How to Identify and Report Senior Abuse in Nursing Homes and Long-Term Care Facilities
Few decisions are as important as finding the right nursing home for your loved one. This will be their new home. It’s where they will eat, play, and live out their golden years. In other words, it will almost entirely dictate their overall quality of life.
Unfortunately, many seniors have less-than-enjoyable experiences in long-term care settings. Countless seniors face mistreatment, exploitation, and neglect at the hands of their caregivers and other residents in nursing homes. Aside from being traumatic for your loved one, senior abuse has been linked to negative health outcomes — including premature death.
This isn’t to say that all nursing homes offer low-quality care or that all caregivers will perpetrate abuse — just that nursing home abuse is more prevalent than you may realize. To keep your loved one safe, happy, and healthy, it’s critical to learn more about nursing home abuse, what you can do to prevent it, and how to deal with it if it affects your family.
What Is Senior Abuse and Neglect?
Senior abuse is, essentially, the intentional mistreatment of seniors. A wide variety of abusive behaviors fall under the umbrella of senior abuse, including physical, sexual, psychological, and financial abuse. Though caregivers may seem like the only perpetrators, anyone can commit senior abuse — even other seniors or nursing home residents.
Senior neglect occurs when a senior’s basic care needs are not met. Negligence in nursing homes can also take many forms but commonly manifests in physical mistreatments, such as not giving seniors the proper medication or leaving them unattended for extended periods of time. Neglect can be done intentionally, but it can also be unintentional or accidental.
The primary types of senior abuse and neglect include:
- Physical Abuse: Physical abuse involves any kind of mistreatment that results in physical or bodily harm to a senior. It includes intentionally inflicting harm, such as hitting or pushing, as well as being inappropriately or needlessly forceful, such as not being careful when helping someone into a wheelchair.
- Sexual Abuse: Any kind of unwanted or nonconsensual sexual contact or activity is considered sexual abuse. Engaging in sexual contact with someone who cannot give consent, such as someone who has experienced a severe cognitive decline or been diagnosed with dementia Alzheimer’s disease, is also abusive. Sexual abuse can range from being forced to look at pornographic materials to inappropriate touching to assault or rape.
- Psychological Abuse: Psychological abuse refers to behaviors, both verbal and nonverbal, that cause emotional, mental, or psychological pain and distress. This can include insulting, harassing, threatening, and humiliating a senior. A lack of action or communication can also be considered psychological abuse, such as ignoring or socially isolating a senior.
- Financial Abuse: Also called “financial exploitation,” this kind of abuse is nonconsensual, unauthorized use, theft, or mismanagement of a senior’s finances or property. Stealing someone’s property or money, committing identity theft, and scamming someone are all forms of financial abuse. This commonly overlaps with digital abuse, which is any kind of mistreatment facilitated by technology, and psychological abuse.
Caregivers, family members, friends, strangers, and other nursing home residents are capable of committing each type of abuse. Further, each kind can take place simultaneously or in conjunction with other kinds of abuse.
Why Does Senior Abuse and Neglect Occur?
Similar to other forms of abuse, it’s difficult to know exactly why some people neglect or abuse seniors. However, several factors have been associated with increased risk of abuse and neglect in nursing homes and long-term care settings:
- For-Profit Nursing Homes: For-profit nursing homes are associated with lower-quality care, higher rates of abuse and neglect, and worse health outcomes for residents. Many believe for-profit nursing homes are more likely to prioritize profits, leading to poor patient care and opening up the door for mistreatment.
- Understaffing: Similarly, understaffing can contribute to myriad problems in nursing homes, including the abuse and neglect of residents. In addition to simply not having enough staff members to properly care for patients, understaffed nursing homes can lead to increased stress and burnout for staff members. This can result in harmful caregiving mistakes, as well as intentional mistreatment.
- Lack of Training: Some staff members at nursing homes do not have enough training, education, or experience to provide proper care to residents. They may not be able to provide specialized care or know what other kinds of support and care residents need. Further, continuing education is crucial for nurses, certified nursing assistants (CNAs), and other healthcare staff to stay informed about best practices and any changes or updates in the field.
