Warning Signs of Nursing Home Neglect

Placing your elder family member or loved one into a nursing home was a tough decision to begin with, and the possibility of nursing home abuse only compounds the emotional difficulty. There are many types of abuse, including physical abuse, emotional abuse, and neglect. Rampant neglect or obvious physical abuse is rare, but by learning the signs of nursing home abuse and neglect, you may be able to quickly identify and respond to them. While the warning signs can be subtle, awareness can increase your chances of early intervention. Oftentimes, diligent attention and further investigation is needed to confirm or dispel a suspicion of neglect. Your courage to take action now helps your loved one and could help prevent future incidents with other elders.


What is physical and emotional elder abuse?

The existence of any one or more of these does not necessarily mean that abuse has occurred. However, you should treat them as signs that diligent attention or further investigation is needed.

Physical abuse includes:

  • Physical assault
  • Sexual assault

Neglect includes:

  • Failure to assist in personal hygiene
  • Failure to provide clothing and shelter

Emotional abuse includes:

  • Verbal assaults, threats, or intimidation
  • Subjecting an individual to fear, isolation, or serious emotional distress

The first questions to ask yourself when identifying nursing home abuse:

Does your loved one have injuries or show physical signs of neglect?

Are your loved one’s complaints insistent and frequent?

Are objections directed at a particular nursing home staff member?

Has your loved one displayed unusual behavior changes?

General Signs of Abuse

Staff refuses to allow visitors to see resident, or delays in allowing visitors to see resident.

Staff does not allow visitors to be alone with resident.

Frequent arguments or tension between the caregiver and resident.

General Signs of Physical Abuse

Call light is not functioning or is removed from resident’s reach.

Development or worsening of pressure sores (bedsores).

Excessive weight loss.

Unusual or recurring scratches, bruises, skin tears, or welts.

Bilateral bruising (bruises on opposite sides of the body).

“Wrap around” bruises (bruises that typically encircle the arm).

Torn, stained, or bloody underclothing.

Signs of excessive drugging.

Foul smelling, uncombed, or matted hair.

Patches of hair missing or bleeding scalp.

Injuries that are incompatible with explanations.

Injuries caused by biting, cutting, pinching, or twisting of limbs.

Burns caused by scalding water, cigarettes, or ropes.

Any injuries that reflect an outline of an object, for example a belt, cord, or hand.

General Signs of  Neglect

Complaints about painful blisters or abrasions


Poor hygiene

Weakness or inexplicable weight loss

Soiled bedding

Constant thirst or extremely dry skin

Hazardous or unsafe living conditions


Behavioral Changes

Sudden personality changes

Uncharacteristic anger, lack of interest, or anxiety

Fear of being alone

Overwhelming sadness and frequent crying

Change in alertness

Outright complaint

Rude or humiliating comments by staff


Confused or extremely forgetful


Helpless or angry

Hesitant to talk freely



Causes of Nursing Home Abuse

Caregiver burnout is considered to be the primary cause of nursing home abuse and negligence. Greater risk is present in nursing homes with the following:

  • No abuse prevention policy
  • Inadequate staffing levels
  • Inadequate staff training
  • Insufficient employee background checks
  • High staff turnover rate
  • A history of complaints

Other possible reasons for greater abuse include elders with dementia or disruptive behavior, those who are dependent upon others for significant needs, and those who are socially isolated.

Elder Abuse is Illegal

No matter what the causes are, elder abuse is illegal. In 1987, the United States Congress passed the Nursing Home Reform act (NHRA), which includes the Nursing Home Residents' Bill of Rights. This forms the basis for elder law, which is the legal practice area dedicating to protecting the quality of life for residents of nursing homes and improve the quality of care provided by their caregivers. 

Some of the rights and freedoms laid out in the Resident's Bill of Rights (part of the NHRA) are:

  • The right to freedom from abuse, mistreatment, and neglect.
  • The right to be treated with dignity.
  • The right to freedom from physical restraints.
  • The right to privacy.
  • The right to access personal medical records.
  • The right to accommodation of medical, physical, psychological, and social needs.
  • The right to refuse treatment.
  • The right to communicate freely with persons inside and outside the facility.
  • The right to participate in the review of one's care plan.
  • The right to be fully informed in advance about any changes in care, treatment, or facility's status.
  • The right to voice grievances and exercise rights without interference, coercion, discrimination, or reprisal.

How We Can Help

Your brave decision to respond could help others. If you suspect nursing home abuse or neglect, or you yourself are being victimized, there are alternatives to suffering in silence. When your family is ready, call for a free consultation about your legal rights.