Nursing Home Abuse: What You Need to Know

Nursing home abuse refers to any intentional act or omission that causes harm or risk to the physical or emotional health of elderly residents, often due to neglect, mistreatment or exploitation by care providers. The abuse can have devastating consequences on victims and their families, including physical injuries, emotional trauma, and loss of trust in the healthcare system.

Sad woman in nursing home who is being abused

According to the federal government, “nursing home abuse means the willful infliction of injury, unreasonable confinements, intimidation, or punishment with resulting physical harm, pain, or mental anguish.” Nursing home abuse involves harm or injury done to an older adult intended to cause pain, suffering, or impairment.

The National Council on Aging (NCOA) found that nursing home abuse:

Nursing home abuse can be physical, mental, emotional, and sexual. The NCOA states that nursing home abuse includes:

  • Physical abuse, which can be made apparent by bruises or unexplained falls
  • Sexual abuse, including any sexual activity without consent
  • Neglect, indicated by matted hair, dirty bedding, and so on
  • Emotional abuse, such as verbal threats and harassment
  • Financial exploitation, such as forged financial documents or missing personal belongings

How common is nursing home abuse?

Nursing home abuse is a pervasive problem. A 2019 bipartisan Senate investigation, leading to reform efforts, found that poor resident care is “common” in about 5% of the nation’s care facilities.

According to the NCOA, approximately 5,000,000 elderly persons are abused every year.

A 2017 study based on evidence from 52 pieces of research estimated that 15.7% of people over 60 years old are subjected to abuse. On top of that, 96% of elder abuse cases go unreported.

In an Atlanta Long Term Care (LTC) Ombudsman Program study of 80 residents in 23 Georgia-based nursing homes, 44% of the respondents experienced abuse, while 48% experienced mistreatment. In addition, 38% percent of respondents witnessed fellow residents abused, while 44% had seen others being mistreated.

survey involving 577 nursing aides from 31 care facilities revealed that 36% of caregivers had witnessed some form of elder abuse within 12 months.

Overall, elder abuse affects hundreds of thousands of families annually. In 2013 alone, the National Center for Victims of Crime (NCVC) noted approximately 10,000 care facility complaints related to elder abuse.

Types of Nursing Home Abuse

There are different types of nursing home abuse, including physical abuse, emotional abuse, neglect, sexual abuse, and financial exploitation.

Physical Abuse

Physical abuse occurs when older adults in a care facility experience pain, injury, illness, distress, functional impairment, or death due to the intentional use of physical force.

Examples include:

  • Striking with objects
  • Pushing
  • Hitting
  • Slapping

According to the NCVC, 27.4% of reported complaints were related to physical abuse. Sadly, physical elder abuse cases are increasing by the day. The Center for Disease Control and Prevention noted that the abuse rate among 60-year-old men increased by 75% between 2002 and 2016. The rate of abuse among women over 60 years old increased by 35% within the same timeframe. The rate is expected to rise as the elderly population grows.

Emotional Abuse

Emotional or psychological abuse refers to verbal or nonverbal actions and behaviors that inflict fear, mental pain, distress, or anguish on nursing home residents.

Examples include:

  • Threats
  • Humiliation
  • Harassment
  • Disrespect
  • Yelling

According to a 2020 WHO study, emotional abuse was the most prevalent form of abuse. What’s more, 33% of care facility staff members admitted to having emotionally abused residents. The NCVC found that 19.4% of the reported cases involved emotional abuse.

Nursing Home Neglect

According to the CDC, neglect is “the refusal or failure of a caregiver to fulfill his or her obligations or duties to an older person.” Nursing home neglect can include:

In 2020, 12% of caregivers admitted to neglecting residents’ needs, according to the WHO. Nearly 12% of victims (or their families) also reported cases of elder neglect. According to the NCVC, 15.3% of all elder abuse complaints are related to neglect. In another study of 2,000 residents, 95% had witnessed or experienced elder neglect.

Sexual Abuse

Sexual abuse is any non-consensual sexual activity. It may be a result of manipulation and deception.

Examples include:

  • Forced nudity
  • Rape
  • Forced observation of pornography or masturbation
  • Taking sexually explicit videos, audios, or photos

The WHO found that sexual abuse accounted for fewer than 2% of nursing home abuse cases reported by residents. Its prevalence was even less in cases reported by caregivers. However, since shame often accompanies sexual abuse, that might be the cause of lower reported cases.

Financial Abuse/Exploitation

Financial exploitation is the improper, unauthorized, or illegal use of an elder’s property, belongings, assets, money, or benefits.