- Underpaid Staff: Because most nursing homes are privately run and for-profit organizations, there is great variety in caregiver wages, and it’s common for staff members to be underpaid. Some may only care about getting their paycheck, rather than providing high-quality care to residents, which is dangerous for patients.
- Poor Management or Supervision: Lack of supervision of caregivers and residents alike can leave patients vulnerable to mistreatment. If residents are not properly supervised, they may suffer from a lack of care or even succumb to self-neglect. If caregivers aren’t supervised, they may not feel the need to provide high-quality care to patients. A lack of supervision also opens up more opportunities for abuse and neglect to continue, as caregivers’ abusive behavior goes unnoticed.
- Caregiver Risk Factors: Even in the best-run and well-staffed facilities, there may be caregivers who choose to abuse or neglect their residents. Some risk factors that may compel caregivers to mistreat seniors include a history of experiencing or perpetrating abuse, personal troubles, and physical or mental health issues. These are not acceptable reasons to commit abuse, and not every caregiver dealing with these issues will mistreat residents.
- Resident Risk Factors: There are also risk factors that can make some seniors more likely than others to experience abuse. This does not mean that they are deserving of mistreatment, just that certain individual factors are associated with a greater likelihood of abuse. Some of these risk factors include being a woman, having a disability, or having some kind of cognitive impairment or decline.
There is no single reason that abuse occurs. Further, it doesn’t matter if there are extenuating circumstances or other contributing factors — there is never an acceptable reason to purposefully hurt another person.
Warning Signs and Symptoms of Senior Neglect
Whether intentional or accidental, senior neglect is a serious issue. At best, it causes discomfort; at worst, it can result in severe illness and injury. To keep your loved one safe, it’s best to prevent neglect from happening in the first place — and to identify it and intervene as quickly as possible if it does occur. Some of the main warning signs of senior neglect include:
Common Nursing Home Injuries
Any injuries your loved one sustains in a nursing home or care facility can be a warning sign of neglect. Injuries can occur when a caregiver ignores their duties altogether, but also if they are not being careful enough when caring for your loved one.
- Common injuries that occur in nursing homes include:
- Pressure or bedsores;
- Facial injuries;
- Spinal injuries;
- Slips and falls;
- Bed rail injuries;
- Broken bones
It’s important to note that not all injuries are the result of abuse or neglect. Cautious residents and vigilant caregivers alike can make mistakes that result in unintentional physical harm. Even accidents that result in a serious injury aren’t necessarily abuse or neglect.
It’s more important to look out for a continued pattern or series of injuries. If your loved one mentions repeated mistakes or always seems to have a new injury, it may be indicative of abuse or neglect.
Malnutrition and Dehydration
Malnutrition refers to an improper, imbalanced, or insufficient nutrition pattern that negatively impacts health, including deficiencies of specific nutrients, being unable to use the nutrients derived from food, and not eating enough food to meet nutritional needs. If left unchecked, it can have severe health consequences.
Seniors are at a high risk of malnutrition. Physical changes, medications, and certain health conditions can make it more difficult to eat and for the body to absorb nutrients. Further, dehydration is also dangerous for seniors, as the thirst response weakens with age. This can result in short-term discomfort as well as serious, long-term health problems.
Nursing home residents have to rely on caregivers for their food and water, leaving them susceptible to both malnutrition and dehydration. Caregiver neglect can manifest as:
- Ignoring residents when they claim to be hungry or thirsty;
- Failing to provide enough food or water;
- Not following dietary prescriptions, restrictions, recommendations, or preferences;
- Leaving patients unsupervised while eating or drinking, especially if they need assistance to do so;
- Not properly helping residents to eat or drink;
- Failing to treat residents who are experiencing malnutrition or dehydration.
Because malnutrition or dehydration can quickly have negative health effects, it’s crucial to identify them as early as possible. Be sure to pay attention to your loved one’s health and behavior, as they may act confused and disoriented, experience mood changes, or seem fatigued or physically weak. Additional signs include changes in weight, dry hair and skin, and decreased feelings of appetite and thirst.
