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What are the Warning Signs of Nursing Home Abuse or Neglect?

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April 28, 2022

Nursing homes, skilled nursing facilities, rehabilitation centers, assisted living facilities, and in-home elder care services are used by many families trying to provide care for their parents, grandparents, and other loved ones in our aging society. Sometimes, family members need to spend time in short-term or long-term care facilities because of a recent injury that requires focused treatment, but other times, patients may need this care because of a chronic medical issue for which a family is simply ill-equipped to handle. Unfortunately, the trust that we put in long-term care facilities and other caregivers is all too often abused. Throughout the country, the elderly are suffering neglect and abuse from the very people entrusted with their care. In 2021, the World Health Organization revealed that 2 in 3 staff in institutional care settings, such as nursing homes and long-term care facilities, reported that they had committed elder abuse in the past year. Unfortunately, family members cannot monitor caregivers 100% of the time, and in today’s world, family can be scattered across the country and the world, doing their best to care for their elders from a distance. 

In its broadest terms, nursing home abuse is any abuse or neglect that happens in a nursing home setting. People often think of nursing home abuse or neglect as needing to occur at the hands of an individual staff member, but nursing home residents are at risk of abuse by all staff members (clinical or administrative,) other residents, visitors to the building, and the institution as a whole. In some cases of abuse by an individual, the nursing home itself is also liable for its failure to protect the vulnerable, elderly victim.

There are different types of nursing home abuse, and they often happen alongside each other. Sometimes signs of abuse or neglect are obvious, but more often, an abuser will not act when family members are present. In those cases, the patient and the patient’s family will have to watch out for warning signs of abuse. Examples of abuse or neglect include:

  • Physical Abuse

Physical abuse is any bodily harm, pain, or injury caused by the action or inaction of the abuser. Hitting, pushing, dragging, and misused restraints are all obvious examples of physical abuse. Physical abuse can also overlap with other forms of abuse, such as neglect, because the resident suffers physical harm (e.g. bedsores) due to a lack of basic care. Warning signs of physical abuse are broken bones, scratches, bruising (including restraint marks,) burns, muscle sprains, and sudden or unexplained injuries. 

  • Emotional Abuse

Emotional abuse is verbal or psychological abuse and is the most common form of abuse in nursing homes. Seniors can be very vulnerable to emotional abuse from their caregivers, whether in an institutional care setting or in the community, especially if they are already weakened by physical or mental health issues. Threats, yelling, screaming, bullying, causing embarrassment, and name-calling are just some examples of emotional abuse.

You may be able to spot emotional abuse if the victim appears depressed, withdrawn, agitated, anxious, or reluctant to participate in conversations or favorite activities. Often the victim acts fearful or particularly “well-behaved” when their abuser is present. Some victims try to appear happy and positive for loved ones, which is easier on short or scheduled phone-calls or visits, so frequent, longer, and unscheduled check-ins are a good idea. In person visits, if possible, or even video calls can also be more revealing than phone-calls. Any unusual efforts by a caregiver or nursing home to restrict visits also should raise suspicion.

Where the emotional abuse leads to physical harm, such as depression, change in eating habits and weight loss, or other physical manifestations of the harm (such as outbreaks of rashes), there may be a claim for medical malpractice. 

  • Sexual 

Sexual abuse is non-consensual contact that is sexual in nature. It can include unwanted touching, rape, sexual photography, and forced nudity. Female nursing home residents are at much greater risk of sexual abuse than male residents, but anyone can be a sexual abuse victim.

Warning signs of sexual abuse include STDs, infections, vaginal bleeding, bruising or injury to the genital area (which may present as difficulty sitting or moving around,) or clothing that is torn or stained with blood or bodily fluids. Victims of sexual abuse will also often suffer emotional abuse, so it is important to also watch out for signs of emotional abuse including agitation, depression, anxiety, and withdrawal.

  • Financial

Financial abuse happens when someone takes the senior’s money, assets, or personal belongings and uses them for their own personal gain. It would include actions such as outright theft, using a resident’s credit card or checks, improper use of a power of attorney, and coercing a senior to sign a document such as a contract or will.

