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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
pie chart

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.

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).

This type of abuse can include:

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  • Lack of communication and being withdrawn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

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

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.

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.

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

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.

This type of abuse can include:


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.

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.

holding hands

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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Nursing home abuse can severely disrupt the living environment of the ones you love. Residents may suffer from concerns like physical abuse and neglect. Often it takes a family member stepping up to change things. Tell us about your experience and we will provide you with legal options.

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  2. National Center on Elder Abuse. (2014). Types of abuse. Retrieved from http://ncea.aoa.gov/FAQ/Type_Abuse/
  3. National Center on Elder Abuse. (2010). Abuse of residents in long term care facilities. Retrieved from http://www.ncea.aoa.gov/Resources/Publication/docs/NCEA_LTCF_ResearchBrief_2013.pdf
  4. Williams, G. (2014, May 7). 5 traits of the worst nursing homes. U.S. News & World Report. Retrieved from http://money.usnews.com/money/personal-finance/articles/2014/05/07/5-traits-of-the-worst-nursing-homes
  5. Herman, C. (2012, April 27). Suing nursing homes. Huffpost. Retrieved from http://www.huffingtonpost.com/carole-herman/suing-nursing-homes_b_1459713.html
  6. Department of Health and Human Services, Office of the Inspector General. (2014). Nursing facilities' compliance with federal regulations for reporting allegations of abuse or neglect. Retrieved from http://oig.hhs.gov/oei/reports/oei-07-13-00010.pdf
  7. National Center on Elder Abuse. (2005). Nursing home abuse risk prevention profile and checklist. Retrieved from http://www.ncea.aoa.gov/Resources/Publication/docs/NursingHomeRisk.pdf
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