Elder Abuse in Nursing Homes: The Essential Guide to Legal Action

Elder abuse cases shouldn’t go unpunished. Learn to spot signs of nursing home abuse and how to get fair compensation for your elderly loved one.

An estimated 2.5 million people live in long-term care facilities, with about 1.6 million in licensed nursing homes and more than 900,000 in assisted-living facilities, and the number is rising.¹

Research has shown that long-term care residents are at much higher risk of abuse than elderly who are cared for at home. Unfortunately, elder home care is often not available or affordable for many families.

Thousands of complaints of nursing home abuse and neglect are reported annually. However, government studies suggest that most incidents of elder abuse go unreported.²

You’ve done your best to ensure good care for your elderly loved one. We’ll help you identify signs of elder abuse and act to protect your vulnerable family member.

Elder abuse and neglect in nursing homes is a despicable breach of the facility’s duty and your trust. Here’s how to prove liability and seek compensation from negligent nursing homes.

State and Federal Nursing Home Laws

Several federal and state laws help protect elderly patients in nursing homes and other types of long-term care facilities.

Nursing Home Reform Act

In 1987, Congress passed the Nursing Home Reform Act. The act applies to all nursing home facilities receiving Medicare and Medicaid funding. Under the act, nursing homes:

[M]ust provide services and activities to attain the highest practicable physical, mental, and psychological well-being of each resident in accordance with a written plan of care.

Under the Nursing Home Reform Act, patients are legally entitled to basic rights.

Nursing home patients have the right to:

  • Privacy
  • Services to meet their physical, mental, and psychosocial needs
  • Freely communicate in and out of the facility
  • Be treated with dignity and respect
  • Be free from mistreatment, abuse, and neglect
  • Make their own decisions
  • Lodge complaints without facing retaliation
  • Be free from physical restraints
  • Participate in family, resident, and community groups
  • Participate in their care plan, including advance notice of changes in treatment, medications, or facility standing

To ensure compliance with regulations, nursing homes receiving federal funds are subject to periodic unannounced visits by federal investigators. When found to violate the provisions of the act, Medicare and Medicaid may deny continued funding.

Older Americans Act Reauthorized 2016

The Older Americans Act contains definitions of elder abuse and authorizes federal funding for the National Center on Elder Abuse (NCEA).

The NCEA works with elder abuse and neglect programs throughout the country to promote awareness of elder abuse, develop community responses to abuse, and train professionals to recognize and respond to elder abuse and neglect.

The Elder Justice Act of 2009

The Elder Justice Act went into effect in 2010 as part of the Patient Protection and Affordable Care Act to facilitate the coordination of elder abuse detection and prevention programs within the Offices of the Secretary of Health and Human Services (HHS).

The Act requires nursing home operators and employees to file a written report of suspected elder abuse or other crimes to the federal HHS office and the local state authorities.

State Elder Care Protection Laws

Long-term care facilities are usually licensed and regulated at the state level, with every state having rules governing nursing home care. Regulations vary from state-to-state, but most include rules regarding:

  • Residency contracts, including guidelines on admission
  • Medication delivery provisions, including who is authorized to distribute medications to patients
  • Food and dietary regulations
  • Nursing home staff and staff training, including background checks
  • Rules for dementia care
  • Inspection requirements

Use this map for State Elder Abuse Laws and Statutes and other state-specific information for the elderly.

Common Types of Nursing Home Abuse

The older adult is most vulnerable when they become dependent on nursing home care. Physical infirmity and dementia make them easy prey for unscrupulous nursing home owners and staff.

Greed often plays a substantial role in elder abuse in nursing homes. Motivated by profit, many nursing home owners offer low wages and employ caregivers who are poorly trained and poorly motivated to provide compassionate care.

Categories of nursing home abuse include:

  • Physical Abuse
  • Mental or Psychological Abuse
  • Neglect
  • Sexual Abuse
  • Financial Abuse/ Exploitation

Physical Abuse: Uncaring, lazy, and malicious staff members use physical abuse as a means of subduing nursing home residents. Rather than having to deal with their cries for help, some staff members use aggressive tactics, striking patients to make them fearful of additional physical retaliation if they continue to cry out.

Some staff members use physical abuse as a means of punishment. A staff member may strike an elder for dropping food or urinating on himself, or some other action the staff member considers objectionable.

Force feeding, excessive use of restraints, over-sedation, and even intentionally gripping or squeezing an elderly patient’s hand or arm to cause pain are forms of physical abuse.

Mental or Psychological Abuse: Verbal abuse, taunting, humiliation, withholding mail, and isolation are examples of mental abuse. Treating an older adult like a child, or any other treatment that causes emotional pain, distress, or anguish are abusive.

Neglect: Failing to provide a nursing home patient with the necessities of food, clean water, personal hygiene, medical care, and safety are all forms of neglect.

For example, failing to take a confused patient to the bathroom at regular intervals, or leaving an incontinent patient in soiled clothes or bedding are both forms of neglect.

Sexual Abuse: Sexual abuse of nursing home patients is particularly abhorrent. Sexual abuse includes any unwanted touching, sexual penetration, photographing, or forced nudity of a patient.

Sexual contact with patients who suffer from confusion or dementia is always considered sexual abuse. Undressing, bathing, or changing incontinent pads on a patient in view of other patients or visitors is also a form of sexual abuse.

