Nursing Home Abuse & Neglect: What Every Family Needs to Know
Yann Cazavet • July 19, 2025
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Placing a loved one in a nursing home or long-term care facility is never easy. Even when it’s the best and safest option, trusting others with the care of someone you love can be emotionally overwhelming. While many caregivers work with compassion and professionalism, nursing home abuse and neglect remain disturbingly common across the United States.
By learning what elder abuse looks like and how to respond when you suspect it, families can become powerful advocates for the vulnerable adults in their lives.
Table of Contents
- What Is Nursing Home Abuse?
- Understanding the Different Levels of Care
- Types of Nursing Home Abuse
- Why Does Nursing Home Abuse Occur?
- Signs to Look Out For
- How To Report Nursing Home Abuse
- Helping Prevent Nursing Home Abuse
- Protecting Your Loved Ones
What Is Nursing Home Abuse?
Nursing home abuse refers to any type of mistreatment, harm, or neglect of a resident in a long-term care setting. This may involve physical violence, emotional mistreatment, financial exploitation, or the failure to meet basic care needs. Unfortunately, abuse is underreported — with estimates suggesting that only 1 in 14 cases ever reach authorities.
Family members are often the first line of defense. If you believe something is wrong, trust your instincts and take action.
Understanding the Different Levels of Care
Abuse and neglect are not limited to nursing homes. Vulnerable adults can be mistreated in any elder care setting, including:
- Independent Living: Private residences within a senior community, with no daily medical care provided.
- Assisted Living: Help with daily activities like bathing, dressing, and medication, but less medical oversight.
- Skilled Nursing: 24/7 nursing care, often for residents with complex medical needs.
- Memory Care: Specialized care for individuals with Alzheimer’s or dementia.
- Continuing Care Retirement Communities (CCRCs): Offer a range of care levels within one campus.
Each environment carries different risks. Understanding what level of care your loved one is receiving helps identify potential red flags.
Types of Nursing Home Abuse
Elder abuse can take many forms. Common types include:
- Physical Abuse: Hitting, slapping, or using excessive force during care.
- Emotional or Psychological Abuse: Yelling, threatening, humiliating, or isolating residents.
- Sexual Abuse: Any unwanted or inappropriate sexual contact.
- Financial Exploitation: Misuse of funds, theft, or identity fraud.
- Neglect: Failing to meet basic needs like hygiene, nutrition, and medical care.
Neglect may be unintentional, but its effects are just as serious — especially in facilities with chronic understaffing.
Why Does Nursing Home Abuse Occur?
There is no single cause, but several systemic issues create a dangerous environment for residents:
Staff Shortages
According to the American Health Care Association, 99% of U.S. nursing homes report staff vacancies. Many are forced to hire underqualified employees or stretch existing staff too thin. Undertrained or overworked caregivers may lash out, neglect duties, or make preventable mistakes.
Failures in Management
Leadership plays a critical role in facility culture. Poor management can mean inadequate supervision, missed safety issues, and failure to enforce protocols. Some facilities may prioritize profit over resident well-being, choosing to cut staff or skip training rather than invest in care.
Lack of Accountability
In some cases, abuse is reported but ignored. Complaints may be dismissed, or administrators may delay taking action. Facilities that don’t hold staff accountable are more likely to see repeated abuse and systemic neglect.
Signs You Should Look Out for if You Suspect Elder Abuse in Nursing Homes
Abuse isn’t always visible, but here are signs to watch for:
- Unexplained Injuries: Bruises, fractures, or burns with vague explanations.
- Frequent Falls: Could point to a lack of supervision or poor facility safety.
- Rapid Weight Loss: May suggest neglect or emotional distress.
- Poor Hygiene: A sign of missed care routines like bathing and grooming.
- Bedsores: Indicates a failure to reposition immobile residents regularly.
- Fearfulness or Withdrawal: Sudden behavior changes or reluctance to speak.
- Medication Irregularities: Missed doses or overmedication can be abuse.
- Unsanitary Conditions: Dirty rooms, foul smells, or infestations.
- Restraint Marks: Evidence of improper or excessive physical restraint.
