Nursing Home Abuse

Nursing Home Abuse and Neglect

Although there has not been much research into elder abuse, evidence suggests that it is just as common in the community than child abuse.

Different Types of Abuse and Neglect

Assault and Battery (including kicking and slapping as well pinching, pushing, shaking and beating)

Inadequate care for medical conditions

Persistent or prolonged starvation or deprivation

Violation or other forms sexual assault or battery

Unreasonable physical restraint, seclusion

Any use of a psychotropic or physical restraint medication or a chemical restraint for any reason other than that which a doctor has authorized is prohibited

Nursing Home Abuse Neglect

Common Signs of Physical or Verbal Abuse and Neglect

Bed injuries/asphyxiation


Extremely withdrawing and non-communicative, or emotionally upset.

Head injuries, falls and fractures


Examples of wandering/elopement


Pressure ulcers (bed sores)

Rapid weight loss, weight gain; signs and symptoms of malnutrition

Reluctance in the presence of staff members to speak

Unexpected or unexplained death of a resident

Unexplained injuries, such as cuts, bruises, or wounds, can be treated in different stages of healing.

Conditions that are unsanitary or not clean

Behavior changes that are sudden or unusual (fear of touching, sucking, biting or rocking).

Desiring to be alone from others

Common Signs of Physical or Verbal Abuse and Neglect

Other Warning Signs of Physical or Verbal Abuse and Neglect

Injuries that require hospitalization or emergency treatment

Broken bones and fractures, particularly hips, are all possible

Any injury or death that occurs during or shortly following a wandering episode (including outside the facility).

Sedation or heavy medication

One resident injures another

Resident becomes frequently ill and is not able to report the illness promptly to their family physician.

Elder Abuse in Long-Term Residential Care Settings: What is known and what information is needed?

Although there has not been much research into elder abuse, evidence suggests that it is just as common in the community than child abuse. Despite some attention being paid to elder abuse and neglect in recent years, the majority of research has been focused on its causes, incidence, and risk factors. Research and policy communities have not paid much attention to elders who live outside their homes, apartments, or family members. Elderly who are living in residential facilities that provide long-term support services are more at risk of abuse and neglect. Many are afraid of being retaliated against or threatened with retaliation for reporting abuse and neglect. As Shapira pointed out, the elderly in skilled nursing facilities are some of the most vulnerable members our society. They rely on the operator of the nursing facility for their food, medication, and dental care.

Around 1.6 million people are residing in 17,000 licensed nursing homes. Another estimated 900,000.1 million to 1 million reside in 45,000 residential care facilities. These facilities are also known as personal care homes or adult congregate living homes, adult care home, adult care homes and homes for the elderly. Research shows that 2.5 million elderly people living in these settings are more at risk of abuse and neglect than those who live at home. These figures could underestimate the actual number of people who are at risk of abuse or neglect in a nursing facility. According to the National Mortality Followback Survey data, more than two-fifths (Kemper and Murtaugh 1991; Murtaugh and co. 1990) of all 65-year-olds will be admitted to a nursing home before their death. More than half (55%) of those who go into a nursing home will use it for at least one year in their lifetime. As we age, our chances of being used increase dramatically. It is now at least 17 percent for people 65-74 years old and 60 percent for people 85-94 years. Women live longer than men so their risk of using a nursing home over the course of their lives is greater. The elderly are the fastest growing population segment, and the likelihood that they will use a nursing home at some point in their lives is likely to rise. While only 2.5 million seniors are at risk of abuse in long-term residential care facilities, many older people could be exposed to abuse over the course of their lives.

This paper's general purpose is to provide evidence regarding the nature, scope, and causes of abuse and neglect in residential care facilities. It also suggests a research agenda. The following structure is used to achieve these goals:

Definitions of Abuse and Neglect

Physical abuse is defined as the area in which there is most agreement. It is injury or harm that is done to someone with the intent of causing suffering, pain or impairment. In its long-term care guidelines to ombudsmen, the Administration on Aging defines abuse as "willful infliction, unreasonable confinement or intimidation with resulting bodily harm, pain or mental anguish or deprivation of goods or services by a person, even a caregiver, that is necessary to prevent physical harm, mental anguish and/or mental illness." (1998:13). This definition is consistent with that used by the Centers for Medicare & Medicaid Services in their guidelines to states regarding reporting abuse and neglect in nursing home settings.

