Elder Abuse in Nursing Homes

A nursing home is a place where seniors and the elderly should be safe—it's their home, after all. Unfortunately, a significant number of nursing homes abuse their residents in some way, including:

• physical abuse
• stealing money, and
• illegally restricting activity (false imprisonment).

If you have a relative or close friend living in a nursing home, pay attention to how that person is treated. It helps to learn about some common signs of elder abuse in nursing homes. Then, if you suspect abuse, take steps to deal with the problem. Here's how.

Types of Elder Abuse

Abuse of the elderly can come in many forms. Elderly people who live in nursing homes can be abused physically (including sexual abuse) and emotionally. The abuse can be committed by nursing home staff or other nursing home residents.

Some abuse is obvious, like hitting a resident. But other types are less apparent to the public, such as:

• neglect
• sexual abuse
• emotional abuse
• false imprisonment,
• and financial abuse.

Nursing Home Neglect Is Elder Abuse

A nursing home neglects a resident when it fails to meet the resident's basic needs, including:

• food and water
• clothing
• hygiene
• a clean, safe environment, and
• proper medical care (like treating bedsores or calling a doctor when the resident is ill).

Neglect can be considered abuse when it results in serious actual or possible harm. For example, if an elderly resident needs assistance to eat and the nursing home staff doesn't provide that assistance, the resident can become malnourished.

Sexual Abuse of the Elderly In Nursing Homes

When a nursing home resident experiences any type of unwanted sexual contact, it's considered sexual abuse—whether committed by a staff member or another resident. Although sexual abuse can include unwanted physical contact with another person, it doesn't have to. Sexual abuse in nursing homes can take many forms, like:

• requiring the resident to unnecessarily undress in front of the abuser or another person
• subjecting the resident to sexual comments or threats
• forcing the resident to view pornography, or
• forcing the senior to witness nudity or sexual acts.

The physical and mental disabilities that many elderly nursing home residents have makes them especially vulnerable to this type of abuse.

Elder Emotional or Verbal Abuse

Emotional abuse (sometimes called psychological or verbal abuse) involves behaviors that inflict emotional distress on an older adult, like:

• anguish
• mental torment
• fear, or
• shame.

Emotional or verbal abuse in a nursing home can come from a staff member or another resident. It's often a form of bullying and can include any of the following:

• making hurtful or demeaning comments
• yelling and using harsh language
• threatening the resident, or
• intentionally ignoring the resident.

Keeping someone isolated from others or not letting a resident see friends or relatives is another form of emotional abuse.

False Imprisonment in Nursing Homes

If the nursing home staff prevents a resident from leaving a certain area, such as their room or a wing of the facility, it can be considered false imprisonment. There are a few methods abusers typically use to confine a resident, such as:

• leaving the resident without their wheelchair or crutches
• threatening the resident with harm, or
• threatening to withhold food, water, or medication.

Financial Abuse in Nursing Homes

Unfortunately, not everyone who works in nursing homes is trustworthy. There are several ways someone who lives in a nursing home could fall victim to financial abuse.

Theft. A nursing home staff member could steal a resident's personal property. If something is missing, that's a warning sign. A staff member could also steal a nursing home resident's personal information and use it to withdraw money from the resident's bank account (a form of identity theft).

Undue influence or coercion. A staff member might pressure a resident to modify a will, deed, or trust. The pressure can come in the form of threatening behavior or by taking advantage of the elderly person's trust.

False fees. Financial abuse can also come in the form of illegitimate fees or charges that deprive a resident of a significant amount of their income or savings.

Signs of Elder Abuse in Nursing Homes

Each type of elder abuse has different warning signs. And generally, you should be watchful if a staff member is unwilling to let you spend time alone with an elderly resident.

If a resident has become frequently argumentative or uncooperative, or if the resident's personality has drastically changed, it could be a sign of abuse. Below are other warning signs of different types of elderly abuse.

Physical abuse. Signs of physical abuse include:

• sudden weight loss
• dehydration or malnutrition
• bruising or marks from restraints
• bedsores
• broken bones or injuries resulting from falls, and
• overmedication and oversedation.