Urinary Tract Infections (UTIs)
Any infection in the urinary system (including the bladder, urethra, and kidneys) is considered a UTI. Most commonly, UTIs develop when bacteria enter the urethra and bladder. More rarely, bacteria can travel up to the kidneys or lead to more serious infections, such as pyelonephritis, if left untreated.
UTIs are common in senior adults due to physiological changes, particularly those in the immune and urinary systems. Nursing home residents may be even more susceptible to UTIs, as they are exposed to many different kinds of bacteria. A UTI isn’t necessarily a sign of abuse, but neglect can be the direct cause of UTIs.
Dehydration, improper catheter maintenance, and poor caregiver hygiene can all lead to UTIs. If they have difficulties moving on their own, your loved one may develop a UTI as bacteria has more time to multiply in their bladder — all because a caregiver failed to help them to the bathroom promptly. Whether due to cruelty, understaffing, or mismanagement, UTIs caused by neglect are entirely preventable. Failure to treat a patient for a UTI is also a form of neglect that, in extreme cases, can be fatal.
A medication error is any kind of mistake that takes place while prescribing or administering to a patient. This includes giving the wrong medication, giving the right medication incorrectly, giving multiple medications that shouldn’t be taken simultaneously, and failing to give a patient their medication at all.
Though they can happen in doctor’s offices and pharmacies, medication errors are incredibly common in nursing homes. One report determined that as many as 16% to 27% of study patients had experienced a medication error of some kind. Another found that over 37% of medication errors occurred more than once.
Many medication errors can be attributed to honest mistakes on the part of busy or burnt-out healthcare workers. However, it is still neglectful and entirely preventable. Residents and their loved ones trust caregivers to do their jobs correctly. Failure to do so can be harmful to patients. More rarely, a medication error may be a deliberate attempt by a caregiver to harm or abuse a patient.
Warning Signs and Symptoms of Senior Abuse
While there can be some overlap, the warning signs of abuse differ from those of neglect. If you aren’t sure what to look out for, abuse can be difficult to identify. What’s more, each type of abuse has its signs and symptoms that you should look out for:
Warning signs of senior physical abuse include:
- Any sign of physical harm or injury, including cuts, scratches, burns, and broken bones;
- Injuries that cannot be explained or that have flimsy explanations;
- Frequent injuries or injuries that are in different stages of the healing process;
- Signs of physical damage to your loved one’s possessions or living space, such as broken glasses;
- Signs of restraint, such as marks on their wrists or ankles;
- Sudden changes in your loved one’s mood or behavior;
- Reports from your loved one of physical abuse.
- Psychological Abuse
Sometimes referred to emotional or mental abuse, some of the most common signs of this kind of senior abuse include:
- A general decline in mental health;
- Development of anxiety or depression;
- Paranoia, confusion, or disorientation;
- Loss of interest in previously enjoyable activities, hobbies, or events;
- Withdrawal and social isolation;
- Apathy or resignation;
- Sudden changes in your loved one’s mood or behavior, especially when their caregiver is present;
- Observations of inappropriate behavior or communications from the caregiver;
- Reports from your loved one of psychological abuse.
Common signs of senior sexual abuse include:
- Pelvic injuries;
- Development of a sexually transmitted disease;
- Stained or bloody underwear, clothing, or linens;
- Bruises on or near the genitals;
- Bleeding from the genitals;
- Increased or newfound difficulties or pain when walking or sitting down;
- Atypical or inappropriate sexual behavior;
- Sudden changes in your loved one’s mood or behavior, especially around a particular person;
- Reports from your loved one of sexual abuse.