Physical abuse can be defined as hitting, slapping or pushing with objects. Other types of abuse can be found in nursing homes. These include improper use of chemical or physical restraints. Other types of abuse include sexual abuse, nonconsensual sexual involvement and rape.

However, there is less consensus on whether verbal and psychosocial abuse should be included when it comes to older people. This can be described as "intentional pain infliction of distress, anguish or pain through verbal or other acts". It also includes harassment and threats to intimidate or humiliate the older person (Clarke & Pierson 1999:632).

Focus group interviews were conducted in 2000 by certified nursing assistants. They defined abusive acts as both verbal and physical abuse.

Definitions of Abuse and Neglect

Aggressiveness Towards an Elder Resident

Handling rough;

Not enough care for a resident

Yelling in anger


Punching, slapping and kicking;

Use a harsh tone or curse at residents.

In recent years, neglect of elderly persons has been a topic that has attracted more attention. Clarke and Pierson pointed out that "definitions of neglect are probably most disputed among any category" for maltreatment of elderly people. In general, neglect can be defined as "the refusal or failure to fulfill one's obligations or duties to an elderly person, including ....". Provide any food, clothing or medicine that is necessary for the well-being and safety of another person.

Participating in focus groups, CNAs had clear and precise ideas about what constitutes neglect in nursing homes. There were many examples.

no oral/dental care;

Not doing range-of-motion exercises

Residents should not be changed every time they get wet from an episode of incontinence.

Not offering any activities or ignoring residents who are in bedfast;

Not following prescribed wound care

Residents are not allowed to take regular baths.

If the resident needs a two-person transfer, you can do a one-person move.

Residents who require cuing or task segmentation are not eligible for this kind of assistance in order to maximize their independence.

Not helping residents ask for help or doing scheduled toileting;

Residents should not be kept hydrated.

Turning off the call light and not responding to residents' requests.

Federal government has also established formal guidelines for defining abuse and neglect in nursing home settings. In the Omnibus Budget Reconciliation Act of 1986, nursing home reforms stated that residents in nursing homes had the right to be free from verbal and sexual abuse, corporal punishment and involuntary isolation IV. These provisions were implemented by the OBRA 1987 legislation through regulations and guidelines issued by HCFA. These regulations provided the following definitions.

Abusive refers to the willful infliction or unreasonable confinement, intimidation, or punishment that results in physical harm, pain, and mental anguish.

Neglect is the inability to provide the goods and services needed to avoid mental anguish, physical harm, or mental illness.

Federal regulations that implemented OBRA 1987 also required long-term care facilities to "develop, implement, and maintain written policies and procedures that prohibit abuse, neglect, or mistreatment of residents" and the misappropriation and mistreatment of resident property. The law also stipulated that the facility must not employ anyone who has been found guilty of mistreating, neglecting or abusing residents or had a finding in the state nurse aide registry regarding abuse, neglect, mistreatment or misappropriation.

What is Nursing Home Neglect?

The most common problem in America is nursing home neglect. This happens when residents of nursing homes are not given the proper care they need and end up with mental or physical health problems.

The National Center for Victims of Crime reports that 15.3% of elder abuse complaints received in nursing homes by seniors are for neglect.

Nursing homes often treat seniors with respect. Unfortunately, many nursing home staff do not give elderly residents the proper care they need. Neglecting to provide basic care for a resident in a nursing home is considered neglect.

There are options if you suspect that a loved one is suffering from neglect. Talk to a trusted member of staff at a nursing facility or report your concerns to an elder care agency.

To find justice and closure, you may be eligible for legal compensation. To find out if you are eligible, request a free case review.

Nursing Home Neglect Versus Abuse

People mistakenly believe that nursing home abuse is only about physical injuries. Neglect is another type of abuse.

If a staff member intentionally neglects to care for a resident, they should be held accountable if their actions cause harm or wrongful death.

Even neglect in nursing homes can cause serious injuries. In some cases, such as when an elderly person is given the wrong medication, it can lead to life-threatening complications.

What causes nursing home neglect?

Inadequate staffing is often the cause of neglect in nursing homes. Stressed or overworked employees may not be able provide the necessary care to maintain residents' health.

