Nursing Home Abuse: Key Warning Signs Families Must Not Ignore

If you have an older parent getting extended care services, you worry. You hope your parent is receiving the care they deserve. Whether it is a caregiver in their home, an assisted living facility, or a nursing home, you can generally count on them to keep your loved one safe and provide the quality extended care they deserve.

You hope the staff are paying attention. And you hope you will notice the warning signs if something is wrong.

There are cases where families have uncovered issues only after the harm had escalated. Abuse and neglect rarely begin with one catastrophic event. They usually start with small, explainable problems that gradually pile up.

According to the Centers for Medicare & Medicaid Services (CMS), more than 1 million Americans live in nursing homes and millions more in other long-term care facilities, including with in-home caregivers.

Older adults over age 65 make up most of the residents of any long-term care facility, and many have complex medical or cognitive needs that make them vulnerable.

Your vigilance matters. You have the power to intervene early, advocate for your loved one, and—when necessary—pursue legal remedies.

National Landscape: What the Data Shows

CMS tracks nursing home quality across the United States. While most facilities provide appropriate care, consistent federal audits show that problems with staffing, hygiene, pressure injuries, medication management, and resident safety remain common.

A recent CMS review found that 1,050 nursing homes across 25 states were identified for needing quality improvement, yet many others still struggle with core safety measures. When a facility fails to meet federal standards, residents face the risk of physical, emotional, or medical harm.

Families should not ignore changes in their loved one’s condition. Subtle red flags often provide the earliest clues.

According to nursing home abuse lawyer Rachel Berenson, we may not be able to undo the damage done, but we can hold the at-fault party accountable for their misconduct through legal means.

Unexplained Injuries or Physical Changes

When you walk into the facility, look closely at your parent’s physical condition.

Common warning signs include:

• Bruises, cuts, or abrasions with vague or inconsistent explanations
• Burns or marks on wrists or ankles
• Sudden weight loss or dehydration
• Evidence of restraints
• Bedsores (pressure injuries), which should never occur with proper care

Physical injuries can result from neglect, rough handling, inadequate supervision, or unsafe conditions such as falls.

Experts say that nursing home residents rely entirely on staff to keep them safe. When injuries appear without a clear medical reason, it often signals a breakdown in supervision or care.

If something feels off, trust your instincts. Document what you see. Ask questions. Notify the charge nurse, and if the answers seem evasive, escalate to the administrator.

Watching for Changes in Behavior or Mood

Abuse is not always visible on the skin. Sometimes it shows up in your loved one’s personality.

Watch for:

• Fearfulness around certain staff
• Withdrawal or emotional flatness
• Sudden depression or anxiety
• Agitation, pacing, or “acting out”
• Refusal to participate in normal activities

Psychological abuse, including intimidation, humiliation, or isolation, can cause dramatic shifts in behavior. A calm conversation with nursing staff can help clarify whether your parent is experiencing distress, confusion, medication effects, or something more serious.

Your loved one still deserves to feel safe, respected, and valued—even when they live outside the home.

Withdrawal from Social Interactions

If your parent stops attending group activities, avoids meals, or declines visits, consider what has changed?

Social withdrawal may indicate:

• Fear of another resident
• Hostility or mistreatment from a staff member
• Inappropriate isolation
• Depression linked to neglect
• Being punished or ignored

Older adults depend on social connections for emotional well-being. If they suddenly retreat from interactions, it may be because something in the environment feels unsafe.

Create space for them to talk. Let them know they can trust you. Sometimes a resident will only open up after being reassured that their concerns will be taken seriously.

Poor Hygiene or Unsanitary Living Conditions

Poor hygiene is one of the clearest early signs of neglect.

Look for:

• Soiled clothing
• Unwashed bedding
• Persistent odors of urine or feces
• Unclean bathrooms
• Overfilled trash cans
• Untidy or cluttered rooms

Facilities must follow strict CMS sanitation requirements. If the environment looks unclean or your loved one appears neglected, raise the issue immediately. A healthy environment is essential for infection control, dignity, and quality of life.

Lack Of Proper Medical Care or Attention

Medical neglect can escalate quickly, especially in residents with chronic conditions.

Warning signs include:

• Missed medications
• Delayed treatment
• Worsening pressure injuries
• Unmonitored chronic diseases
• Lack of routine physician visits
• No care plan updates

You have the legal right to review the care plan and ask how medications, vitals, hydration, mobility support, and cognitive needs are being addressed.

If you notice a decline that staff cannot explain, demand documentation. Federal regulations require accurate charting of care.

What to Do if You Suspect Abuse

Acting quickly can prevent further harm. Key steps include:

• Document everything: injuries, room conditions, photographs, and names of staff.
• Request an immediate care-plan meeting with the director of nursing.
• File a written complaint with facility administrators.
• Contact your state’s long-term care ombudsman, who must investigate concerns.
• If harm occurred, consult an elder-law or nursing home abuse attorney to understand your rights.
• If you think it is a life-threatening emergency, contact law enforcement, now.

Legal action cannot undo the damage, but it can protect your parent, compensate for harm, and hold negligent parties accountable. Lawyers at Hobbs Law Group say you can fight for your loved one to be properly compensated for injuries caused by someone else’s negligent or malicious actions.

Why This Matters for Long-Term Care Planning

The best time to protect yourself and your family is long before a crisis.

• Most long-term care is custodial.
• Medicare and health insurance do not pay for long-term care beyond short-term skilled services.
• Quality caregivers and long-term care facilities are costly but often have better patient-to-staff ratios, improving safety.
• Without planning, the burden falls on the family.

Long-Term Care Insurance helps ensure your loved one receives quality care in safer settings—whether at home, assisted living, memory care, or nursing homes. Although keep in mind that abuse and errors can occur anywhere, including in a quality facility.

Quality care providers and facilities are costly now, and those long-term care costs keep rising each year. Use the LTC News Cost of Care Calculator to compare local nursing home pricing and understand how costs rise each year:

When Safety Matters Most 

No older adult should live in fear or neglect. With vigilance, early action, and the right legal protections, you can help ensure your loved one receives the dignity and care they deserve.

If an older family member needs extended care now, or you need to move a loved one from a facility you are not happy with, use the LTC News Caregiver Directory to find and compare caregivers, memory care, assisted living, and nursing homes by ZIP code.

If your loved one shows any signs of abuse or neglect, take action right away. Your family member deserves safe, attentive care, and while most facilities provide it, you cannot wait if something feels wrong. Your vigilance can make the difference.

Meanwhile, take action now to prepare for your personal aging and the access to quality long-term care you deserve in the future. Learn more about how Long-Term Care Insurance can provide the financial resources to access the quality care you deserve.