Nursing Home Abuse and Neglect

There are many types of nursing home abuse and neglect including physical, emotional, sexual and financial abuse.  The vulnerability of older adults makes them an easy target for predators and those seeking to exploit them.

Unfortunately, elderly persons do not always have the ability to speak out about their mistreatment.  In some cases, they may fear the consequences of reporting their abuser.  In others, they may be ashamed of their situation.

If you have an elderly family member who lives in a nursing home or requires the assistance of a caregiver, learning to recognize the signs of nursing home abuse and neglect can help you protect them. Below, we discuss some of the most common types of abuse and neglect that occurs in nursing homes.

Abandonment

Abandonment occurs when a facility or caregiver fails to provide necessary care and supervision to an elderly person. In nursing homes, residents cannot live independently and they often require daily supervision and medical care. Without this assistance, the residents health may deteriorate and the situation can quickly become life-threatening.

See (“Neglect of Basic Needs”, “Medical Neglect”, “Bedsores”, “Dehydration”, “Malnutrition” and “Wrongful Death”).

Alzheimer’s Abuse

Alzheimer’s disease is a type of dementia. This incurable brain disorder destroys functions in the brain, including memory and intellectual functions. People who have Alzheimer’s disease are incredibly vulnerable. They need constant care and supervision. Sadly, many people with Alzheimer’s do not get the care that they need. In fact, as many as 50% of Alzheimer’s patients experience some form of Alzheimer’s abuse or neglect.

See (“Bedsores”, “Caregiver Abuse”, “Medical Neglect”, “Poor Hygiene”, “Sexual Abuse” and “Wrongful Death”).

Bedsores

Bedsores – also called pressure ulcers, pressure sores or decubitus ulcers – are one of the most unfortunate signs of nursing home abuse and neglect. These injuries occur when a patient has limited mobility and is left in the same position for an extended period of time. Often, this coincides with a lack of medical care and poor hygiene. What begins as a small irritation can quickly escalate into an open wound. This can further lead to infection, sepsis or even death.

See (“Poor Hygiene”, “Medical Neglect”, “Dehydration”, “Malnutrition”, “Sepsis”, “Wound Care” and “Wrongful Death”).

Caregiver Abuse

Nursing home residents have a right to a safe and comfortable environment. That includes receiving care from individuals who are properly trained and are capable of providing the necessary care. Unfortunately, not all caregivers uphold their responsibilities. Sometimes this is due to factors outside their control, such as staffing shortages or insufficient training. Other times, however, it is simply due to negligence or sometimes intentional wrongdoing.

Dehydration 

One of the most important factors for a healthy body and mind is proper nutrition and hydration. Dehydration can be caused by a variety of factors, including illness, side effects of medications, or simply not drinking enough fluids. When someone is severely dehydrated, they are at risk for serious medical problems, including:

• Bedsores
• Pneumonia
• Infection
• Immune system dysfunction
• Worsening dementia symptoms

In nursing homes, caregivers must ensure that residents have access to adequate food and hydration. They must also monitor residents for symptoms of dehydration and get medical help if needed. (See “Bedsores”, “Medical Neglect” and “Wrongful Death”).

Malnutrition

Malnutrition is an unfortunately common type of nursing home neglect. It occurs when there is not enough food available, or the quality of food available is lacking in vital nutrients. Generally, malnutrition is the result of negligence and not a lack of food. Nursing home caregivers must pay attention to the dietary needs of each resident and make sure that they have adequate food and the ability to properly eat it.

Elderly individuals, especially those with dementia, may be unable to feed themselves properly. It is up to caregivers to make sure they are using the correct feeding methods for residents who need help. (See related topics “Dehydration” and “Neglect of Basic Needs”).  

Emotional Abuse

Emotional abuse in nursing homes is far too common. It is also often overlooked because there may be no outward signs that abuse is occurring. Instead, the signs of emotional abuse may be limited to changes in behavior or mood, or unexplained changes in overall health. Emotional abuse can manifest in a variety of ways, including:

• Humiliation
• Threatening
• Isolation
• Controlling
• Bullying
• Ignoring the resident and his or her needs

The psychological effect of emotional abuse can extend into physical illness or withdrawal, and can be indicative of a pattern of abuse that may include physical or sexual abuse as well. (See “Abandonment”, “Caregiver Abuse”, “Neglect of Basic Needs” and “Sexual Abuse”). 