- Evasiveness from Staff: Dodging questions or denying access to records.
- Sudden Financial Trouble: Unusual transactions or missing personal items.
When something doesn’t feel right, investigate. Silence allows abuse to continue.
How To Report Nursing Home Abuse
Taking action protects your loved one and others who might be suffering in silence. Here's what to do:
1. Document the Evidence
Take photos, save emails or texts, and write down any concerning events.
2. Report to the Facility
Speak with the director or head nurse. Document your concerns and their response.
3. Notify State Agencies
Contact your state's Department of Health or Department of Aging to launch a formal investigation.
4. Contact Adult Protective Services (APS)
Every state has an APS office to handle elder abuse. They can assess the situation and intervene.
5. Call Law Enforcement
If you believe a crime has occurred or someone is in immediate danger, call 911.
6. Seek Legal Advice
A nursing home abuse attorney can help determine whether you have a case and assist in gathering additional evidence.
Helping Prevent Nursing Home Abuse
Abuse thrives in secrecy. The more present and informed you are, the better you can protect your loved one.
- Visit Frequently: Show up unannounced when possible.
- Get to Know Staff: Establish rapport and open communication.
- Stay Observant: Pay attention to mood, cleanliness, and behavior changes.
- Know Their Rights: Learn about nursing home resident rights in your state.
- Stay Involved: Attend care planning meetings and advocate for their needs.
Choosing the right facility matters — but continued advocacy matters even more.
Keep Your Loved Ones Protected From Nursing Home Abuse
No one should suffer abuse in the place they are meant to feel safe. If your loved one is in a nursing home, stay involved, stay alert, and know what to do if something goes wrong. Abuse and neglect can be stopped — but only when someone speaks up.
If you suspect nursing home abuse, don’t wait. Document your concerns, report them, and get help. Your vigilance could protect not just your loved one, but many others too.
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At Tanglewood Assisted Living, we practice the five foot rule with memory loss patients. If you wish to be understood by a memory loss patient, you should be within five feet of that person when you speak to them. Most memory loss patients simply cannot process words that are shouted at them from across the room. In order to communicate effectively you should get close, make eye contact and begin by using the person’s first name. If the patient is sitting down, you should not stand over them and talk down to them. When you stand up, you assume a dominate posture which makes people feel uncomfortable. Instead, kneel down so you are at the same eye level as the patient and you will immediately put them at ease. Touch is important to memory loss patients. While you’re speaking, hold their hand or put your hand on their arm or shoulder. Be generous with hugs and handshakes. At Tanglewood, the staff is trained repeatedly to maintain a calm and pleasant tone of voice. Memory loss patients have not lost their ability to appreciate tone of voice and if you become upset you will only make a bad situation worse. Some patients will be depressed or mad at the world. With these you should commiserate. Offer compassion, sympathy and condolences. Other patients may be mad at you. They may accuse you of all sorts of atrocities. With these folks you should simply apologize and say you’ll try to do better. You should never get mad. Always remain calm and pleasant. If you do feel yourself becoming upset, walk away. Make sure the patient is safe and walk away. Come back in ten minutes and the patient’s attitude will have changed completely. Ask only simple questions of a memory loss patient - questions which require a yes or no answer. Don’t ask “would you like lemonade or ice tea?” Even such mildly complex questions generate confusion. Ask only yes or no questions. The best chance of having a coherent conversation with a middle or late stage memory loss patient is to talk about events that happened long ago. Such very old memories usually remain intact and the memory loss patient will feel comfortable talking about them. If possible, bring photographs from the patient’s younger days and talk about the people and places in the pictures. Finally, musical memories also remain intact. A patient will remember and enjoy the lyrics and melodies of music they’ve heard throughout their lives and especially music they heard as a child. They will usually enjoy and sing along with hymns and pop music songs they heard in their youth.