The following signs are common symptoms of financial exploitation or abuse against seniors:
- Unpaid utility or healthcare bills, despite having the financial resources to do so;
- Unusual activity in their bank account;
- Purchase of items or services they can’t or won’t be able to use;
- Addition of authorized users to bank accounts or credit or debit cards;
- New credit cards, loans, or other kinds of debt taken out in your loved one’s name;
- Missing belongings or valuables, such as clothing or jewelry;
- A new friend, romantic partner, or another person who they quickly become close to;
- A previously uninvolved relative becoming close to your loved one;
- Sudden changes to important financial or legal documents, including their will;
- Sudden changes to their entire financial situation;
- Reports from your loved one of financial abuse.
This is not a comprehensive list of warning signs, and your loved one is not guaranteed to exhibit the above symptoms if they are being abused. Everyone experiences and deals with abuse differently.
Above all else, pay attention to your loved ones, their physical health, their mental state, and their finances. You know your loved one well, and if something feels wrong or strange, it’s worth asking them about it. It’s easy for abuse to go undetected if you aren’t actively looking for or willing to do something about it.
Resident-to-Resident Senior Mistreatment
Though caregivers and staff members are the most common perpetrators of abuse in nursing homes, residents can also mistreat and abuse each other. Research from the National Center on Elder Abuse found that nursing home caregivers have reportedly seen a variety of abusive behaviors between residents. They noted physical, psychological, sexual, and financial abuse, with physical and psychological abuse being the most common.
According to the research brief linked above, resident-to-resident abuse can contribute to a decline in both physical and mental health, lowering residents’ overall quality of life. Identifying resident-to-resident abuse is also difficult; some residents may not even recognize the mistreatment as abuse. If your loved one discloses mistreatment from another resident, it’s important to take it as seriously you would any other kind of abuse.
Legal Rights of Nursing Home Residents
Seniors and nursing home residents have legal rights that must be honored and protected. The main federal laws protecting seniors and nursing home residents include:
- Title XX of the Social Security Act of 1935: The Social Security Act is a landmark piece of legislation that offers a financial safety net for disadvantaged Americans, including seniors. Title XX provides federal funding to each state so they can offer higher-quality social services and programs. For seniors, this includes offering support so they can stay independent, preventing and intervening in cases of abuse, and preventing or intervening in cases of substandard care (both in long-term, home, community-based, and institutional care settings).
- The Older Americans Act of 1965: The Older Americans Act is the first piece of federal legislation to provide sweeping support and programs to American adults over the age of 60. It offers funding for a wide range of services, including food and meals, caregiver support, home health services, and senior abuse prevention. Its objective is to help seniors stay healthy, independent, and engaged for as long as possible. This law has been reauthorized several times, including in 2016 and 2020.
- The Nursing Home Reform Act from the Omnibus Budget Reconciliation Act of 1987: The Nursing Home Reform Act works to improve and protect the quality of care that residents receive in nursing homes. It outlines the services that residents are entitled to receive, as well as the federal rights guaranteed to each resident. It also details the guidelines facilities must follow to receive federal funding, including the conduction of random surveys to evaluate the quality of care at each facility.
- The Elder Abuse Prevention and Prosecution Act: The Elder Abuse Prevention and Prosecution Act works to prevent senior abuse, particularly financial exploitation, and support those who are taken advantage of. In addition, it improves efforts to prosecute the perpetrators of senior abuse and introduces penalties and punishments for frauds, schemes, and scams that target seniors.
Be sure to check the laws and regulations in your area, as there may be additional protections and rights guaranteed by your state’s laws or your local government.
Reporting Senior Abuse and Neglect
There are several different things you can do if you suspect your loved one — or anyone else — is being abused or neglected. If someone is in immediate danger, you should call 9-1-1 or contact emergency services at once.
If danger is not imminent, you should still reach out to someone, such as your loved one’s primary care provider, for help. You can also contact one of the following organizations:
- Eldercare Locator: The Eldercare Locator offers a variety of different support services and programs to seniors and their family members, including assistance with senior abuse. You can call their helpline at 1-800-677-1116, which is open from 9 AM to 8 PM Eastern Time, Monday through Friday. You can also contact them via email or using their online chat system.
- Local Adult Protective Services (APS): You can always contact your local APS agency for assistance. You can find more information about your local community resources at this State Resources guide from the National Center on Elder Abuse.