Fall Injuries

Falls in nursing homes are unfortunately common. Elderly individuals are much more likely to suffer a fall than younger individuals. Furthermore, 75% of nursing home residents fall each year. More than one-third of those falls are among residents who cannot walk without assistance. This begs the question of why nursing home residents fall so frequently? One answer is nursing home abuse and neglect.

Nursing home caregivers must be trained in, and must utilize, proper fall prevention techniques. Residents often have medical conditions that affect their mobility, or take medications that make them dizzy or weak. Residents who are immobile rely on caregivers to help them move from one place to the next. Improper monitoring of residents and improper care when assisting with ambulation (walking or transferring) can easily result in a resident fall.

More information about specific fall injuries is provided in separate articles. (See “Fractures and Broken Bones”, “Head Injuries”, “Spinal Injuries” and “Wound Care”).

Fractures and Broken Bones

Nursing home residents are at a higher risk of fractures and broken bones than their younger, more agile counterparts. Factors that contribute to this increased risk include age, medical conditions, physical limitations, medications and mental disabilities. Sometimes broken bones are the result of an accident, or are the consequence of a medical condition. Most often, fractures and broken bones can be prevented with proper supervision and care.

Fractures and broken bones are often the result of nursing home falls, but can also be a sign of nursing home abuse and neglect. Nursing homes must ensure that residents have proper supervision and assistance with moving about. If they are a fall risk, there should be proper fall prevention strategies in place. Nursing home staff must also ensure that the facility is clean and free from clutter or debris that could result in a fall or other hazard. (See “Abandonment“, “Fall Injuries”, “Understaffing” and “Caregiver Abuse”).

Head Injuries

Head injuries in nursing homes are most often caused by falls. When a resident falls, he or she may hit their head on the floor, furniture or other objects. Some of the common hazards that contribute to head injuries include tripping and falling, falling while moving between the bed and a chair or toilet or trying to reach heavy items on upper shelves.

But not all head injuries in nursing homes are accidents. Unfortunately, some are the result of nursing home abuse and neglect. Nursing homes must ensure a safe environment for residents. That includes making sure that residents are safe from negligent caregivers or potentially dangerous fellow residents. Physical altercations between the resident and another resident or staff member can lead to head trauma or brain injuries, which can be devastating or even fatal. (See “Caregiver Abuse”, “Fall Injuries“, “Physical Abuse” and “Wrongful Death”).

Healthcare Abuse and Fraud

Healthcare abuse and fraud occurs when a nursing home or caregiver improperly or unlawfully bills medical facilities or insurance companies. Most nursing home residents rely on Medicare to help pay for their costs of living. If the nursing home or a caregiver unlawfully bills Medicare in order to get a kickback, the resident may not have access to their full benefits and coverage.

Without full benefits and coverage, residents are vulnerable. They may be stuck with bills that they cannot afford to pay out-of-pocket. Also, they may be denied coverage for medical care that is essential. This could be disastrous for residents to require routine medical care and medications.

Heat Stroke and Heat Exhaustion

When the human body overheats, the individual can quickly experience heat stroke or heat exhaustion. These conditions are dangerous and can be life-threatening if not treated quickly. Nursing homes are responsible for keeping the facility properly heated and cooled, and well ventilated. If they don’t, residents can suffer from serious medical issues or may even die as a result of overheating.

Elderly individuals are at a greater risk of heat stroke and heat exhaustion because their bodies have a more difficult time adapting to changes in temperature. Also, many medical conditions and medications alter the way that the body naturally manages heat and cold. (See “Dehydration” and “Wrongful Death”). 

Infections

Nursing home residents – and the elderly in general – are more vulnerable to certain types of infections. As we age, our bodies and immune systems change. As a result, it is harder for our bodies to fight off infection. For an elderly person, even something a “routine” as a urinary tract infection can lead to more serious medical problems without proper diagnosis and treatment. Furthermore, an infection from a cut, blister or bug bite can escalate to sepsis without proper wound care.

