Types of Abuse and Neglect in a Nursing Home

Close up shot of the hand of an elderly person sitting in a wheel chair - types of nursing home abuse concept

Here at The Dickson Firm, we are contacted almost every day by someone who would like to know if their loved one is receiving appropriate care at a nursing home. Oftentimes, the nursing homes tell them that whatever happened to their loved one at the nursing home is normal or can't be avoided.


One of the most common types of abuse and neglect in nursing homes is poor care leading to falls in the nursing home. Oftentimes, residents go into a nursing home and suffer multiple falls. When the family inquires, the nursing home tells them there is nothing they can do. They tell them they're not allowed to restrain the resident, and that the resident has the right to refuse care. These are often just excuses for poor care.

Falls are incredibly dangerous for nursing home residents. A resident who falls can suffer a fracture or even a head injury. An elderly resident, who has a variety of co-morbidities, has a very high mortality rate if he suffers a fall and suffers an orthopedic fracture. This means that an elderly resident who falls and suffers a fracture is unlikely to be alive a year later. Orthopedic fractures often require surgery, and they lead to people being rendered immobile. This can lead to bedsores, pneumonia, and a variety of consequences. As a result, nursing homes truly need to treat fall prevention as a matter of life and death. They often don't and instead, make excuses.

Not Using Alarms to Monitor Residents

Nursing homes have a legal obligation to provide their residents with adequate supervision to prevent accidents and to provide them with a safe environment. One of the ways they should be doing this is through the use of alarms. Alarms can be set so that if a resident begins to get up, the alarm goes off. This alerts the staff to the fact that the resident is trying to stand up and trying to walk unattended. If it's not safe for that resident to walk unattended, then the staff can respond immediately and offer assistance.

However, many nursing homes don't use alarms. If you are admitting your loved one into a nursing home that does not use alarms and your loved one is a fall risk, one of the things you should ask is what they're doing to keep an eye on the resident. Think to yourself, at 3:00 in the morning, when the residents are in bed, how is the staff providing adequate supervision for all of these residents who are at risk for falls? They are obviously not providing one-on-one care. They are most likely not assigning a single staff member to each resident to watch them sleep. If there are no alarms, how do they know if your loved one is getting up and walking on their own?

Nursing homes often claim that alarms are a restraint. This is just an excuse not to use alarms. An alarm is an effective tool to help prevent falls, not a restraint. If the sound bothers the resident, there are alarms that buzz a pager carried by the staff. There are alarms that illuminate a light over the resident’s door. There are alarms that only sound at the nurse’s station. There are countless options available to keep residents safe.

Poor Care Leading to Bed Sores

Another type of abuse and/or neglect in a nursing home, that we unfortunately see often, involves the failure to prevent skin breakdown. Very often, a family has a loved one whose condition is such that the family can no longer care for them and they have to admit them to a nursing home. Other families have people who have suffered falls at home, which sometimes result in a fracture, requiring surgery. After the resident gets out of the hospital, they need short-term nursing home care, or perhaps they need long-term nursing home care. In either event, many residents are admitted to a nursing home, and because of recent events, they are in need of help with their mobility. Often they can not get up on their own or even reposition themselves in bed without help. At that time, they are completely dependent upon the staff to help them get up and move around.

If someone is at risk for skin breakdown, it's important that they are turned and repositioned every two hours. If they're in bed, they need to be turned and repositioned. If they're in a chair, they need to be repositioned. They need to be helped up during the day and moved around. Unrelieved pressure is what leads to skin breakdown, bedsores, or decubitus ulcers. If a bedsore develops, then the staff has to make sure they keep the pressure off the area where the bedsore is developing so as to allow that area to heal. The more severe a bedsore is, the more difficult it is to heal.

A Stage 1 bedsore is a reddened area. It is not open, and it is relatively easy to heal. A Stage 2 bedsore now has open skin, and it's a little harder to heal. A Stage 3 bedsore is deeper and larger and is even harder to heal. A Stage 4 bedsore can go all the way into the muscle and the bone. It can be very deep, and it can be very difficult to heal.

Once a person has a Stage 2 or greater bedsore, once their skin is open, they are now susceptible to infection. If a person has a bedsore in their sacral area near their buttocks, obviously that open sore is subject to contamination from feces or urine and can lead to infection. Accordingly, nursing homes must take skincare very seriously. They must make sure that they report any skin breakdown to a resident's doctor and his or her family. They also must update the care plan if the resident is developing skin breakdown and implement additional interventions. If you go to visit your loved one and they complain that their behind hurts, or they seem uncomfortable, you should check their skin or insist that the nursing home check their skin to see if they have any skin breakdown.

Failure to Properly Supervise Residents

Another type of abuse and neglect that we see in nursing homes is a failure to supervise residents. This can lead to falls as stated above. It can also lead to elopement which is when a resident leaves the nursing home unattended. This can be incredibly dangerous. We have seen residents who were hit by cars, died due to inclement weather, drowned in nearby ponds or lakes, and many other terrifying outcomes. Nursing homes must be very careful with any resident who cannot leave the facility safely on their own to make sure they do not leave unattended. As stated above, nursing homes are legally required to provide their residents with adequate supervision.

Physical Abuse or Assault

Finally, and perhaps most tragically, one of the most significant types of abuse and neglect that we see in nursing homes are assault cases. We see residents who have been assaulted by other residents, as well as residents who have been assaulted by staff. Tragically, some of these assaults are even sexual in nature. These are very heartbreaking cases. Nursing homes have a legal obligation to vet their staff, to run a background check on their staff, and to not hire residents who have been convicted of a series of criminal charges here in Ohio. Any staff member who has a history of abusing residents should not be hired to work in a nursing home, and any staff member who has a conviction for any number of different crimes cannot legally work in a nursing home in Ohio. Nursing homes are obligated to check the background of their staff to make sure they're appropriate to work in a nursing home. They are also obligated to train their staff, to monitor their staff and to follow up on all complaints.

It is important to be on the lookout for the warning signs for the types of abuse and neglect in nursing homes outlined above. Often the residents of nursing homes are unable to advocate for themselves and rely on their loved ones to do so.

If someone you love has been neglected or abused in a nursing home, please call us as we will be happy to talk with you and help you in any way that we can. You can reach us here at The Dickson Firm at 1-800-OHIO-LAW.