Examples include:

  • Fraud
  • Forged financial documents
  • Missing property and belongings

According to the NCOA, elderly people are more likely to report financial exploitation than other forms of abuse. According to the National Adult Protective Services Association (NAPSA), 5% of older adults suffer from financial abuse.

The NCVC reported that 7.9% of complaints were related to financial exploitation. And according to NCEA, approximately 60% of cases involve family members.

What causes nursing home abuse?

The causes of nursing home abuse depend on the quality of the care facility, its policies, staff members, and operation and management. Regardless, there tend to be some common contributing factors, such as:


When there is not enough staff to care for the nursing home residents, aides can be overloaded and overworked, which can lead to patient malnourishment and dehydration in nursing home residents. The prevalence of understaffing can make it hard for employees to respond properly.

Unfortunately, understaffing in nursing homes is on the rise. A report by the U.S. Public Interest Research Group noted that 20% of U.S. nursing homes were understaffed as of December 2020.

Negligent Hiring

When care facilities fail to screen their employees properly, they can endanger their residents. Aides with a history of abuse or drug addiction are more likely to abuse people in long-term care facilities.

Inadequate training

Untrained or poorly trained staff are more likely to be abusive, especially when dealing with residents with aggressive or combative behaviors.

Risk Factors in Nursing Homes

Any person in a care facility may suffer from elder abuse. However, some residents are at a higher risk due to the following factors:


Any person in a care facility may suffer from elder abuse. However, some residents are at a higher risk due to the following factors:

Socioeconomic Status

Scientific studies suggest a link between lower socioeconomic status and nursing home abuse. For example, elderly persons relying on Medicaid to pay for their care in long-term care facilities may wind up at lower-quality facilities.

Past Trauma

According to the NCEA, residents who have experienced traumatic events or abuse are more likely to be abused in the future.

Health Problems

Poor physical and mental health may increase the chances of elder abuse. For instance, residents with dementia or Alzheimer’s are more vulnerable to elder abuse. According to NCEA and NCOA, nearly 50% of residents with dementia experience elder neglect or abuse.

Aggressive Behavior

Residents with tendencies towards physical aggressiveness are at higher risk of abuse. Regardless of the cause, many staff members view combative residents’ behaviors as intentional attempts to be difficult. That makes it more likely for such residents to be abused or mistreated.

Two elderly women sitting on a wheelchair looking outside

Warning Signs of Nursing Home Abuse

Here are some of the signs to look out for in cases of suspected nursing home abuse.

Physical Abuse

  • Broken bones
  • Unexplained injuries
  • Refusal of visitors
  • Improper medication and treatment

Emotional abuse

  • Odd behavior
  • Anxiety
  • Depression
  • Control by the caregiver
  • Fear of the caregiver
  • Extreme agitation
  • Panic attacks
  • Suicide attempts
  • Withdrawal from social interactions
  • Unexplained change in behavior
  • Increased nightmares


Sexual abuse

  • Bruises around the inner thigh, breasts, or genital areas
  • Sexually transmitted infections
  • Unexplained vaginal or anal bleeding
  • Difficulty walking or sitting down
  • Torn, bloodied, or stained underclothing

Financial exploitation

  • Missing items
  • Sudden changes in financial situation
  • Significant fund withdrawals

How can you prevent nursing home abuse?

Nursing home abuse prevention is complex. It requires the involvement of different parties, including residents, nursing staff, and the government. There are many ways to proactively prevent abuse, including the following:


  • Understand the different forms of abuse that can occur in a care facility
  • Learn nursing home policies, services, and prohibitions
  • Express concerns about abuse to staff members, administrators, social workers, doctors, and nursing directors
  • Inform a loved one that you believe abuse is taking place
  • Document evidence
  • Reach out to state survey agencies or a long-term care ombudsman

Friends and Relatives

  • Review different care facilities and choose are putable one
  • Visit long-term care facilities to ascertain their conditions
  • Visit and check in on your loved one often
  • Take any complaints from your loved one seriously
  • Notify relevant authorities about any abuse

Additionally, when deciding on the best care facility for your elderly loved one, consider choosing a nursing home that properly vets its staff members. Nursing home staff should communicate transparently with residents and their family members about boundaries, services and medications.

Ensure that the nursing home:

  • Has written procedures and policies that prevent, prohibit, and investigate abuse
  • Trains staff members on what constitutes elder abuse and steps for reporting incidents
  • Screens every employee thoroughly before hiring
  • Adopts policies that foster abuse disclosure in a non-victimizing manner
  • Posts contact details for all relevant authorities dealing with nursing home abuse
  • Maintains a sustainable staff-to-resident ratio
  • Implements caregiver support interventions.
  • Implements caregiver training on Alzheimer’s and dementia
  • Installs quality monitoring systems

There are no fail-proof ways of preventing elder abuse, but the above strategies can serve as a starting point for seniors and their families.