Financial Abuse/ Exploitation: Financial abuse of the elderly can range from forging the person’s signature, coercing them into giving the abuser material possessions like jewelry, or conniving to get the patient to sign over checks or sign documents, like a power of attorney, that may not be in their best interest.

Warning Signs of Abuse in Nursing Homes

There are several signs of elder abuse that can help you uncover what’s been happening to your family member. Recognizing the warning signs, even when your loved one is confused or non-verbal, is essential for their health and safety.

Keep an eye out for changes in the elderly patient’s behavior or personality.

When an elder who is generally alert and cheerful becomes quiet and nervous, or a dementia patient suddenly exhibits a marked change in their behavior, look further.

A big red flag is the nursing home staff not leaving you alone with the elderly person or intervening before you can help the patient change clothes or go to the bathroom. They may not want you to see signs of physical or sexual abuse.

Signs of physical abuse include:

  • Unexplained broken bones, dislocations or swollen joints
  • Bruising, skin tears, or welts on the body
  • Refusing to accept medications
  • Evidence of restraints, such as rope marks on the wrists, neck, chest or waist
  • Broken eyeglasses or dentures

Signs of sexual abuse include:

  • Unexplained genital infections
  • Bruising near the genitals or around the breasts
  • Indications of unexplained genital or rectal bleeding

Signs of neglect can include:

  • Bedsores or skin rashes
  • Soiled linens
  • Weight loss
  • Symptoms of dehydration, like sunken eyes, sparse and dark urine, and poor skin turgor
  • Lack of personal hygiene including hair, nails, skin, and mouth care
  • Unsafe living conditions, including bugs, rats, lack of heating/air conditioning, dirty floors

Slip and falls frequently occur in nursing homes. Elders sometimes have difficulty standing and walking without assistance. When staff isn’t available to help patients to the restroom or dining room, many elderly patients choose to go it alone.

Without proper assistance, they can easily slip and fall, with devastating results. Falls are the number one cause of injury deaths in older adults.

Take Detailed Notes of the Abuse

Begin taking careful notes of your observations. Similar to a diary, date every entry in your written record. Describe in detail the changes you see in your loved one, and why it’s different from before.

Write down the name and title of every staff person you encounter on your visits, including the charge nurse, nursing assistant, orderly, housekeeper, and dietary workers. Note if any staff members are new, or newly assigned to care for your relative.

Listen closely and carefully your loved one’s comments and complaints. Take what they have to say seriously. Don’t dismiss their reports, especially when complaining of mistreatment.

Take Names and Photographs

Speak with staff members and supervisors. Don’t hesitate to use your smartphone or a micro-recorder to capture what they have to say about your concerns.

To cover up abuse, staff members, supervisors, and nursing home administrators can be quick to downplay your concerns or play it off as the imaginings of a confused patient.

Favor your loved one’s interpretation of abuse over that of the nursing home staff.

Speak with other people who’ve placed their family members in the same nursing home. Determine if they made similar observations or complained of similar abuses. Get their names and contact information. Ask if they’re willing to write down a statement describing the abuses their loved ones suffered.

Take photographs and video of your loved one’s bedsores, bruises, and other evidence of injuries. Take pictures of soiled clothing and sheets, dirty bathrooms, and other conditions you think contributed to your loved one’s injuries.

Take Immediate Action

Remove your loved one from the nursing home as soon as possible. In most states, you have a legal obligation to remove your loved one from a dangerous environment.

If you discover severe abuse or untreated injuries to a nursing home patient, immediately call 911 and ask for police and an ambulance. Then contact a personal injury attorney for important legal advice.

Contact your loved one’s primary care doctor to advise of the circumstances and arrange for further care.

Report the nursing home to authorities. Physical abuse, sexual abuse, and negligent care of the elderly are crimes. Federal and state regulators will investigate and force improvements or close the nursing home.

Report suspected elder abuse to your State Adult Protective Services Office.

Compensation for Elder Abuse and Neglect

Elder abuse cases can be complicated, involving issues of family authorization, patient competency, and medical privacy. Wrongful death cases and probate concerns are especially challenging for the family.

Only an experienced personal injury attorney should handle a nursing home abuse claim. Today, many attorneys specialize in elder abuse cases. They have specific training and experience in identifying nursing home abuse and neglect.

When it comes to nursing home abuse, you may have two claims: one for negligence, and another for medical malpractice.

The statute of limitations for elder abuse and medical malpractice varies from state to state. It ranges anywhere from one to five years, depending on the type of negligence and the time you first discovered it, so you must move as quickly as possible.

There’s too much at stake to try battling the nursing home on your own.

An experienced attorney can recover money for the cost of your loved one’s future medical care, your out-of-pocket expenses, your lost wages while caring for your loved one, and for the pain and suffering and emotional distress your loved one suffered at the hands of the nursing home.

Also, if your attorney can prove the nursing home’s actions rose to the level of reckless conduct, or were criminal, your loved one may receive punitive damages. Punitive damages are the court’s way of punishing the nursing home for its actions. In severe cases, punitive damages can reach into the millions of dollars.

There’s no obligation, and it costs nothing to find out what a skilled personal injury attorney can do for your family.

For more information, see our helpful list of Elder Abuse and Neglect Resources.

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Nursing Home Abuse Questions & Answers