It is crucial that nursing homes and caregivers carefully monitor patients for signs of infection and take action quickly to prevent them from getting worse. Failing to properly monitor and manage an infection is a type of nursing home abuse. (See “Bedsores”,  “Caregiver Abuse”, “Medical Neglect”, “Sepsis” and “Wound Care”). 

Medical Neglect

Medical neglect means that a healthcare provider has violated the standard of care that is owed to the patient. This can also include the standard of care that a nursing home or caregiver owes to a nursing home resident. Nursing home residents have a legal right to safety and support of their physical and mental wellbeing. When caregivers or healthcare professionals do not provide safety and support of residents’ basic needs, they are violating their rights and are committing nursing home abuse and neglect.

(See “Bedsores”, “Healthcare Abuse and Fraud”, “Infections”, “Neglect of Basic Needs”, “Overmedicating or Wrong Medication”, “Sepsis”, “Wound Care” and “Wrongful Death”).

Neglect of Basic Needs

Every human has basic needs that must be met – food, water, shelter and comfort. Neglecting any of these basic needs causes physical and emotional harm. Sadly, even the most vulnerable people can experience a neglect of basic needs, even those living in a nursing home. Neglect of basic needs in a nursing home is a tragic example of nursing home abuse and neglect.

Nursing home residents have the right to a safe and healthy environment. That means they have adequate shelter, food and water, climate controls, assistance with activities of daily living, assistance with hygiene and cleanliness, and more. When nursing homes fail to meet these needs, they place nursing home residents at risk for a variety of physical and emotional injuries.

Learn more about the types of harm that results from neglect of basic needs. (See “Bedsores”, “Dehydration”, “Malnutrition”, “Heat Stroke and Heat Exhaustion”, “Infections”, “Poor Hygiene”, “Sepsis” and “Wrongful Death”). 

Overmedicating or Wrong Medication

The vast majority of nursing home residents take some kind of daily medication. Some estimates suggest that Americans over 75 years old take an average of 11 different medications over the course of a year. Nursing home residents rely on nursing staff to ensure they have the right medication at the right time. For some residents, getting their medication is a matter of life or death. Unfortunately, sometimes medication errors happen. Nursing staff may accidentally give a patient the wrong medication, or may give them the wrong dose. While this can happen by accident, it can also happen due to confusion, improper training or distraction. In the worst cases, it can also happen intentionally.

Overmedicating a resident or giving them the wrong medication is a dangerous type of nursing home abuse. It can lead to serious medical emergencies or even death. (See “Caregiver Abuse”, “Fall Injuries“, “Medical Neglect” and “Wrongful Death”).   

Poor Hygiene

Nursing home residents rely on their caregivers to help them maintain proper hygiene. This is especially important for residents who are unable to care for themselves. Nursing home residents rely on caregivers for help with tasks that most of us take for granted, such as brushing their hair or teeth, applying makeup, or taking a relaxing bath or shower.

Hygiene also relates to the nursing home environment. The nursing home itself should be clean and sanitary, and caregivers should help residents maintain their private living areas. Food preparation areas must be kept sanitary and in compliance with food service guidelines.

A nursing home’s failure to maintain proper hygiene in any of these situations is a violation of resident rights. It is also a common form of nursing home abuse and neglect. (See “Neglect of Basic Needs” and “Understaffing“).

Physical Abuse

Physical abuse or assault on nursing home residents is difficult to imagine, but it occurs quite often. This type of abuse in nursing homes is a sad reality that leaves residents suffering mental and physical pain. It can also make residents vulnerable to other types of nursing home abuse and neglect, and can lead to deteriorating health.

Physical abuse consists of much more than hitting the resident. It can also include pushing, use of restraints, unnecessary confinement, using drugs inappropriately to restrain or alter consciousness or using inappropriate force.

See also (“Caregiver Abuse”, “Emotional Abuse”, “Fractures and Broken Bones“, “Overmedicating or Wrong Medication” and “Sexual Abuse”).

Sacral Ulcers

Sacral ulcers are a type of pressure injury (bedsore) that occurs between the lumbar spine and the tailbone. The sacrum is the back wall of the pelvis that joins at the hip bone. Direct pressure to this area, such as laying or sitting in the same position for an extended period of time, can compromise skin and tissue health. Over time, a sacral ulcer can develop into an open wound.

