How To Investigate and Report Nursing Home Abuse

From medical care and community life to assistance with daily activities, long-term care facilities provide valuable services and can promote the well-being of older adults in many ways.

However, nursing home residents are also a highly vulnerable population. Despite resident rights protections under the federal Nursing Home Reform Act of 1987 and state laws, many abuse cases involving nursing home residents occur every year.

If you have a loved one who lives in an assisted living facility, it’s important to be aware of the warning signs of mistreatment. This article will explain the most common types of elder abuse and neglect in nursing homes and when to report mistreatment. For legal advice about possible abuse, contact a local nursing home lawyer.

Who Is Most Likely To Suffer Abuse in a Nursing Home?

Many factors make nursing home residents more vulnerable to abuse, says Ashley N. Hadler, a personal injury and nursing home abuse attorney at the Garau Germano law firm in Indianapolis, Indiana.

“Any portion of a nursing home population that requires a lot of hands-on assistance will be more vulnerable,” says Hadler, including those who:

• Require a very high level of care
• Have a very high acuity level because of immobility
• Are unable to get out of their bed, feed themselves, or drink from a glass of water on their own
• Suffer from any type of memory loss or other cognitive problem that would call into question their ability to recall or report events

Nursing home abuse can be perpetrated by nursing home staff members, such as nurses and other caregivers, or by other residents.

“It’s more common than people think,” says Joel R. Bryant, an elder law attorney at Green Bryant & French in San Diego, California. “And it almost always happens due to a lack of staffing, lack of supervision, and a lack of training [of caregivers and nursing home staff members].”

Types of Nursing Home Abuse: Spotting the Warning Signs

Hadler says that in her practice, “The most prevalent type of injury would be something associated with falls or development and deterioration of bedsores.”

She adds that “malnutrition and dehydration are also, unfortunately, things we see becoming very common. The reason for that, we believe, is because of staffing shortages that predated the COVID-19 pandemic and, since the pandemic, have been exacerbated by difficulties in finding staff or, sometimes, decisions at the corporate level to understaff nursing facilities or not pay a reasonable rate to keep and hire new employees to staff the nursing home.”

The most common types of abuse in nursing homes include:

1. Physical abuse
2. Emotional abuse
3. Sexual abuse
4. Financial abuse
5. Neglect or abandonment

Let’s look at these forms of abuse in more detail and the signs to look for if such abuse is occurring.

1. Physical Abuse

Physical elder abuse occurs when someone uses physical force against an older person, resulting in physical harm or personal injury. It includes actions such as hitting, shoving, or kicking, as well as restraining or locking someone up against their will.

Physical abuse can lead to serious injuries, including broken bones, bleeding, burns, and sprains.

The following behaviors could be signs that physical abuse is happening:

• Recurring injuries
• Frequent hospitalizations
• Delayed reporting of injuries or no reporting at all
• Vague explanations for what happened or none at all

2. Psychological or Emotional Abuse

According to the National Center on Elder Abuse (NCEA), psychological abuse is the most commonly reported type of abuse in nursing homes. It is when someone intentionally says or does something to cause another person distress, fear, or anguish.

Psychological abuse can result in physical harm and deteriorate the resident’s mental health and well-being. Psychological or emotional abuse can involve various behaviors, including:

• Insulting residents
• Screaming at residents
• Threatening or taunting residents
• Isolating residents from other residents, family members, or staff
• Punishing residents by taking away social interaction or personal belongings

You may notice sudden mood swings, depression, or heightened fear and anxiety if emotional abuse is occurring.

3. Sexual Abuse

Sexual abuse involves any unwanted sexual contact or action against someone else, including sexual assault or rape, groping, or fondling.

Signs of sexual abuse include:

• Bruising, bleeding, or other injuries around the genitals
• Stains and tears in underwear or other clothing
• Testing positive for sexually transmitted diseases
• Difficulty walking or moving
• Distress and anxiety

4. Financial Abuse

Financial exploitation occurs when an elder’s assets are illegally or improperly used. Assets may include money and bank accounts or items of personal property. Financial abuse not only covers obvious wrongdoing like theft of an elder’s money or property. It also includes:

• Illegally accessing an elder’s bank accounts or funds
• Forcing the elder to give money account access
• Coercing an elder into changing their will or other estate plan documents

Consider investigating whether some form of financial exploitation is taking place if you notice that:

• Money or other property has gone missing
• There are strange withdrawals from checking or savings accounts
• Unaccounted purchases or transactions on credit or debit cards

5. Neglect and Abandonment

Neglect is a type of abuse that occurs when a caregiver fails to give adequate nursing home care. Types of nursing home neglect include:

• Not giving residents their medication
• Giving residents the wrong medication
• Not giving residents the needed physical therapy or stimulation
• Not giving residents enough food or drink
• Not cleaning residents who need assistance with personal hygiene

Signs of neglect include:

• Bedsores
• Muscle atrophy
• Drastic weight loss
• Dehydration
• Poor hygiene
• Deteriorating dental health
• Malnutrition-related health problems

Abandonment is a type of neglect that occurs when the person responsible for giving care leaves the elder and doesn’t arrange for others to care for the elder. Abandonment leaves the elder without any assistance and can result in severe harm or death if abandonment persists.

