Nursing homes may be the best option for elderly parents who have serious healthcare needs. Yet every child who has placed a parent in a nursing home worries about the possibility of abuse. News accounts of nursing home patients who suffer from neglect or abuse create anxiety about the safety and comfort of aging parents who reside in nursing homes.

The extent of nursing home abuse is difficult to quantify, in part because most studies depend upon self-reporting that is not always reliable. However, significant numbers of nursing home residents are abused or neglected. According to a 2019 report by the Health and Human Services inspector general’s office, an estimated one in five high-risk Medicare ER claims resulted potentially from abuse or neglect in the nursing home. 

Patients do not always tell visitors about the abuse they experience in a nursing home. For that reason, it is important for family members and other visitors to maintain a watchful eye for signs that a patient has been subjected to abuse.

Physical Evidence of Abuse

Children and visitors may see evidence of physical or sexual abuse while interacting with a patient. You should be concerned if you see any of the following when visiting a parent or friend at a nursing home:

• Bruising
• Scrapes or cuts
• Bandages
• Bite marks
• Unusual marks on the body that might have been inflicted by a belt, cord, or other objects
• Burns
• Missing hair or the sudden appearance of bald spots
• Walking with a limp or an inability to raise an arm or use a hand
• Torn clothing or bloody underwear

There may be innocent explanations for your observations, ranging from health conditions and accidents to self-inflicted injury. Any sign of abuse nevertheless merits an inquiry.

Behavioral Evidence of Abuse

Some acts of physical abuse (such as shaking a patient) do not result in visible injuries. Sexual abuse may be difficult to detect without conducting an intimate medical examination.

Emotional abuse is even more difficult to detect because it does not produce a physical injury. Emotional abuse occurs when staff members or other patients insult, belittle, humiliate, isolate, threaten, intimidate, harass, or shout at a patient. Emotional abuse can be just as harmful to a patient as physical abuse.

A patient’s behavioral changes are often key warning signs that alert family members and other visitors to the possibility of abuse. Those changes might include:

• Depression or withdrawal
• Anxiety, agitation, or aggression
• A fearful reaction when a particular staff member is near
• Sudden silence in the presence of a particular staff member
• Attempts to run away from the nursing home
• A sudden aversion to being touched
• An unwillingness to turn out the light
• The appearance of a speech disorder, such as stuttering or stammering
• Rocking, head-banging, or other habitual behaviors

While behavioral changes might be symptomatic of disease or a natural consequence of aging, sudden changes should be viewed with suspicion. Any behavioral change that raises a red flag is worth investigating.

Evidence of Neglect

Neglect of a patient may produce some of the behavioral changes described above. It may also produce physical symptoms, including:

• Bedsores
• Weight loss
• Rashes
• Body odors
• Lice or scabies
• Insect bites
• Symptoms of illness that appear to be untreated
• Inappropriate clothing for environmental conditions (such as light pajamas in a cold room)
• Loss of mobility that results from the lack of opportunity to exercise

While some changes in a patient’s condition may be a natural result of aging or deteriorating health, the patient’s treating physician should be alerted to those changes. A physical examination of the patient may confirm that patient neglect has contributed to the patient’s problems.

Talk to the Patient

Patients who experience abuse may be reluctant to talk about the problem. They might fear retaliation, they might blame themselves, or they might lack the capacity to express their concerns. Patients with memory problems might be afraid of a staff member without recalling what the staff member did to provoke the fear. Patients who were sexually abused may be too embarrassed to discuss the assault.

While patients may be unwilling to volunteer their experiences of abuse or neglect, gentle questioning in the course of normal conversation may encourage the patient to open up about troubling events in the patient’s life. It is important to avoid “leading” the patient to make an untrue accusation, but it is also important to remind the patient that you care about them and want to protect them from harm. Establishing a sense of trust is important, particularly if trust issues developed because the patient was not happy about being placed in a nursing home.

Question Staff Members and Doctors

Since many patients are afraid of reporting abuse or are incapable of recalling or communicating the circumstances that produced injuries, ask the nursing home staff about your observations. Direct your inquiries to several different people — administrators, nurses, social workers, and attendants — and compare their answers. If staff members provide inconsistent explanations, they may be covering up incidents of abuse.

You should also talk to the patient’s treating physician. Doctors who are not on the nursing home’s payroll are unlikely to conceal abuse. A doctor’s examination may help you confirm or dispel your suspicions of physical abuse.

Report Suspected Abuse

If you suspect that a nursing home patient has been abused, report your suspicions to appropriate authorities so that your concerns can be investigated. If it is clear that the patient has been intentionally injured or if you fear that a resident is in immediate danger, call the police.

Most states have an agency with a name like “Adult Protective Services” that is charged with investigating elder abuse. You can also contact a state ombudsman who is responsible for investigating complaints against long-term care facilities.

Contact information for reporting problems or a concern about the quality of care you or your family member gets from a nursing home in your state can be found at the Medicare website.  In addition, you can search for contact information by city or zip code on the Eldercare Locator website maintained by the Department of Health and Human Services. If you prefer, you can contact Eldercare Locator by calling 1-800-677-1116. Finally, some states accept complaints filed through their websites. You can find links to those websites on Medicare.gov.

Search for Complaints

Different states have different policies about providing public access to complaints about nursing home abuse. Some states treat complaints as public records but require individuals to follow a cumbersome procedure to request those records. Some states maintain the confidentiality of complaints but will make public any disciplinary action taken by a licensing authority. Reviewing the resources listed above will help you understand whether you can learn about complaints of abuse that have been made against a specific nursing home. The state ombudsman is also a valuable source of information.

If the nursing home is certified to accept Medicare payments, you can find useful information on the Nursing Home Compare website. That website provides information about complaint investigations conducted during the previous three years for each certified nursing home, as well as detailed information about the results of health and safety inspections conducted at the nursing home.