Signs of Abuse in Nursing Homes

The National Center on Elder Abuse (NCEA) reports that 1 to 2 million Americans ages 65 and older are abused by their caretakers.

If it is happening to someone you care about, it may be up to you to make it stop. An elderly or infirm nursing home resident who is being abused may be too weak or afraid to defend themselves or to speak up about their abusers.

Here are some facts to keep in mind and what to look for when you visit a nursing home resident:

Nursing Home Abuse / Elder Abuse and Neglect is Widespread

It is important to understand that nursing home abuse does happen, and it can happen to someone you care about.

In many studies, nursing home abuse is treated as a form of “elder abuse.” The NCEA defines abuse as intentional actions by a caregiver or other person who stands in a trust relationship with the elder person that cause harm or create a serious risk of harm to the vulnerable elder.

Because it often goes unreported, authorities are uncertain how many people suffer from elder abuse in the U.S. It appears that female elders are abused at a higher rate than males, and the older a person is, the more likely they are to be abused.

Signs of Physical and Sexual Abuse in a Nursing Home

Physical abuse is an intentional act that results in bodily injury, pain or impairment. Physical abuse includes slapping, burning, cutting or bruising a nursing home resident, using excessive or improper restraints or forcing a resident to ingest food or medication against his or her will.

Warning signs of physical abuse include:

  • Bandages, bruising or bleeding
  • Open wounds, bed sores or cuts
  • Torn, stained, or bloody clothing or bedding
  • Ligature marks around throat, mouth, wrists or ankles
  • Burns and abrasions
  • Sudden changes in weight
  • Soiling, poor hygiene, urine and feces odor
  • Additional or more serious infections
  • Hair loss
  • Lack of cleanliness in living quarters, and cleaning materials not put away
  • Broken personal items such as eyeglasses or hearing aids.

Physical abuse also includes any kind of non-consensual sexual contact. Nursing home residents with dementia, aphasia (loss of ability to communicate) or similar conditions can never consent to sexual contact. Sexual abuse includes forced, non-consensual sex with the perpetrator or a third person or coercing a nursing home resident into witnessing sexual behavior or pornography.

Warning signs of sexual abuse include:

  • Vaginal or anal bruises or bleeding
  • Bruises about the breasts
  • Torn, stained or bloody underwear or bed clothes
  • Venereal disease or genital infections
  • Emotional withdrawal or sudden anxiety in the presence of certain individuals.

Signs of Emotional Abuse in a Nursing Home

Emotional or psychological abuse is the infliction of mental or emotional pain, anguish or distress through threats, humiliation, intimidation, isolation or similar conduct. Psychological abuse can be difficult to detect. Unlike physical abuse, emotional abuse leaves no visible scars and marks.

Warning signs of emotional abuse include:

  • Complaints about insults, threats, intimidation, humiliation, harassment or “the silent treatment.”
  • Social isolation or exclusion from activities
  • Listlessness or unresponsiveness
  • Infantile or other strange behaviors
  • Nervousness around other residents or staff members
  • Unusual sucking, biting, rocking or behavior usually attributed to dementia
  • Disappearance of personal items
  • Sudden and unusual financial transactions
  • Physical or emotional withdrawal, depression or an unwillingness to open up and talk.

Nursing home staff members who are abusing or otherwise mistreating residents are unlikely to do it openly. Planned visits are helpful. You should also visit unexpectedly. Don’t limit your visits to the same day and time every week.

Take any complaints of abuse seriously. If your loved one complains of mistreatment, ask for specific examples and find out when and how often it occurs. Question nursing home management about what you have been told. If the explanations are not satisfactory or indicate that further investigation of the abuse complaints is warranted, take steps to report the abuse.

If you have questions or concerns, talk them over with a family member or friend. You may ask them to visit the nursing home with you and make their own observations.

What authorities do know is:

  • 6 to 10 percent of elderly persons surveyed for recent studies said they experienced abuse in the prior year
  • Only 1 in 14 cases of elder abuse comes to the attention of authorities.
  • In a study of 2,000 nursing home residents, 44 percent said they had been abused.
  • 95 percent of nursing home residents surveyed said they had been neglected or had seen another resident neglected.
  • Disabled elderly adults are more likely to be abused.
  • Among 200 adult women with disabilities, 67 percent said they had experienced physical abuse and 53 percent had experienced sexual abuse.
  • 33 percent of institutionalized adult women with disabilities reported physical abuse compared to 21 percent of institutionalized adult women without disabilities.
  • 55 percent of disabled men said they experienced physical abuse after becoming disabled.
  • 47 percent of participants in one study who had dementia were reported to have been mistreated by their caregivers.

Indicators and Consequences of Nursing Home Neglect

Nursing home neglect is the refusal or failure by those responsible to provide food, shelter, health care or protection for a resident of a long-term care facility. This includes any service required to ensure the health, safety or welfare of the nursing home resident. The neglect may be intentional or unintentional.

