Warning Signs for Abuse and Neglect in Nursing Homes and Long-Term Care Facilities

When you are trusting the care of a loved one to others, you hope that they will receive the best of care. You want a facility that is clean and well-cared for and properly equipped, an attentive, professional, properly trained staff, and a concerned, caring environment.

What signs should you watch for that may suggest that you select a different care facility, or that it is time to move your loved one to a new home?


Warning Signs When Selecting a Care Facility

When you are considering a care facility, you should start evaluating the facility from the time of your first contact.

  • Is the Facility Properly Maintained? - Is the facility clean? Are the premises and equipment in good repair? Are the floors clean and clear of tripping or slipping hazards?

  • What Does Your Nose Tell You? - Does the care facility smell of urine or bodily waste? Does it smell of industrial cleaning solutions? A care facility should smell clean and, while sometimes the smell of cleaning products cannot be avoided, should be using cleaning solutions appropriate to residential facilities with potentially vulnerable residents and should have adequate ventilation such that chemical odors don't linger.

  • Do Residents Appear Well-Cared For? - Do residents appear well-nourished? Are they appropriately clothed? Do they have appropriate walking aids? Are activities available other than watching television? Do residents appear to be over-medicated? Do you see any sign of the use of physical or chemical restraints, other than as medically necessary to protect a resident's safety or the safety of others?

  • Is the Facility Properly Staffed? - Does the facility have a sufficient number of employees to provide for the needs of residents? Beyond basic needs, does it have sufficient specialized staff members to properly address the needs of residents? Are staff members overworked? Is the facility properly staffed at night and on weekends?

  • Is Staff Responsive and Helpful? - When you place a call to the facility, is somebody quick to answer the phone? Are they helpful and friendly? When you have questions for a member of the staff are they helpful and courteous? Do staff members appear to be properly monitoring residents, including those with signs of mental impairment or dementia? Does the staff respect residents' need for privacy?

  • Physical Activity - Do residents have the opportunity to engage in physical activity, or to receive physical therapy or similar assistance to help build or preserve their physical health, fitness and balance?

One significant factor in ensuring that your loved one receives appropriate care is your frequent visits. When a care facility knows that a resident will be frequently visited by family and friends, the resident is less likely to suffer from abuse or neglect.

Warning Signs When Your Loved One is in Residence

When your loved one is in a nursing home or other long-term care facility, you may see conduct by staff members relating to the care of your loved one or other residents, issues with the facility, or other problems, issues or injuries that suggest problems with the level of care provided to residents.

Warning signs of possible problems include:

  • Staff Behavior and Attitude - Staff may become less helpful, less friendly, or less interactive with you, your loved one, or with other residents and their families.

  • Changes in Behavior by a Resident - A resident may show chances in behavior, in their interactions with you and others, and in their general emotional health that are not otherwise easily explained. A resident my behave normally, but suddenly become quiet or show different emotions when staff members are nearby.

  • Chances in Physical Health - A resident may have frequent or unexplained injuries, frequent falls, frequent infections, bed sores, loss of weight, illnesses, or similar medical issues that raise questions about the adequacy of care.

  • Changes in the Facility - A once-clean facility may start to appear less clean, cluttered, or poorly maintained.

  • Changes in the Staff - High staff turnover may raise questions about the management and financial stability of a care facility.

Signs of Neglect

Neglect involves the failure of a facility and its staff to provide a resident with the level of care and services reasonably necessary to ensure that the resident will be safe, protected from injury, harm and dangerous situations, including both physical and emotional injury. Neglect may result from intentional choices, such as saving money by not making repairs or obtaining equipment necessary to ensure residents' safety, or through unintentional acts or omissions that result in injury, even though the injury itself is not intended.

Examples of neglect include:

  • Emotional and Social Neglect - Ignoring a resident, isolating the resident, failing to provide the opportunity for social interactions with other residents or visitors.

  • Neglect of Personal Hygiene - Failure to provide necessary support for a resident's cleaning, bathing, shaving, brushing of teeth, and other personal care. Failure to provide clean laundry and bed linens.

  • Medical Neglect - Failure to provide appropriate medical support to prevent injuries, to properly manage chronic illnesses and avoid complications from those illnesses, or to care for infections, illnesses, or bedsores. Over-medication in lieu of proper diagnosis and care.

  • Dietary Neglect - Failure to provide proper hydration and nutrition. Failure to properly monitor a resident's consumption of food and liquid so as to prevent dehydration, malnutrition, or other medical problems.

  • Injuries from Falls - Although not all falls can be prevented, nursing homes are aware of the physical injuries and mental suffering that can result from a fall. Care facilities should conduct risk assessments of residents, and should train staff members about the importance of preventing falls and in fall prevention strategies.

  • Failure to Inform - Failure to keep a resident's medical care providers, family members, or guardian informed about illnesses or injuries.

Signs of Abuse

Abuse involves the intentional infliction of a physical or mental injury on a resident. Examples include:

  • Confinement - Unreasonable confinement of a resident, whether to a physical location or through the inappropriate use of restraints.

  • Intimidation - Using tactics of intimidation or fear to limit a resident's activities or to keep them from reporting problems within the facility.

  • Deprivation of Care and Services - Withholding care or services to punish a resident, or to coerce and intimidate the resident.

  • Deliberate Over-Medication - Use of excessive medication in order to effectively chemically restrain a resident, despite the physical and mental consequences to the resident.

  • Punishment - The use of physical, emotional, or other punishments against a resident, resulting in physical harm, pain or mental anguish.

If you are concerned about the care a loved one is receiving in a long-term care facility or nursing home, it makes sense to trust your gut. While you can expect to be reassured that your concerns are misplaced, a poorly performing long-term care facility will likely try to mislead you or misrepresent the facts to you. Actions speak louder than words: Trust your eyes and your instincts.

If a nursing home or long-term care facility resident is injured through the negligence or wrongful acts of the facility or its staff, it makes sense to consult a personal injury lawyer who specializes in long-term care cases about possible remedies and compensation.

Copyright © 2015 Aaron Larson, All rights reserved. No portion of this article may be reproduced without the express written permission of the copyright holder. If you use a quotation, excerpt or paraphrase of this article, except as otherwise authorized in writing by the author of the article you must cite this article as a source for your work and include a link back to the original article from any online materials that incorporate or are derived from the content of this article.

This article was last reviewed or amended on May 8, 2018.