Unfortunately, almost all memory loss patients will become incontinent. At first they will have an occasional accident but eventually they will forget when and how to use the bathroom and will need to wear an undergarment all the time. While nothing can prevent this from happening, there are some techniques which can delay incontinence and cut down on the number of accidents. Prompting: Accidents often occur because the memory loss patient simply waited too long before heading for the bathroom. If a caregiver will prompt the patient every two to three hours, by asking if they need to use the bathroom, the number of accidents can be reduced significantly. If the memory loss patient continually says they don’t need to use the bathroom, the caregiver should respond with “let’s give it a try” and help the patient to the bathroom. By the time you get to the bathroom, the memory loss patient may suddenly realize they have to go. An old trick which may help is to sit the patient on the toilet and run water. Bedside Commodes: Many accident happen at night. Often a sleepy resident will have trouble getting to the bathroom in time. Putting a portable commode next to the bed and keeping a night light in the room will help this situation. Washable Protective Pads: An incontinent patient can damage or destroy furniture, mattresses and carpeting. A caregiver may have to remove and wash bed linen every morning. Even the best undergarments are subject to leaks. If you have a loved one in the house who suffers with incontinence, you should cover your furniture with washable protective pads, often called “chuck” pads. Chuck pads should be used to cover furniture and mattresses. Even mattresses with waterproof mattress pads should also have an extra large chuck pad underneath. These pads are now available in a variety of colors to match the furniture. Undergarments: Some undergarments pull up and down like underwear and are useful in the early stages of incontinence when the patient still uses the bathroom by themselves and the undergarment is mainly to protect against accidents. To change this type of undergarment however, the caregiver must remove the patients shoes and pants to put on a new undergarment. This inconvenience can be avoided by using briefs which are secured on the sides with elastic bands and buttons. These can be changed without removing the patient’s pants.
Memory loss in the elderly, whether brought on by Alzheimer’s disease or some other cause, is a progressive condition, becoming worse over time. At some point in the progression of this condition an elderly patient will lose the ability to make rational decisions and someone else, usually an adult child, will have to take over responsibility for making medical and financial decisions on behalf of the memory loss patient. For this change to take place legally, quickly and inexpensively, two important documents must be signed by the elderly patient while they are still competent to make legal decisions. Medical Durable Power of Attorney A Medical Durable Power of Attorney (MDPA) is a legal document appointing someone else to speak for a patient regarding medical decisions, in the event the patient cannot speak for themselves. The document specifically names an individual, plus one or two alternates, to take charge of medical care. The document also allows a patient to specify certain types of treatment they do or do not want in the event the patient cannot speak for themselves and will not recover from their illness. Ideally, this document should be signed long before someone develops memory loss. If an elderly patient is diagnosed with memory loss and does not have a MDPA in place, the patient may still have time to sign a MDPA. Most elderly patients in the very early stages of memory loss, are still quite independent and rational and would still be considered legally competent to sign legal documents. This fact affords the memory loss patient an opportunity to execute and sign a MDPA even after being diagnosed. Once a memory loss diagnosis is made, the elderly patient and their family need to move quickly to have a MDPA executed, before the elderly patient’s competency to sign legal docments become questionable. Memory loss can progress quite rapidly in some patients and dramatic changes in abilities can occur almost overnight. The family of a patient with memory loss will be called upon to make difficult choices regarding medical care. One such choice occurs frequently with late-stage memory loss patients and provides a good example of the importance of an MDPA. Near the end of life, many memory loss patients stop eating. A patient may be hand-fed for a time but eventually the patient stops swallowing and any further attempts at hand-feeding will cause aspiration or choking. At this point the family must decide whether to connect their parent to a feeding tube or allow their loved one to pass away. With an MDPA in place, the family will not have to guess how their parent felt about such a difficult decision. The MDPA will state specifically whether the patient does or does not want such life-prolonging medical care. The MDPA accomplishes many objectives. It makes the transition of responsibility for medical decisions smooth and inexpensive, avoiding the possibility of costly and time-consuming court hearings. It allows the elderly parent to set forth in detail the type of medical treatment they do or do not wish to receive in the event they are terminally ill and cannot speak for themselves. It relieves the adult children of the burden and uncertainty of trying to guess how the parent felt about life-prolonging medical treatment. It allows the patient advocate to execute a Do-Not-Resuscitate Order to make certain the facility caring for their parent follows their parent’s wishes regarding life-prolonging medical treatment. General Durable Power of Attorney Similar to a Medical Durable Power of Attorney, a General Durable Power of Attorney (GDPA) appoints someone to act on behalf of the memory loss patient for financial and property decisions. (If the memory loss patient has a trust, the language of the trust may have the same effect as the GDPA, giving authority to a successor trustee to handle financial affairs when the memory loss patient can no longer handle such matters.) Without a GDPA (or the equivalent language in a trust,) a court hearing will be required to appoint and empower a conservator who will handle financial and property affairs for the memory loss patient. Such court hearings can be expensive. Both the Medical Durable Power of Attorney and the General Durable Power of Attorney are critical legal documents. They give effect to the wishes of the people involved and they avoid the expense and uncertainty of probate court oversight.