Neglecting to train caregivers and understaffing are two common causes of caregiver stress. Nursing homes might not adequately screen and run background checks on employees they hire.

Abusive Staffing

Inadequate staffing could mean there isn't enough care for residents. This can lead to a decrease in the overall quality of the facility. Staff who are overwhelmed by the demands of their jobs and more likely to make errors will be less able to perform their duties.

Unfortunately, nursing home staff shortages have been a problem for many years and have only gotten worse in recent years. A report by the U.S. Public Interest Research Group found that 20% of nursing homes in America were unstaffed as of December 2020.

Negligent Hiring Practices

Some nursing homes do not conduct background checks and hire people who aren't qualified to care for their residents. For residents of nursing homes, this can pose a risk and be dangerous.

Statistics show that those who have had to deal with substance abuse or have suffered from drug and alcohol addiction are more likely than others to abuse other people. Former criminals may be hired by nursing homes to care for elderly people.

Negligent hiring practices can also extend to other facilities, and even those running major nursing home chains.

Arizona's governor, for example, disbanded the board of administrators for nursing homes after they hired a felon as their leader. The felon made it mandatory that employees who had tested positive for COVID-19 could still work, exposing residents to this deadly virus.

Poor Staff Training

Even though new employees pass a background check they still can commit nursing home neglect if not properly trained by their facility.

After multiple allegations of neglect, abuse and mistreatment, a Wisconsin nursing home shut down. Staff members weren't trained at the least acceptable level of care to provide for others, according to reports.

Staff made medication errors, causing serious injuries to residents.

Types of Neglect in Nursing Homes

There are many types of nursing home negligence. Below are the most popular types.

Medical Neglect

When a staff member of a nursing home fails to provide the resident with health care, it is called medical neglect.

The following are possible causes of medical neglect:

Failure to administer medication when it is necessary

Inadequate medical care for current health conditions like dementia or diabetes

Seniors with mobility issues are at greater risk of falling if they don't move regularly.

Not reporting symptoms of illness or infection to doctors or nurses

A jury awarded over $1 million to a 72 year-old resident of a nursing home after finding that her negligence led to severe bedsores. Her attorneys claim that the woman, who was living in a nursing home at the time, never visited a doctor even though she knew she had bedores.

Emotional Neglect

Seniors can make new friends in nursing homes. Social interaction can make a senior feel happier and improve their mental health.

If they stop residents from interacting with one another, however, staff at nursing homes can be guilty of emotional neglect.

If staff members are not careful, this can happen.

Inadvertently isolate vulnerable residents

Residents with mobility issues should not be denied canes, wheelchairs or walkers

Do not forget to transport residents with mental or severe disabilities.

Neglecting Basic Living Needs

This type of neglect can lead to the nursing home and its staff failing to maintain safety for the facility.

These could include:

Failure to maintain a normal temperature in the nursing home

Cleaning common areas and resident's rooms not on a regular schedule

Seniors are at risk of eating or drinking unsafe food and water

Personal Hygiene Neglect

Staff members who neglect to maintain the hygiene of residents can have a negative impact on their appearance and health. Neglecting to maintain hygiene in nursing homes can have serious consequences.

Neglecting to maintain personal hygiene could lead to:

Refusing to change senior's clothes on a regular basis

Residents not regularly checked in

Seniors who have soiled themselves should not be changed into new clothes or bedding

Seniors are not properly bathed

Elder Neglect Symptoms

These are the warning signs of neglect in a nursing home

  • Bedsores (pressure ulcers/pressure sores)
  • Broken bones
  • Bruises
  • Burns
  • Dehydration
  • Insomnia
  • Malnutrition
  • Untreated or new medical conditions
  • Hygiene issues
  • Important personality changes
  • Other unspecified injuries

Neglect can still be detected despite these warning signs. However, it might require witness testimony. It may be more difficult if an elder is suffering from dementia or Alzheimer's. They might not be able tell their side.

There are many signs that could indicate neglect by staff members.

Staff members may be guilty of elder neglect if they are unable to recognize the signs.

A negative attitude towards caregiving

Long-term administration of incorrect or ineffective medication.

Prescriptions that contain conflicting medication or have excessive side effects


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