Nursing homes are a place where seniors and the elderly should be safe. Unfortunately, a significant number of nursing homes abuse their residents in some way -- from physical abuse to stealing money to illegally restricting activity (false imprisonment).

If you are the relative or close friend of someone in a nursing home, pay attention to how that person is being 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

According to a study presented before the U.S. Senate in 2002, between the years of 1999 and 2001, almost one third of nursing homes in the United States were cited for an abuse violation. And 10% of nursing homes engaged in abuse violations that caused or placed elderly residents at risk of actual harm. The study estimated both percentages would increase in coming years.

Elder abuse can come in many forms. Elderly people who live in nursing homes can be abused physically, sexually, and verbally. The abuse can occur at the hands of nursing home staff or other residents. Some abuse is obvious, such as hitting a resident. But others are less well-known to the public, such as neglect, false imprisonment, and financial abuse.

Neglect. Neglect can become abuse if it results in serious actual or possible harm. For example, if an elderly resident needs assistance to eat and the staff does not provide such assistance, then the elderly person can become malnourished, which rises to the level of physical abuse.

False imprisonment. False imprisonment occurs when the nursing home staff prevent the resident from leaving a certain area, such as their room or a wing of the facility. Typically, the person who imprisons the resident will disable the resident by leaving them without their wheelchair or crutches, or threaten the resident with harm or deprivation of food or water.

Financial abuse. A staff member of a nursing home might steal a resident's personal property or steal information in order to withdraw money from the resident's bank account. A staff member might also pressure a resident to modify a will, deed, or trust. Financial abuse can also come in the form of false fees or charges that deprive a resident of a significant amount of their income or savings.

Signs of Elder Abuse

Each form of elder abuse has different warning signs. Generally, you should be watchful if a staff member is unwilling to let you spend time alone with an elderly resident. You should also be mindful if a resident has frequently been argumentative or uncooperative, or the resident's personality has drastically changed.

Signs of physical abuse include:

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

Signs of sexual abuse include:

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

Signs that an elderly person has been verbally abused include:

• a showing of excessive fear or apprehension around certain persons
• the elderly person blaming themselves for insignificant problems
• visible depression or anger most of the time, and
• rocking, sucking, or mumbling -- called "false dementia."

Signs of financial abuse include:

• recent, frequent withdrawals from bank accounts
• losses of personal property
• new loans or mortgage contracts, and
• recent revisions to wills, deeds, or trusts.

You can learn more about common signs of elder abuse on the National Center on Elder Abuse's website at www.ncea.aoa.gov (click on "Frequently Asked Questions").

What to Do if You Suspect Elder Abuse

If you suspect that an elderly person has been abused or neglected by their nursing home, you should take action. Here's what to do:

1. 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. If you can, check with other residents of the nursing home who seem to be coherent. Also gather medical records, or take photos, of recent injuries or prescriptions.

2. Consider removing the elderly person to another facility. If you are worried about the safety of a nursing home resident, assist them in leaving the nursing home immediately.

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

4. File a complaint with the appropriate agencies. File a complaint about the nursing home to your state's department of social services, adult protective services, or elder protective services.

5. Consider hiring an attorney. You should retain a civil attorney who specializes in one or more of the following areas: nursing home law, elder abuse, personal injury, or consumer fraud. In certain situations, it is possible to join with other persons who have suffered damages as a part of a class action lawsuit.

Legal Claims in Nursing Home Abuse Cases

Seniors and their relatives may bring several types of claims against nursing homes, including actions alleging physical, sexual, or verbal abuse, false imprisonment, consumer fraud resulting in financial abuse, and financial exploitation. In order for abuse to qualify as elder abuse, the victim must be older than a certain age. This age varies between states and usually ranges from 60 to 65.

Plaintiffs can also institute a lawsuit for neglect. Industry standards require nursing homes to provide reasonable care to its 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 may have an action for 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 who 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 verbal, mental, physical, and sexual abuse. To learn more about the rules stated in the NHRA, read Residents' Rights: An Overview on the National Citizen's Coalition for Nursing Home Reform's website at www.nccnhr.org (search for "Fact Sheets").

States and municipalities, counties, or provinces, often impose additional regulations on nursing homes as well.

If a nursing home fails to abide by a specific state or federal regulation, and that failure results in abuse or neglect, you may have grounds to sue the nursing home. If the nursing home does not comply with regulations, but no neglect or abuse results, then the Attorney General is the only one that can bring an action.

Getting Help

Lawsuits against nursing homes can be complex. Many nursing homes are run by corporations that avoid lawsuits by burying the opposing party in paperwork. If you decide to sue a nursing home, consider hiring an attorney. For help in choosing the right lawyer for your case, read Nolo's article Finding a Personal Injury Lawyer. Or you can go to Nolo's Lawyer Directory to get a list of attorneys in your geographical area.

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).