice area dedicated to protecting seniors. This law was intended to protect the quality of life for residents of nursing homes and improve the quality of care provided by their caregivers. The following are some of the rights and freedoms specified in the Residents’ Bill of Rights, one of the primary features of the NHRA:

  • The right to freedom from abuse, mistreatment, and neglect
  • The right to be treated with dignity
  • The right to freedom from physical restraints
  • The right to privacy
  • The right to access personal medical records
  • The right to accommodation of medical, physical, psychological, and social needs
  • The right to refuse treatment
  • The right to communicate freely with persons inside and outside the facility
  • The right to participate in the review of one’s care plan
  • The right to be fully informed in advance about any changes in care, treatment, or facility’s status
  • The right to voice grievances and exercise rights without interference, coercion, discrimination or reprisal

Take Action Immediately if You Suspect Abuse

The warning signs are clear, and now you suspect that your family member or other loved one may be at risk of nursing home abuse. Now is the time to protect your elder and find a safe and comfortable facility for their care.

Nursing home and assisted living abuse can be demoralizing and traumatic, but what is happening is not your fault or the resident’s and must be stopped. Responding to and reporting assisted living abuse might be difficult, but it can have a positive effect by removing the abuser and preventing them from hurting others.

You do not need definitive proof that abuse is happening to report it. But reporting suspected abuse may have a positive effect by removing the abuser and preventing them from hurting others.


1. How to report nursing home abuse:

  • Call 911 if you, a loved one, or another senior is in immediate physical danger.
  • Each state has toll-free hotlines to report elder abuse. Look up your state’s long term care ombudsman. An ombudsman is someone who investigates complaints and mediates fair solutions.
  • When you call your state’s elder abuse hotline, be prepared to give the nursing home resident's name, address, and details about the suspected abuse. Some states ask for your contact information, but others will allow confidential reports to be made.
  • Local law enforcement officers and Adult Protective Services are often trained on how to investigate and handle assisted living abuse cases. Sometimes what you suspect may only be a fraction of what is actually occurring.

2. After you report the abuse:

  • Remove your loved one from the abusive situation immediately.
  • Research other long term care options in your community. This nursing home evaluation checklist can help you select a comfortable and safe nursing home for your family member.
  • In some cases, poorly run nursing homes may know about the abuse and are not stopping it. Large corporate nursing homes may not be aware that one individual is abusing or neglecting seniors. But it is up to you whether or not to inform the nursing home about why you are leaving.

3. Consider consulting a nursing home abuse lawyer to discuss your legal options:

Nursing home abuse is a serious offense that should be punished and prevented from occurring again. Your willingness to take legal action with the help of a nursing home abuse lawyer against the facility which allowed the abuse to occur, or the abuser who caused the harm, may help save other nursing home residents from the same abuse, neglect, or exploitation.

Contact Vold LLC immediately if you suspect that your loved one was abused in a nursing home, assisted living, or long-term care facility.

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