Senior Resource: Nursing Home Abuse

Abuse of elderly residents in nursing homes and assisted living facilities can be physical, emotional and financial. Children of these senior citizens should pay attention to their loved ones’ environment – and know that legal help is available.

As the number of elderly Americans increases, so does the need for quality long-term care. According to a 2014 report published Department of Health and Human Services, there will be almost 90 million Americans over age 65, double the number in 2010. Families may be faced with the tough choice of choosing a nursing home to care for an aging loved one. Along with the cost – an estimated $87,600 a year – families must also deal with the dark reality of nursing home abuse.

Sadly, some of these companies count profits as a core mission and not a desire to provide excellent care. Medicaid and Medicare foot the bill for a great many of the costs, and some of the more disreputable homes accept new residents with the goal of continuing to collect government-paid fees without following through with proper care. Understaffing, poor training and high turnover rates contribute to issues of resident neglect and mistreatment.

A recent government study found that 85 percent of nursing homes reported at least one incidence of abuse or neglect in 2012. These numbers are probably higher: the Office of the Inspector General said that nursing homes only reported 53 percent of the allegations leveled at them in 2012. Other statistics count 1 in 3 elderly residents as a victim of abuse.

What do experts consider abuse? These are things like bed sores, open wounds, bruising, broken bones and nagging infections that never seem to go away. It can also show up as inadequate or inconsistent medication distribution and unresponsive managers who fail to address issues such as constant falls and dirty or unsanitary living conditions.

Sometimes, neglect and mistreatment can lead to death.

Luckily, these elderly residents – and their loved ones – can seek help from the court system. “The lack of government enforcement is also a reason why many families turn to elder abuse attorneys to file civil lawsuits against the industry for the horrific deaths of their loved ones,” wrote Carole Herman Founder and President of The Foundation Aiding the Elderly.

What Qualifies as Nursing Home Abuse?

The Department of Health and Human Services defines abuse as “[t]he willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish.”

About 5 million seniors a year suffer some kind of mistreatment or neglect. In nursing homes and long-term care facilities, abuse typically occurs when nurses, certified nursing assistants, staffers, managers and administrators leave residents unsupervised and without adequate physical, mental or medical attention. Sometimes, staffers, fellow residents or strangers harm residents intentionally. Abuse falls into several categories:

  • Physical
  • Sexual
  • Psychological or emotional
  • Gross neglect
  • Financial
  • Resident

Nearly half of the reported incidents involve the neglect and abuse of residents by facility employees, while about 25 percent are resident-to-resident harm. Another 26 percent comes from unknown assailants.


If you or a loved one was abused or neglected in a elder care facility, you may have legal options.

Types of Abuse

When people think of nursing home abuse, they might think of bed sores from neglect, but there are many different kinds of abuse. Typically, it falls into six categories defined by the National Outbreak Reporting System (NORS): physical, sexual, emotional or psychological, gross neglect, financial and resident to resident abuse. There are also additional types detailed by the National Center on Elder Abuse (NCEA).

Physical Abuse

Physical abuse remains the most prevalent type of abuse in long-term care facilities. According to NORS, 29 percent of all abuse complaints in 2010 were physical. This involves the use of physical force that results in bodily injury or pain.

This type of abuse can include:

  • Acts of violence with or without an object (hitting, kicking, punching, etc.)
  • Inappropriate use of drugs
  • Inappropriate use of physical constraints
  • Force-feeding
  • Physical punishment

Here are some warning signs of physical abuse that family members should be aware of:

  • Caregiver’s refusal to let family see their elder family member alone
  • Elder’s report of being hit, slapped, kicked or mistreated
  • Lab findings of medication overdose or lack of necessary medication
  • Broken bones
  • Bruises, lacerations, rope or tie marks
  • Open wounds, cuts, untreated injuries
  • Sprains, dislocations, internal bleeding or injuries

Sexual Abuse

Sexual abuse makes up only 7 percent of cases but carries a lot of devastation with it. This type of mistreatment involves non-consensual sexual contact of any kind. Disabled seniors and people with Alzheimer’s or dementia are vulnerable because they can be incapable of expressing non-consent. Preying on those conditions is also considered abuse.

Sexual mistreatment can range from unwanted touching to violent assault such as rape, sodomy and even forced nudity and explicit photos. Signs include:

  • Bruises in the genital area or marks around the breasts
  • Infections in the genital area and sudden signs of venereal disease
  • Injury to the genitals and anus with bleeding
  • Stained, torn or bloody undergarments

Psychological or Emotional Abuse

The third-most prevalent type of abuse is psychological or emotional, and it accounts for 21 percent of all reports tracked by NORS. This occurs when verbal or nonverbal acts cause anguish, pain or distress through intimidation, humiliation or harassment. Separating elders from family and friends or forcing them into social isolation are also examples of this type of abuse.

Signs of psychological abuse include:

  • Agitation
  • Strange behaviors of rocking, biting, sucking
  • Lack of communication and being withdrawn
  • Reports of mistreatment

Gross Neglect

Gross neglect makes up 14 percent of abuse cases. It happens when those responsible for the care of a senior refuse or fail to fulfill their professional and legal obligations. Examples include failure to feed, clothe, shelter, clean and keep elders safe – even from other residents or abusive employees. Failing to give residents their medicine is also considered neglect.

Signs include:

  • Bed sores, poor personal hygiene
  • Malnutrition, dehydration
  • Dirty living conditions
  • Residents are covered in urine, fecal matter, lice or fleas
  • Untreated health problems
  • Unsafe living conditions (no running water, heat, etc.)