Nursing Home Abuse Laws

Several national laws have been enacted in America to ensure every citizen is treated with respect and dignity, regardless of age. Elder protection laws include:

Elder Justice Act

The Elder Justice Act was signed into law in 2010 as a part of the Affordable Care Act. It allocates resources and funding towards prosecuting and preventing elder abuse cases. The law also included a section outlining the creation of a database for nursing aides’ background checks, ensuring care facilities make smart recruitment decisions.

This law requires:

  • All nursing home aides to report suspected cases of elder abuse
  • Care facilities to provide a written notice to the Secretary of Health and Human Services 60 days before any permanent closures

Older Americans Act

This act was signed in 1965 and reauthorized in 2016. It helps define abuse among older adults and allocates resources to awareness programs like the National Center of Elder Abuse (NCEA). The act helps build resources for victims and their family members as well.

Violence Against Women Act

This act was signed in 1994 and reauthorized in 2013 and again in 2021. The legislature focuses on domestic abuse cases that cross state, federal, or tribal boundaries.

The act allocates resources to women’s programs, including special services for women above 50 years old. The resources can help:

  • Improve services for abuse victims
  • Enact community response for elder abuse victims
  • Cross-train (for organizations created to help abuse victims)
  • Boost prosecution training programs

No Fear Act

The No Fear Act protects individuals who report instances of nursing home elder abuse. The law helps guarantee equal opportunities for nursing home abuse whistleblowers concerning promotions, future employment, and raises.

State Laws & Statutes

Individual states also have laws that help prevent elder abuse in care facilities. Elder protective services (EPS) or Adult Protective Services (APS) are present in all states. Some states have multiple statutes and laws; thus, the level of abuse support varies by state. Overall, the APS and EPS help ensure a base level of older adults’ protection.

In addition, long-term care ombudsman programs exist in all states. They ensure high-quality care in nursing homes to prevent neglect and injuries like bedsores or broken bones in the nursing home to prevent neglect and injuries like bedsores or broken bones in the nursing home. The programs also protect the rights of elderly persons by investigating abuse and neglect complaints and holding nursing homes responsible for their actions.

Finally, institutional abuse laws, criminal laws, and mandatory reporting laws vary by state, but exist to protect victims of abuse.

Can I sue a nursing home for abuse or neglect?

The Omnibus Budget Reconciliation Act of 1987 states that care facility residents have the “right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion.” If a facility or its staff members violates this law, they may be liable for elder abuse.

On their end, care facilities are obligated to hire caring aides and train them to provide the best care possible. They must also employ enough caregivers to cater to residents adequately.

Thus, a long-term care facility can be liable for abuse in cases of:

  • Understaffing
  • Negligent hiring
  • Medication errors
  • Inadequate training

If a staff member harms a resident intentionally or through neglect, they may be liable for the abuse and associated damages. The same goes for any hired contractors.

Two elderly women and a young woman smiling at each other

How can a nursing home abuse lawyer help me?

If you believe that your loved one is experiencing elder abuse of any kind. Whether it’s physical, mental, sexual or emotional abuse, a nursing home abuse lawyer can help with the following:

  • Identifying signs of abuse
  • Investigating reports of abuse
  • Establishing legal theories
  • Quantifying damages
  • Reporting damages
  • Exploring options to determine the best course of action

Your loved one has a legal right to be treated well. If you believe a family member was injured due to elder abuse, maltreatment, or neglect in a nursing home, contact us for a free case evaluation.

Medically Reviewed by:

Dr. Patricia Shelton, MD

Picture of a woman smiling


  • University of Washington, Doctor of Medicine – MD. June 2008
  • University of Washington, Bachelor of Science – BS, Jun 2003


Neuroscience and Medicine


  • Dr. Shelton primarily writes content for health-related websites, but has also written test prep materials, white papers, published research articles, court documents, and more.
  • Dr. Shelton teaches anatomy and physiology at the college level for the National Institutes of Health.

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Our fact-checking process begins with a thorough review of all sources to ensure they are high quality. Then we cross-check the facts with original medical or scientific reports published by those sources, or we validate the facts with reputable news organizations, medical and scientific experts and other health experts. Each page includes all sources for full transparency.
Our fact-checking process begins with a thorough review of all sources to ensure they are high quality. Then we cross-check the facts with original medical or scientific reports published by those sources, or we validate the facts with reputable news organizations, medical and scientific experts and other health experts. Each page includes all sources for full transparency.