Nursing home neglect. Red flags for neglect include:

• lack of basic hygiene or clothing
• unexpected weight loss
• untreated bed sores or pressure ulcers, and
• basic medical needs not being met (lack of needed glasses, walker, dentures, hearing aid, or medications).

Sexual abuse. Watch for these signs of sexual abuse:

• bleeding in genital areas
• bruises in genital areas
• torn or bloodied undergarments, and
• contraction of sexually transmitted diseases.

Elder verbal or emotional abuse. Signs of emotional abuse to look for include the elderly person:

• showing excessive fear or apprehension around certain people
• blaming themselves for insignificant problems
• being visibly depressed or angry most of the time, and
• rocking, sucking, or mumbling—called "false dementia."

Financial abuse. Signs of financial abuse include:

• recent, frequent withdrawals from bank accounts
• personal property has gone missing
• new loans or mortgage contracts, and
• recent changes to legal documents like:
• wills
• deeds, or
• trusts.

You can learn more about common signs of elder abuse on the National Center on Elder Abuse's website.

Reporting Nursing Home Abuse

If you suspect that an elderly person has been abused or neglected by their nursing home, you should take action. Here are the steps you should take if you suspect elder abuse in nursing homes.

Verify the elderly person's story. Your first step should be to see if the elderly person is telling the truth. Get clear about what your relative or friend is saying by going over the problem with them. Gather medical records or take photos of recent injuries or prescriptions. And if you can, talk with the other nursing home residents.

Consider moving the elderly person to another facility. If you're worried about the safety of a nursing home resident, get them out of the nursing home immediately.

Inform the authorities. Tell the police or district attorney. There are laws protecting the elderly from nursing home neglect and abuse.

In some states, such as California, you're required to report elder abuse when you learn it has occurred. If the district attorney determines that the evidence you present rises to the level of criminal behavior, the state will file charges against the nursing home.

File a complaint with the appropriate agencies. File a complaint about the nursing home to the appropriate government agency in your state, such as:

• social services
• adult protective services, or
• elder protective services.

You can find more information about reporting nursing home abuse at Medicare.gov.

Consider hiring an attorney. Depending on the type of elder abuse you're dealing with, you may want an attorney who specializes in one or more of the following areas:

• nursing home law
• elder abuse
• personal injury, or
• consumer fraud.

An attorney can advise you on how to report nursing home abuse. In certain situations, joining with other victims as a part of a class action lawsuit is possible.

Legal Claims in Nursing Home Abuse Cases

Seniors and their relatives can bring several types of claims against nursing homes, including those claiming:

• physical, sexual, or verbal abuse
• false imprisonment
• consumer fraud resulting in financial abuse, and
• financial exploitation.

For abuse to qualify as elder abuse, the victim must be a certain age, depending on the state you're in—usually, it's between 60 and 65.

You can also file a lawsuit based on neglect. Industry standards require nursing homes to provide reasonable care to their residents. If the nursing home fails to provide reasonable care or fails to adhere to a specific industry standard and that failure causes injury to the nursing home resident, you might have grounds for a lawsuit based on neglect.

In general, nursing homes are held to a high standard of care. The federal Nursing Home Reform Act (NHRA) of 1987 requires that all nursing homes that receive Medicare or Medicaid funds maintain facilities that are safe for their residents. In addition, federal regulations also require that all nursing home residents, whether they receive Medicaid or not, have a right to be free from all of the following:

• verbal abuse
• mental abuse
• physical abuse, and
• sexual abuse.

(Learn more about nursing home residents' rights under the NHRA.)

State and local governments often have additional regulations on nursing homes.

If a nursing home fails to abide by a specific state or federal regulation, and that failure results in abuse or neglect, you might have grounds to sue the nursing home. But if the nursing home doesn't comply with regulations and no neglect or abuse results, then the Attorney General is the only one who can bring an action.

Getting Help After Elder Abuse

Lawsuits against nursing homes can be complex. Many nursing homes are run by corporations and will try to avoid your lawsuit by burying you in paperwork. If you decide to sue a nursing home, you'll need an attorney.

For help choosing the right lawyer for your case, read Nolo's article Finding a Personal Injury Lawyer.

To learn more about making the best arrangements for long-term care, read Long-Term Care: How to Plan & Pay for It by Joseph Matthews (Nolo).

_{Updated June 26, 2023}