Red flags for financial elder abuse include missing belongings or cash, unexplained credit card charges, missing financial documents or credit cards, unusual or large purchases, large bank withdrawals or transfers, purchases or withdrawals that the senior could not have made, and new changes to a senior’s will, power of attorney, or other estate planning documents.

  • Neglect and Abandonment

Neglect is a failure to provide the basic needs for life such as food, water, shelter, hygiene, and essential medical care. Similarly, abandonment is the desertion of a vulnerable adult by anyone who has assumed the responsibility for care or custody of that person. It often happens alongside neglect or other forms of abuse. For example, a nursing home that does not administer medication as prescribed for the resident may be guilty of neglect. Seniors who are not given the assistance that they need to bathe or toilet are neglected, and this should be reported. Neglect or abandonment can be caused by one individual caregiver or can be a system-wide failure of the nursing home to provide basic care for their residents. Many times, these failures may be unintentional and are the result of understaffing, lack of resources, or lack of attention by the nursing home facility staff. 

Signs of neglect or abandonment of a nursing home resident might include weight loss, dry or cracked lips, stained clothing, body odor, unwashed hair, overgrown nails, soiled bedding, bed sores or ulcers (including decubitus ulcers, pressure ulcers or pressure sores), frequent urinary tract infections, an unsanitary living space, or evidence that medicines have not been administered as prescribed. If your loved one is always sleepy or disoriented, it may be due to over medication or poor management of side effects. An unexpected decrease in mobility may also be a result of failure to help your loved one move around or participate in daily exercise. An attorney experienced with nursing home neglect can assess whether the changes in the patient’s condition are sufficient to support a medical malpractice case.

What are the warning signs of abuse or neglect in a nursing home?

Sometimes the warning signs of abuse or neglect are obvious. This may occur when a patient is able to report the abuse, such as when a caregiver threatens the patient, fails to assist a patient who needs help, or simply ignores the patient’s needs. Other times, the evidence of abuse or neglect is less apparent. This can manifest when, over time, a patient begins wasting away, becomes suddenly depressed or withdrawn, or has questionable bruises or other physical evidence of physical or mental changes. Sadly, in some cases, a staff member or the institution itself will discover and report the abuse, but institutions and care providers sometimes cover up abuse to protect their own interests. In any case, the patient may have suffered an injury due to abuse or neglect, and the patient and the family may have a claim for medical malpractice.

How can I minimize the risk that my loved one will suffer abuse or neglect?

Family members must be vigilant for warning signs of abuse and neglect of their loved ones in nursing homes, and take action if they become suspicious of abuse. They should try to maintain good communication with elderly loved ones and their caregivers so that they can spot changes and problems at the earliest opportunity. They should also document any concerns they have and, where appropriate, alert the appropriate state and federal authorities. Where you suspect that any physical marks were due to abuse, you should ask the senior and the caregiver for explanations of any injuries. 

What should you do if you suspect abuse or neglect in a nursing home?

If you suspect that someone is being abused or neglected in a nursing home or other elder care facility, you should take action immediately to make that person safe. In many cases of elder abuse, the senior will need medical attention for physical injuries or emotional distress. Even seemingly minor physical ailments can be serious in an elderly person if not properly and promptly treated. If it is an emergency situation, call 911 to summon the police and ambulance.

You should notify the nursing home administrator, the police, and the state authorities about the abuse or neglect. In Delaware, for patients who reside in a long-term care facility like a nursing home, you should report the abuse to the Delaware Division of Health Care Quality on their Complaint & Incident Reporting 24-Hour Toll-Free line at 1-877-453-0012 or via their online complaint form. For patients who do not live in a licensed long term care facility, you should contact the Adult Protective Services Program at 1-800-223-9074. More information can be found here:

You can also report the suspected abuse to the Delaware Long-Term Care Ombudsman which investigates complaints of abuse in long-term care facilities in Delaware, and advocates for residents.

You should also contact a lawyer with experience handling nursing home abuse and neglect cases. A lawyer can advise you about your legal rights, the help that you are entitled to, and how you can protect your abused family member going forward. The nursing home neglect lawyers at Morris James are available to help you navigate this distressing time and help you and your loved one get justice and compensation. Contact your local Morris James office or via our online contact form today.

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