The various types of neglect a nursing home resident may be subjected to include:

Medical neglect

This is the withholding of proper medical care or treatment. In addition to causing a resident to suffer from illness, medical neglect can lead to:

  • Bed sores (pressure ulcers, pressure sores) – These are open wounds that are caused by lying or sitting still for long periods of time. They occur among people who are bed-ridden or in a wheelchair and are not helped to reposition themselves on a regular basis.
  • Infections – When not promptly treated, infections can progress rapidly and lead to blood disease, shock, pulmonary arrest or death.
  • Medication errors – This is the withholding of medication or incorrect administering of medicine, including administering the medicine in wrong dosages or at the wrong intervals.

Hygiene neglect

This is the failure to help nursing home residents to keep themselves and their environment clean. Lack of personal cleanliness can lead to staph infections and other infections. Neglect of a resident’s hygiene needs may be indicated by:

  • Lack of bathing, including dirt on the body or unwashed or unbrushed hair
  • Unbrushed teeth or dentures that have not been cleaned
  • Scraggly, unintentional beard growth
  • Fingernails and toenails that have not been clipped
  • Dirty clothing
  • Infections
  • Dirty bed covers or soiled mattresses
  • Bed sores
  • Unchanged diapers or bed pans
  • Unclean toilets
  • Unclean bathing areas
  • Dirty rooms and furniture
  • Filthy carpets or unwashed floors.

Nutritional neglect

This is the withholding of food and drink or nutritional supplements. Provisions should be made to assist and care for residents who have physical or mental problems that keep them from feeding themselves or chewing and swallowing. Nutritional neglect can be a key factor in the downward spiral of a person who is residing in a nursing home. It can be detrimental to a nursing home resident’s health through:

  • Malnutrition – Caused by a lack of food or lack or the ability to absorb the nutrients in food. Malnutrition can cause physical weakness that increases the risk of falling, cause internal issues involving the blood and organs and impact the skin’s elasticity and ability to fight off bed sores and infections.
  • Dehydration – This occurs when the body lacks enough water and other fluids to carry out its normal functions. In addition to an insufficient intake of liquids, dehydration can be caused by high fever, diarrhea or certain medications such as diuretics. It may also be a symptom of malnutrition.

Emotional neglect

This is the withholding of companionship and personal contact that nursing home staff members are charged with providing to individuals under their care. Proper emotional support would include:

  • Providing companionship (sitting, talking and/or walking with a resident)
  • Showing patience
  • Listening to the resident and responding appropriately
  • Empathizing and providing feedback on problems and concerns
  • Proving appropriate physical comfort such as putting one’s arms around the resident’s shoulder or holding or patting a hand.

Social neglect

This includes keeping the resident from participating in appropriate group activities. Neglect may include actively isolating a resident either through inaction – not going to get a resident who needs assistance or prodding to join a group or activity – or by purposely excluding a resident from activities they are capable and desirous of participating in.

Social and emotional neglect may cause psychological damage that results in:

  • Confusion
  • Depression
  • Emotional distress
  • Regressive or self-destructive behavior
  • Ambivalent feelings toward caregivers or family members.

Neglect of basic needs

This includes the failure to supervise and attend to a resident’s daily requirements, particularly those that are needed to keep a resident safe from harm. Chief among these are:

  • Attention to prevent falls – Nursing home residents fall more than 2.5 times a year, on average, according to the Centers for Disease Control and Prevention (CDC). More than two-thirds (81 percent) of traumatic brain injuries (TBIs) in adults ages 65 and older are caused by falls. More than 95 percent of hip fractures are caused by falling, the CDC reports.
  • Periodic repositioning – Residents who are immobile should be routinely “turned” to prevent bed sores. Staff should be trained to turn patients on schedule and be advised of which residents require assistance.
  • Prevention of wandering and elopement – Individuals with early-stage Alzheimer’s disease are likely to wander. Failure to accommodate and supervise residents’ need to walk or otherwise be active is neglect. Failing to keep wanderers safe is neglect as well. Nursing home staff should ensure residents are protected by using electronic or coded latches on doors, devices that trigger warnings that resident are out of bounds, security cameras and other means.

The most important way to learn about the existence of neglect at a nursing home abuse is to take a resident’s complaints seriously. If your loved one tells you that his or her needs are not being met, ask for specific examples of what is happening and when or how often.

You should also visit a nursing home unexpectedly to see whether you can catch negligent staff member in the act. Vary the day and hour of your weekly visit, for example, and see how things are at the home at different times.

If you have questions or concerns about treatment of nursing home residents, talk them over with a family member or friend. You may have them visit the nursing home with you and make their own observations.

You should also ask the nursing home’s management about what you have found. Judge whether you believe their explanations are satisfactory or indicate that an investigation of complaints about neglect at the nursing home is warranted.

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