Three Steps To Address Concerns About Your Loved One’s Nursing Home Care

If you have a family member who resides in an assisted living facility and you’re seeing problems with the care they are receiving, you want to know: How do I resolve this problem and ensure my loved one receives quality care in the future?

Art Gharibian, an elder law attorney in Glendale, California, whose firm focuses on nursing home abuse litigation, medical malpractice, and wrongful death, shares insights on some of the common issues family members have with nursing homes and the steps you can take to address concerns.

Common Complaints with Nursing Home Care: Activities of Daily Living

Gharibian says that family members’ most common problems with nursing home care involve Activities of Daily Living (ADLs). ADLs include eating, showering, dressing, using the restroom, and routine hygiene.

“For example, we often hear complaints about food not being given on time or at all—or that nursing home staff hasn’t provided the resident with assistance in eating,” Gharibian says, resulting in weight loss and even malnutrition.

“If a nursing home resident is non-ambulatory or bedridden, they can’t get up or move on their own to walk to the restroom. So, they use a call light button to call for assistance, but the nursing home staff doesn’t respond promptly. It takes super long—20 or 30 minutes—for a certified nursing home assistant or registered nurse to help them use the restroom.

Gharibian says that other common complaints and signs of nursing home neglect include:

• Failure to provide physical therapy;
• Failure to give medications or medical care;
• Pressure injuries or bed sores;
• Lack of open communication and easy access to physicians.

Gharibian sums up the problem by saying, “Ultimately, what’s supposed to be a skilled nursing facility providing 24/7 high-quality care simply doesn’t deliver.”

The Root Problem of Nursing Home Negligence? Often, Staff Member Shortages

“Most of the time, nursing home neglect happens because there’s a staff shortage,” says Gharibian.

“I think that, for the most part, nursing home staffing has always been lacking. You’ll never get a place with more staff than it needs. So, you have a certified nursing assistant watching over 10 or 15 residents with high acuity levels. But there’s only so much one person can do, right? Imagine one nanny watching 10 to 15 two-year-olds all day. There’s no way one person could manage all of that. Something’s going to happen; someone’s going to get hurt.”

Gharibian adds that while staffing shortages were worse during the COVID-19 pandemic, he hasn’t seen anything “to believe that staffing is better now than what it was before the pandemic.” The twofold problem of facilities not hiring enough personnel and providing low compensation for nursing home employees persists.

Try to give the facility an opportunity to make things right by providing better care. But, [if you don’t see changes after communicating with them a couple times], you may need to warn the facility about your intention of taking further steps. Ultimately, it’s very case-specific, depending on the facility and your relationship with the individuals there.

Three Ways to Address Your Concerns

What practical steps can you take if you see problems at your loved one’s nursing home facility? Gharibian outlines four basic steps:

1. Speak with the Director of Nursing or Nursing Home Administrator

“If you’re starting to see issues with nursing home care, the first thing to do is bring it up with the director of nursing or the nursing home administrator. The administrator or managing agent is the person who is in control of the facility. Bring it to their attention, preferably in an email so it’s in writing.”

What happens once you’ve reported your concerns to the administrator? “Kind of wait and see if any of the care gets better,” says Gharibian. “If it’s not getting better, address it again. If it’s still not getting better after a couple of inquiries, then I would do a couple of different things.”

2. Contact Your State’s Long-Term Care Ombudsman

“Usually, each state has a long-term care ombudsman program,” says Gharibian. “In California, where I practice, it’s under the state Department of Aging. The ombudsman is supposed to act as a facilitator or mediator between the family and the facility. The ombudsman can come in and say, ‘Okay, what’s going on here? The nursing home facility is having problems with X, Y, and Z; let’s talk to the administrators and see how we can resolve this.’ Getting the problem resolved is what your goal is when you bring in the ombudsman.”

Learn more about state long-term care ombudsman programs and the legal rights of nursing home residents.

3. Report Nursing Home Problems with Your State Department of Health

A more serious step you can take is to file a complaint with your state’s agency that oversees the enforcement of nursing homes — typically, the Department of Health. “The Department of Public Health has a lot of power. For example, they can come into the facility and start asking questions—interview staff, review medical records, and ultimately either substantiate or unsubstantiate the complaint,” says Gharibian.

“If the complaint is substantiated, it will be posted online on the state agency’s website. There will be a report that goes along with the posting. The facility will be issued a deficiency and, depending on how bad their conduct was, they can also be cited a monetary fine.”

Gharibian emphasizes that filing a complaint with your state health department isn’t necessarily the first thing you should do out of the gate. Typically, it’s best first to try the steps outlined above—contacting the nursing home administrator directly and trying to resolve problems internally. Sometimes, however, problems will persist or worsen, and filing a complaint becomes necessary.

The bottom line, says Gharibian, is that family members need to advocate for older adults who live in nursing home facilities—and that requires being present and involved in their nursing home care. The only way to be aware of problems with care or to figure out the best way to resolve those problems is to be in contact. That includes phone calls but, more importantly, regular in-person visits.

Be Patient But Persistent in Getting Results for Your Loved One’s Care

“The tricky thing with filing a complaint [against a nursing home] is the fear of retaliation. Is reporting the facility going to cause them to retaliate or provide better care? I’ve seen it both ways. In my mind, it’s really a coin flip,” says Gharibian.

“So, I wouldn’t necessarily say that reporting the facility is a last resort, but you do want to take the initial steps of talking to them first. In other words, don’t jump the gun and file a complaint with the Department of Health out of the gates. Try to give the facility an opportunity to make things right by providing better care. But, after a couple of times, you may need to warn the facility about your intention of taking further steps. Ultimately, it’s very case-specific, depending on the facility and your relationship with the individuals there.”

Find an Experienced Attorney for Legal Help

If you are seeing signs of nursing home abuse or mistreatment—such as physical abuse, repeated falls, or malnutrition—and are considering legal action against the long-term care facility, reach out to a nursing home abuse lawyer as soon as possible for legal advice.

Many nursing home abuse and personal injury lawyers provide free case evaluations to discuss legal options. Visit the Super Lawyers directory to locate an experienced nursing home abuse attorney in your area. For more information on this area of law, see our overviews of elder law and healthcare law, plus related content on Medicaid and long-term care planning if you have questions about paying for nursing home care.