Reporting Nursing Home Injuries and Abuse

If you suspect misconduct on the part of a care facility or one of its employees, here's what to do.

By , Attorney · University of Tulsa College of Law

The United States Census Bureau estimates that within three decades those persons age sixty-five or older will make up 20% of the population, i.e., an estimated 60 million persons. As the "baby boomer" population ages, more people will reside in nursing homes. So the problem of nursing home injuries and abuse will likely see a corresponding surge, and it will become more and more important to recognize and report any incident where a nursing home resident has been harmed. That's the focus of this article.

What Is Nursing Home Abuse and Neglect?

Nursing home injuries can occur in a variety of situations and environments, but generally actions that rise to the level of abuse fall into the following categories:

  • physical abuse
  • emotional abuse
  • sexual abuse, and
  • financial exploitation.

Neglect can also take many forms, but it is generally defined as a failure to provide for an older person's needs when it comes to food, shelter, clothing, hygiene or health care.

How Widespread is the Problem?

In a study published in 2019 and cited by the National Center on Elder Abuse (NCEA), researchers found high levels of institutional abuse. By type, nursing home residents reported: psychological abuse (33.4%), physical (14.1%), financial (13.8%), neglect (11.6%), and sexual abuse (1.9%). As concerning as these numbers are, studies documented by the NCEA estimate that for every incident of abuse reported to authorities, nearly 24 additional cases remain undetected.

The rating system for nursing homes run by the federal Centers for Medicare and Medicaid Services (C.M.S.) doesn't necessarily give people reliable information about the amount of abuse and neglect at a particular facility. A New York Times investigation conducted in 2021 revealed that at least 2,700 dangerous incidents at nursing homes (like sexual assaults, COVID exposures, and serious falls) were uncovered by state inspectors, but not factored into the rating system because of a secretive appeals process that favors facilities.

What Are the Warning Signs?

According to the Administration on Aging, depending on the nature of the abuse or neglect, there are a number of warning signs that may indicate that abuse or neglect is occurring. Potential signs might include one or more of the following:

Physical or Sexual Abuse

  • inadequately explained fractures, bruises, welts, cuts, sores, or burns
  • unexplained sexually transmitted diseases

Financial Exploitation

  • lack of affordable amenities and comforts in an elder's home
  • giving uncharacteristically excessive gifts or financial reimbursement for needed care and companionship
  • a caregiver has control of an elder's money but fails to provide for the elder's needs
  • an older adult has signed property transfers (power of attorney or will, for example), but is unable to comprehend what the transaction means

Emotional Abuse

  • unexplained or uncharacteristic changes in behavior, such as withdrawal from normal activities, or unexplained changes in alertness
  • caregiver isolates the elder (doesn't let anyone in the home or doesn't let visitors speak to the elder)
  • caregiver is verbally aggressive or demeaning, controlling, or uncaring


  • lack of basic hygiene or appropriate clothing
  • lack of nutritional food
  • lack of medical aids (e.g., glasses, walker, dentures, hearing aid, or medications)
  • person with dementia left unsupervised
  • person confined in bed is left without care
  • home is cluttered, dirty, or in disrepair
  • home lacks adequate facilities (stove, refrigerator, heating and cooling, plumbing, or electricity)
  • untreated bed sores or pressure ulcers

Where Do I Report Abuse or Neglect?

If you suspect nursing home abuse or neglect, and it is an emergency, call 911. If it is not a life-threatening emergency you should contact your local law enforcement agency or district attorney's office and make a report.

There are also several other resources available to assist you in reporting instances of abuse or neglect. Typically, the first agency to respond to a report of nursing home abuse is Adult Protective Services (APS). Although the role of APS varies from state to state, generally it investigates reports of abuse, offers responsive services, and advises on other resources that may be available.

The National Council on Child Abuse and Family Violence has a list of elder abuse reporting hotlines in each state. For more information on how to contact Adult Protective Services in your state, you can also call the Eldercare Locator, a service of the U.S. Administration on Aging.

Even if you report instances of abuse or neglect to your local law enforcement agency or Adult Protective Services, it is also recommended that you seek the advice of a lawyer who is licensed to practice in your state, and who has experience in handling these kinds of cases. The lawyer can assist you in properly reporting the abuse to the correct agency, ensuring that the agency is following up and investigating the reported abuse, and exploring your legal options. Contact a Nursing Home Lawyer in your area.

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