Financial Abuse and Exploitation

Like sexual abuse, financial exploitation is one of the more rare forms of abuse. This typically happens when a nursing home employee or another facility resident illegally uses a resident’s funds, property or assets. Examples include: cashing checks without permission, forging signatures, stealing belongings or money, bullying or deceiving a senior into signing financial documents.

Even rarer is when a professional outside the elder care facility takes advantage of a resident. This can involve improper or illegal use of a power-of-attorney privilege or of a guardianship.

Signs of financial abuse include:

  • Unauthorized charges on an elder’s ATM or credit card.
  • Discovery of forged signatures
  • Sudden changes in legal documents such as a will
  • Additional names on an elder’s bank card
  • Unpaid bills despite adequate funds being available
  • Missing possessions
  • Withdrawal of large sums of money

Resident to Resident

This type of abuse makes up 22 percent of all abuse. It encompasses all types of abuse just mention, but occurs when other residents prey on weaker residents because of lack of supervision by staff.

Recognizing and Preventing Elderly Abuse

According to the National Center on Elder Abuse (NCEA), recognizing and halting neglect is the first step to preventing abuse. In addition to looking for the signs listed above, several risk factors make a senior vulnerable. These risks are put into three big categories: facility, resident and relationship.


The No. 1 cause of abuse in nursing homes is poor staffing. High turnover, poor training and an overworked staff leads to greater risks for residents. When picking a nursing home, talk to the staff and look into a facility’s credentials to help determine whether a facility is adequately staffed.

Examples of poor staffing include:

  • A facility with a high number of residents with dementia and mental impairment with not enough staff
  • Poorly trained staff that cannot provide quality care to dementia patients who may be prone to hitting and kicking
  • Short staffing leads to overworking current staff who will be tired and less likely to provide good care


Sadly, the more dependent a resident is on the staff, the more likely they are to be abused. Mental or physical impairment makes seniors an easier target for mistreatment or neglect.

The biggest risk factors for a resident that lead to abuse include:

  • Social isolation
  • Symptoms of dementia
  • High degrees of dependence on staff


Another important factor in preventing abuse is making sure to visit a family member in the nursing home as often as possible. It’s also possible for family members to become too involved and actually interfere in the caregiving process.

The risk factors dealing with a resident’s relationships include:

  • Residents who receive less visits from family are vulnerable
  • Not developing a relationship with the staff may also contribute
  • Over-zealous family members may impede care

Ideally, nursing homes should take these risks into account and be more proactive in preventing mistreatment of their residents. However, sometimes it is up to the family member to be vigilant and watch for the signs.

Five Signs of a Problem Facility

  • A history of violations
  • A number of severe violations
  • High staff turnover
  • Residents lack independence
  • Inspires an uneasy feeling

Reporting Abuse

If you suspect nursing home abuse and the senior is in immediate danger, call 911. Otherwise, you can call the Long Term Care Ombudsman. Each state has its own ombudsman who will investigate claims specific to nursing homes or long-term care facilities. When you make a call, make sure you have the elder’s contact information and details about any possible mistreatment.

Who Owns Nursing Homes and Assisted Living Facilities?

There are non-profit and for-profit homes, and the majority of the offenders fall in the for-profit category. Many owners are entrepreneurs, real estate moguls or investment bankers — business people who usually do not have a background in health care. Some go to great lengths to conceal their identity to protect themselves from liability and complaints.

One of the biggest nursing home owners in California is entrepreneur Shlomo Rechnitz, who owns about 75 facilities, all with different names. Not even the state’s website has information that links Rechnitz’s companies. The Sacramento Bee reports that this practice is intentional and allows owners to “hide assets and shield themselves from civil and criminal liability when patients are abused or neglected in their care.”

This practice also makes it harder for state regulators to discover patterns of poor care. Attorneys who help families get justice for injured loved ones are experienced in tracking down owners.

Largest U.S. Nursing Home Chains
Name Beds Facilities Location Annual Rev.
HCR Manor Care 38,412 279 Toledo, OH N/A
Golden Living 31,060 304 Plano, TX N/A
Life Care Centers of America 30,983 231 Cleveland, TN N/A
Kindred Healthcare 27,561 226 Louisville, KY N/A
Genesis HealthCare Corp 25,409 206 Kennett Square, PA $2.7 Billion
SavaSeniorCare 21,979 180 Atlanta, GA N/A
Sun Healthcare Group 20,736 200 Irvine, CA N/A
Extendicare Health Services 16,849 168 Milwaukee, WI $1.4 Billion
Evangelical Lutheran Good Samaritan Society 12,067 175 Sioux Falls, SD $95.4 Million
The Ensign Group 10,065 94 Mission Valejo, CA N/A

Nursing Home Lawsuits

In some cases, lack of government action forces families to seek justice on their own. Luckily, qualified nursing home attorneys can help answer questions and assist in filing a lawsuit to hold these disreputable organizations accountable.

Bonnie Nidiver and her son, Scott, filed a lawsuit against Cypress Healthcare Center in Butte County Superior Court after Bonnie’s husband, Eugene, died from poor care in the home. Eugene went into the facility for help healing from a broken pelvis and wrist. Ten weeks later, he was dying in hospice. Before surgery, he was fit and active.

According to the Nidivers’s complaint, Cypress staff kept Eugene drugged on antidepressants, sedatives and narcotics. With no one to supervise him, he fell from his wheel chair twice – and the second fall broke his hip. Bonnie visited the nursing home daily and alerted the staff, but no one seemed to pay attention to her.

The Nidivers’s story is not uncommon. Families across the country continue to file lawsuits against long-term care facilities that injured their loved ones.

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