Nursing Home Neglect: Definition + How to Report

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

Nursing home neglect is a sad and troubling circumstance that affects more people than you might expect. Being in a nursing home is not what most families want for their loved ones, but it is the only option at times. 

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Nursing homes, in general, have a troubling history that has only recently become more visible to the public due to COVID-19. But, there were problems in nursing homes even before COVID was responsible for over 31% of total deaths nationwide. Understaffing, infection control issues, and staff turnover have contributed to poor care, neglect, and premature deaths.

Before considering a move, ask a nursing home questions. You can’t predict or prevent problems, but doing your homework ahead of time might help. 

So, what is a family to do to protect a loved one in a nursing home? First and foremost, you have to be an educated advocate. Taking steps to prevent neglect when you can, recognizing the signs of neglect, and timely reporting will ensure your loved one’s safety and improve care. 

What’s Considered Neglect in a Nursing Home?

The term neglect can be hard to distinguish from abuse, and in fact, neglect is considered a form of elder abuse. And, to clarify, a family member can also neglect someone who is in nursing home care—being short-staffed or any other reasons for neglect are not acceptable excuses. Neglect is never to be tolerated, and knowing what is considered neglect will help you recognize it.

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Medical neglect

Each resident of a nursing home has medical needs; otherwise, they wouldn’t be there. Medical neglect is when those needs are not met and can include:

  • Not administering medications or consistent medications errors
  • Not caring for medical conditions that require regular attention like diabetes, continence care, or dementia
  • A failure to monitor and treat bedsores. Part of the prevention of bedsores involves ensuring that the resident is moved regularly.
  • Failure to report infections or other medical conditions to a nurse manager or physician

Basic living needs 

Basic living needs include providing food and water to keep the resident nourished and hydrated. Malnutrition and dehydration are persistent problems in nursing homes, with estimates that up to 85% of nursing home residents suffer from malnutrition. 

Neglect of basic living needs also includes the failure to keep rooms at adequate temperatures or not fixing safety issues. Poor building maintenance leading to unsafe conditions for residents is part of neglect.

Hygiene

Hygiene is a critical component of infection control and also dignity and respect. Hygiene neglect includes not keeping residents clean or their clothing laundered. Also, not keeping their room cleaned and sanitized. Most rooms in nursing homes are shared with another resident. If that roommate has an infection, the nursing home should follow specific safety protocols to prevent the infection from spreading.

Emotional neglect

Emotional neglect can take many different forms and is one of the more challenging types of neglect to detect. 

Emotional and social neglect include:

  • Staff not attending to the mental health needs of a resident (an example would be the failure to treat depression, agitation, or other mental health problems. Nursing homes have come under criticism for using antipsychotic medications to treat agitation or other disruptive behaviors. Some consider the use of these medications as a type of restraint.)
  • Failing to allow a resident access to social interactions by keeping them isolated
  • Not assisting a resident with mobility issues

How Do You Know If a Loved One is Experiencing Neglect in a Nursing Home?

Knowing if your loved one is experiencing neglect can be a challenge due to their reluctance to self-report problems. The reasons for not reporting are complicated. Perhaps your loved one has dementia, or they fear reprisal from the very caretakers responsible for their care. There are, however, signs and red flags that can alert you to neglect. 

Unsanitary conditions

If the room smells of urine, it is possible your loved one is not being changed or taken to the bathroom in a timely fashion. Aides can’t attend to your loved one immediately but look for a pattern of dirty bedding, urine smell, and unclean clothes. Also, if the floor hasn’t been cleaned in a while or there are pests.

Poor hygiene

If your loved one can’t attend to their personal hygiene, the nursing home is responsible for ensuring cleanliness. Notice whether your loved one’s teeth are brushed, their hair clean, and that they are free of body odor. 

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Unexplained weight loss

Ask to see the weight log to determine if your loved one has lost weight. Also, look for signs of being cold all of the time, clothes not fitting, and hair loss- all of which might indicate malnourishment. 

Mobility issues

Your loved one could be losing mobility due to their medical condition, but a loss of strength and endurance and spending more time in bed could indicate neglect. The care staff may not encourage your loved one to move or assist them out of bed or a wheelchair. Leaving someone in bed or a wheelchair for extended periods of time leads to frailty and pressure ulcers. Another sign of mobility problems is if your loved one is having frequent falls.

Complaints of pain

If your loved one complains of pain, take notice and ask where the pain is coming from. It could be unnoticed or untreated bedsores, fractures, or bruises. 

Psychological changes

You might notice that your loved one has become less talkative, more afraid, or irritable. They may seem more depressed or anxious. Take these signs seriously and see if you can find out why there has been an emotional change. Try talking with your loved one about their feelings.

What Can You Do If a Loved One Experiencing Neglect?

What to do if a loved one is experiencing neglect depends on how serious it is. No neglect should be tolerated, but you also want to be fair. Sometimes neglect is the consequence of a one-time mistake or a misunderstanding. 

Document the neglect

Documenting the neglect details is an important step in making a complaint to either the nursing home administration or federal and state authorities. Keep a log and specifics about what you observe and the efforts you make to rectify the situation. 

Talk with the director of nursing about the neglect

Talk with the director of nursing and the director of the facility about any signs of neglect. Be specific about what you observe, and expect that they’ll offer to rectify the situation immediately. Watch closely for a change, and if there isn’t one, make a formal complaint to the authorities. 

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Consider moving your loved one

If there appears to be a verifiable pattern of neglect, the sooner you can move your loved one, the better.

Moving someone out of a nursing home will take some well-thought-out steps since you don’t want to exchange one bad situation for another. If your loved one can tolerate a less intensive care environment, you could consider moving them home for a short time or assisted living respite until you can find a better nursing home placement.

How Do You Report Nursing Home Neglect?

How and when you report nursing home neglect depends on the urgency of the situation. You might feel more comfortable making a report to all of the authorities simultaneously. In many states, it is your duty to report neglect, and you may be benefitting other residents by making your concerns known.

Report to the nursing home

Report first to the nursing home to allow resolution of the problem. If there is no immediate remediation of the neglect, go to the next steps.

Report to the ombudsman office

Every state is required by law to have an ombudsman office responsible for investigating allegations of abuse, neglect, and exploitation by nursing homes. The Ombudsman number should be prominently displayed at every nursing home.

Report to adult protective services

Adult Protective Services (APS) is responsible for investigating abuse, neglect, self-neglect, and financial exploitation in the community. In some states, APS also investigates complaints in nursing homes or might be brought in by law enforcement.  

Report to law enforcement

If you feel that your loved one is in immediate danger, you can call law enforcement to investigate any criminal intent. 

Report to your state’s department of health

The federal government and state departments of health oversee nursing homes. File a complaint and report to your state’s department of health. 

Nursing Home Neglect

As heartbreaking as nursing home neglect is, it can be prevented. Your close involvement, monitoring, and advocacy can ensure better care for your loved one. Recognizing what nursing home neglect is, and the signs that it may be occurring will help you intervene. Reporting nursing home neglect will alert the appropriate agencies so that other families don’t have to suffer as well. 


Sources:
  1. “Nursing Homes Experienced Steeper Increase In COVID-19 Cases and Deaths in August 2021 Than the Rest of the Country. Kaiser Family Foundation. kff.org
  2. Paulin, Emily. “ 8 in 10 Nursing Homes Cited for Infection Control Issues Before Pandemic.” AARP. 20 May 2020. aarp.org
  3. “Malnutrition Issues in Nursing Homes.” Nursing Home Abuse Guide, 2021. nursinghomeabuseguide.org
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