- Long-Term Care Ombudsman Program: You can get in touch with your local ombudsman to report abuse and advocate for your loved one’s rights in their nursing home or long-term care facility. This map from the National Consumer Voice for Quality Long-Term Care can help you find your local ombudsman, as well as any other helpful groups or resources in your area.
- National Domestic Violence Hotline: You can call 1-800-799-SAFE to reach the National Domestic Violence Hotline. This helpline is available 24 hours per day, seven days per week. You can also find a list of local resources on their website.
Depending on who you suspect is perpetrating the abuse and if you feel comfortable doing so, you may also make a report directly to the leader of the nursing home or long-term care facility.
When you make a report, be sure to provide as much information as possible. This includes personal information — such as your loved one’s name, address, and phone number — and details about any abuse you suspect or have witnessed. You can typically make a confidential, anonymous report if you do not want to share any personal information.
You do not need to know if abuse is happening to make a report. APS is usually the first responder to claims of senior abuse. The intervening agent will investigate your claims and determine what kind of abuse, if any, is taking place. Even if they are not experiencing abuse, APS may offer different social, health, or support services to your loved one so they have access to the resources they need.
Legal Action Options
Senior abuse is against the law, and you may be able to take legal action against anyone who perpetrates it. Pursuing a lawsuit can help hold the responsible parties accountable for their actions (or inactions), secure financial compensation for your loved one, and bring a sense of peace to your family that the worst is over.
Depending on the circumstances, you may be able to pursue a lawsuit against the abuse, as well as the nursing home, other residents, or staff members. In some instances, you may be able to settle your case, but in others, you may have to go to court.
No two cases are the same. It’s best to contact an experienced lawyer in your area, with a proven track record of success with nursing home abuse cases, for more information on how to handle and what to expect from your case. With their guidance, you have a greater chance of getting justice for your family.
National Organizations That Address Senior Abuse and Neglect
If you or your loved ones need more information when it comes to senior abuse or neglect, consult the following organizations for additional support:
- Administration on Aging (AOA): This agency was created to carry out and support the different programs and services outlined in the Older Americans Act. Many different organizations fall under the AOA’s umbrella, including the Office of Supportive and Caregiver Services and the Office of Elder Justice and Adult Protective Services.
- ADvancing States: This nonprofit organization works to improve the government systems that support seniors, people with disabilities, and caregivers.
- Ageless Alliance: The goal of this nonprofit organization is to prevent senior abuse from happening in the first place, by raising awareness and advocating for seniors’ interests.
- Elder Justice Coalition: This nonprofit advocacy group wants seniors to live without abuse, neglect, or exploitation. In addition to increasing awareness, they also work to improve any changes to legislation that may affect the prevention of senior abuse.
- Long-Term Care Ombudsman Programs: Established by the Older Americans Act, the States’ Long-Term Care Ombudsman programs support individuals who live in long-term care facilities, including nursing homes. They also work to make any changes to legislation and regulations as beneficial for residents as possible.
- Maricopa Elder Abuse Prevention Alliance (MEAPA): MEAPA works to prevent both senior abuse and late-life domestic violence. They maintain a 24-hour helpline that you can use to get help at any time of the day or night.
- National Association of Area Agencies on Aging (N4A): N4A is a nonprofit, national membership network made up of the 622 Area Agencies on Aging in the U.S. In addition to education and advocacy, they provide support and assistance to seniors throughout the country.
- National Adult Protective Services Association (NAPSA): This nonprofit organization protects vulnerable seniors and adults with disabilities and offers support to anyone who has experienced abuse or mistreatment.
- National Center on Elder Abuse: This national resource center conducts research, provides supportive resources and information, informs public policy, and raises awareness — all in the name of preventing and intervening in cases of senior abuse.
- The National Consumer Voice for Quality Long-Term Care: This organization was formed to address concerns about substandard nursing home care. They provide training and education to individuals and families so they can make informed care decisions and advocate for themselves.