Sacral ulcers are often a sign of nursing home abuse and neglect. These injuries are preventable and, if caught early, are treatable. If not caught and treated quickly, these injuries can lead to infections and even death. (See “Bedsores”, “Dehydration”, “Malnutrition”, “Medical Neglect”, “Poor Hygiene”, “Sepsis”, “Wound Care” and “Wrongful Death”).

Sepsis

Sepsis is a serious medical condition that occurs when the body overreacts to an infection. When the body experiences a viral, bacteria or fungal infection, it responds by releasing chemicals into the bloodstream to help fight it. When this response is overwhelming or chemicals are out of balance, sepsis can develop. Instead of fighting off the virus, your body then begins to attack itself. This can lead to organ damage and death.

See also (“Bedsores”, “Infections”, “Poor Hygiene”, “Sacral Ulcers”, “Wound Care” and “Wrongful Death”).

Sexual Abuse

Sexual abuse is one of the most tragic examples of nursing home abuse and neglect. This type of abuse has a profound physical and mental impact on victims and their loved ones. Often, sexual abuse in nursing homes goes unreported due to fear of retaliation or because the resident is unable to describe what has happened to them.

Sexual abuse in nursing homes is not just perpetrated by caregivers. It can also happen at the hands of other residents, family members or others. No matter who perpetrates these heinous acts, nursing homes have a responsibility to monitor residents and address concerns of possible sexual abuse. Furthermore, they must investigate any allegations of sexual abuse. (See also “Emotional Abuse“).

Spinal Injuries

Nursing home residents suffer spinal injuries most often due to a fall. These injuries are common among residents who need assistance with walking or moving from the bed to a chair, etc. Sometimes spinal injuries occur because of an accident, but sometimes they are due to the inappropriate actions of caregivers. Caregivers may drop the resident while transferring them, may not provide proper assistance with bathing or may not fix clutter or tripping hazards in the facility.

See also (“Caregiver Abuse”, “Fall Injuries”, “Fractures and Broken Bones”, “Medical Neglect” and “Physical Abuse“).

Understaffing

Understaffing is a huge problem in nursing homes. When nursing homes are understaffed, the staff they do have becomes overworked and residents do not have access to the assistance and supervision that they really need. Understaffing increases the risk of nursing home abuse and neglect in the following ways:

• A lack of staff makes it difficult to provide every resident with quality assistance.
• A lack of staff complicates food supply and assistance for residents who need help eating or drinking.
• Inadequate nursing staff makes it difficult to ensure that medications are dispensed properly and on schedule.
• Inadequate staff means that immobile residents may not get assistance with turning or transferring to another location as often as needed to avoid bedsores.
• Caregivers who are overworked or exhausted are more likely to make mistakes.

See also (“Abandonment”, “Bedsores”, “Dehydration”, “Malnutrition”, “Medical Neglect”, “Poor Hygiene” and “Wrongful Death”).

Wound Care

Whether it is a minor scrape or a surgical incision site, proper wound care is essential for healing and avoiding infections. In nursing homes, residents often suffer from wounds due to medical conditions, fragile skin, neuropathic ulcers or bedsores. It is important that caregivers provide proper wound care. Elderly individuals are more vulnerable to infection and sepsis, and sadly, are more vulnerable to death from these causes.

Inadequate wound care is a type of nursing home abuse and neglect that should never happen. See also (“Bedsores”, “Infections”, “Medical Neglect”, “Sacral Ulcers”, “Sepsis” and “Wrongful Death”).

Wrongful Death

The most tragic examples of nursing home abuse and neglect are those that result in the wrongful death of a resident. A wrongful death is the death of one person due to the negligence or wrongdoing of someone else. In a nursing home, that could mean caregiver abuse, assault by another resident, medical negligence, or neglect of basic needs.

See (“Bedsores”, “Caregiver Abuse”, “Heatstroke and Heat Exhaustion”, “Infections”, “Medical Neglect”, “Neglect of Basic Needs”, “Physical Abuse”, “Sepsis”, “Sexual Abuse” and “Wound Care”).