Investigating Nursing Home Abuse

A good first step toward addressing your concerns is to talk to the assisted living facility’s management in person. “You want to talk to the management who’s responsible for the care,” Bryant says. That could be an administrator, a director of nursing, or an ombudsman.

Document any conversations. “It doesn’t have to be threatening or anything like that, but put it in writing,” Bryant says. “Because I have found that, often, if something really bad happens to their loved one and then a legal case ensues, there’s a big difference of opinion between the management and the family as to exactly what the family told them, if anything.”

If the nursing home patient has a long-term primary care physician, talk to them about any concerns you have regarding their well-being and quality of life. “Has this been [the resident’s] physician for 10, 15, 20 years? If that’s the situation, I think that person can be helpful,” Bryant says.

However, it is often the case that a resident’s primary care provider is reassigned when the resident moves into a facility. A new healthcare provider likely doesn’t have enough history with the patient to be significantly helpful in these types of cases. This may also prove problematic if the doctor works for the nursing home.

“Sometimes, some of these doctors have very tight relationships with the particular facility,” Bryant notes. “So, you’re probably not going to get objective answers in that instance.”

Gather Evidence of Possible Abuse

Family members can also take photographs of signs of potential physical abuse or neglect.

“If it’s your loved one and you see, for example, pressure ulcers, pressure sores, it’s good to document that,” Bryant says. Facility staff often are defensive about photography in order to protect residents’ privacy, so you’ll need to be sure not to photograph other residents. “But if it’s your loved one and you have power of attorney for health, you have the right, certainly, to photograph your loved one,” Bryant says.

Ultimately, by collecting documents and photos, loved ones can start to tell a complete story. “We always feel on a case that we decide to take that if we’re able to tell the true story of what really happened, we’ve done our job,” Bryant says. “If the family documents things in writing along the way, that’s a good thing because now we have control of those documents. They can’t be eliminated, deleted, thrown away, ignored.”

What Are the Steps in Reporting Abuse?

If you suspect that a loved one or someone you know is the victim of nursing home abuse, don’t hesitate to take action to stop the abuse.

If the nursing home resident has a serious injury, such as broken bones or a medical condition that requires immediate treatment, make sure they get it. Call 911. You can contact law enforcement if you’re aware of an immediate danger to a nursing home resident.

You can also contact your state’s Department of Health, adult protective services (APS), or long-term care ombudsman program to report abuse. Anyone can file a nursing home complaint, so even if you are just a friend of the resident, you can still take action.

“It’s a rare day when filing a complaint with either [the Department of Social Services] or CDPH results in any remedy or change. So, whereas we used to recommend it in every case, I think we take it on a case-by-case basis because we find that the investigations are very cursory in most instances.”

For that reason, if a state agency’s investigation says your complaint is unsubstantiated, “Don’t then conclude that you have no case,” Bryant says.

Pursuing Compensation Through a Nursing Home Abuse Lawsuit

In some situations, you may want to pursue compensation for injuries and harm caused by nursing home abuse. If you think you should file a complaint or a lawsuit, Bryant recommends speaking to an experienced nursing home abuse lawyer first. “They will provide advice appropriately,” he says.

If a law firm decides your case has merit, they should conduct an independent review with an experienced nurse or doctor. If there’s enough evidence to warrant a lawsuit, the firm will advise the client at that point that they’re willing to pursue it.

“There’s certain information we just can’t get without a lawsuit,” Bryant says. “Before we file that lawsuit, we make sure that we have sufficient information to warrant this sort of lawsuit.”

If an attorney doesn’t think you have a case, the conversation can still be important for peace of mind. “Most of the people who call me aren’t looking to get rich,” Bryant says. “Instead, they’re looking to find out, ‘What exactly happened to my loved one? Why did they suffer this serious injury, or why did they die so suddenly?’ And when they have the answer, it’s a big relief to them.”

An experienced nursing home abuse attorney will know the law and be able to talk you through your options for taking legal action. They will also be able to formulate the best legal strategy for your case and guide you through the litigation process.

When it comes to any legal action, Hadler emphasizes the “[importance of getting] an attorney involved who can communicate with the facility, gather all of the necessary information, help to evaluate the claim, and ultimately pursue the claim to recover that compensation.”

What To Look for in an Experienced Nursing Home Abuse Attorney

If you do need to contact an attorney to help protect your loved one, there are a few key things to look for. “Step one is finding the experienced attorneys in this field,” Bryant says. “Attorneys who not only have handled these kinds of cases for years, but it is the primary area of law in which they practice.”

Once you’ve narrowed your selection, Bryant advises simply talking to the attorneys. “You need to talk to the person and use your gut instinct: ‘Is this someone who I want to work with to investigate this serious injury or death that occurred to my loved one and to handle our case, if we have a case?'”

An attorney’s fees will help you determine if you have a good fit. Many lawyers provide free consultations for potential clients. They may work on a contingency fee basis, meaning there are no upfront legal costs to understand your legal options.

“Anyone who’s experienced in this area should be willing to review the case for no cost,” Bryant says. “If they say, ‘Hey, you’ve got a case,’ they should be willing to stand behind that and say, ‘I’m willing to handle the case on a contingency and no-recovery, no-fee basis.”

Find Legal Help

To begin your search, visit the Super Lawyers directory to locate an experienced nursing home attorney in your area.