Quite often a memory loss patient will say they need to “go home”, even when that patient is living in a house where they’ve spent their entire adult life. The “home” a memory loss patient seeks is probably the home where they grew up. Even though short-term memory is deteriorating, long-term memories remain intact and are very real to the memory loss patient. Because of this, memory loss patients often behave as if the places of their youth are nearby. They also believe the people who were close to them in their childhood are still alive. Frequently, memory loss patients will say they have to go because their mom or dad is waiting for them. Such powerful impulses often drive patients to leave their own home or an assisted living facility and wander away outside. Sometimes patients will wander outside even in the worst weather. Sadly, wandering is a common cause of injury and death for memory loss patients. DOOR ALARMS: Door alarms are essential for any home where a memory loss patient resides. Wireless versions are available at many hardware stores and are easy to install. Magnetic transmitters are attached next to each exit door and generate an electrical signal whenever the door is opened. The signal then triggers an alarm. During the day the device can be set to emit a one-time alarm, something like a doorbell. At night the setting can be changed so the device emits a noisy, continuous alarm, something akin to a police siren. The alarm will continue to sound until a until a switch on the side of the device is reset. The continuous alarm ensures that a sleeping caregiver will wake up if their loved one is trying to walk out at night. (The alarm has the added benefit of deterring anyone attempting to force entry into your house at night.) Although more elaborate and expensive alarm systems are available, such as ones that sound only when the memory loss patient approaches an exit door, a simple wireless system is probably sufficient. Remember, these alarms don’t work unless the door is closed each time between uses. WINDOW PROTECTION: Memory loss patients can be very determined and will occasionally climb out a window. Windows can be fitted with stop guards which only allow the window to open a few inches. Some windows have stop guards built-in and if not, after-market stop guards can be purchased inexpensively at your local hardware store. Check with your fire department before installing any device that limits the opening of a window which may be considered a fire exit. Window alarms, which function like door alarms, are also available at many hardware and home supply stores. SUPERVISED WALKS: For memory loss patients who remain physically fit and active, a long walk outside with a caregiver can reduce the patient’s desire to leave the house. In addition to reducing the desire to wander, the fresh air and the exercise can also help with the patient’s sleep habits and overall attitude. Usually, longer walks produce better results. The patient returns to the house tired, more content and less agitated. If the patient is willing, you should take walks in all seasons. Walks help the caregiver as well and provide memories of quality time spent with a loved one. IDENTIFICATION WRIST BANDS: Memory loss patients can be fitted with a bracelet which serve the same purpose as a medical alert bracelet. The bracelet identifies the person and their condition and includes phone numbers to call if anyone encounters the memory loss patient on the street. This type of identification is a good idea provided the memory loss patient will wear the bracelet. SEARCHING: If a memory loss patient does wander off, call the police immediately. Many police departments have tracking dogs trained to follow a scent. Call local television stations to broadcast pictures and information about your lost loved one. Immediately have someone visit or call everyone in your neighborhood. Often a memory loss patient will end up on the porch or in the garage of a nearby house. Have as many people as possible begin searching in cars and on foot or bicycle.
One day it may be necessary for a loved one to move to an assisted living facility. How can you be sure the facility you choose is safe and secure? Here are some questions you should ask.
