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Preventing Nursing Home Abuse

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The decision to place someone in a nursing home can be very upsetting. However, when an older adult needs 24-hour supervision and medical care such that they can no longer be cared for at home or in a community-based facility, a nursing home is often the best place. In order to help ensure your loved one receives the care they are entitled to by law, it is important to choose a high-quality facility and stay involved and informed of their care.

In the event a nursing home resident receives substandard care, he or she may wish to bring an action against the nursing home to seek compensation for pain and suffering and to punish the facility for violating the law. If a loved one dies as a result of nursing home abuse, the survivors may be entitled to compensation in a wrongful death action. If you or someone you know is a victim of nursing home abuse — or if you are exploring nursing home care for you or a family member — contact a personal injury lawyer to learn more about the state and federal laws that safeguard the rights of nursing home residents.

Find a Good Nursing Home

What Is a Long-term Care Ombudsman?

Every state is required to have a long-term care ombudsman program. An ombudsman is an individual who is trained to help resolve problems and complaints on behalf of nursing home residents and/or their families. An ombudsman also advocates for residents' rights and quality care, educates consumers and assists with nursing home placement.

The first step in finding a good nursing home is to identify and research potential facilities, preferably ones located close to the resident's family and friends.

Visit the facility. One or more well-timed visits to assess the physical environment and the well-being of the residents can help you assess the risk of an abusive environment. While at the facility, make sure to:

  • Meet other residents and family members to learn about their experiences and to observe their physical and emotional well-being (e.g., are they well-groomed, comfortably positioned or overmedicated)? If possible, talk with their family members.
  • Look for a clean, well-lit facility without obvious hazards (such as loose carpets or uneven floors), suspicious smells and other warning signs.
  • Visit during a mealtime to see if residents are getting the appropriate assistance with nutrition and hydration, and that the meals comply with any dietary restrictions (e.g., diabetic or low sodium).

Make sure the facility is well-staffed. Staffing inadequacies (especially on nights and weekends) are a leading cause of nursing home abuse and neglect. A good nursing home not only employs sufficient qualified staff, but also provides ongoing training. The National Consumer Voice for Quality Long Term Care (NCCHR) has established minimum staffing recommendations required to avoid common quality of care problems such as bedsores, weight loss, and loss of bodily functions (see sidebar).

Other information and resources. Other actions that can provide valuable information during this process include:

  • Consulting state and local ombudsmen, who are trained advocates that can, among other things, help you find a quality home and answer questions about nursing home procedures, eligibility and payment.
  • Contacting the State Survey Agency whose job is to conduct inspections to certify nursing homes and home care agencies for Medicare and Medicaid compliance. They also investigate and validate nursing home complaints.
  • Utilizing the Centers For Medicare and Medicaid Services (CMS) Nursing Home Compare tool, which allows you to view the number of beds, staffing information, explanations of any deficiencies and more.
  • Investigating each nursing home's policies on DNR/DNI (Do not resuscitate/do not intubate) and hospice care.

Be Involved and Informed

Nursing Care Staff Recommendations

Well-trained direct care workers can help reduce the chance of nursing home abuse and neglect. The National Consumer Voice For Quality Long Term Care (NCCNHR) recommends each nursing home resident receive at least 1.2 hours of care from a licensed nurse (RN and LVN/LPNs) and an additional 2.93 hours daily from any member of the direct care staff (RN, LVN/LPN, or CNA) as follows:

For direct care staff there must be at least:

  • Day Shift: 1 full-time employee for each five residents (1.60 hours/resident)
  • Evening Shift: 1 full-time employee for each 10 residents (0.80 hours/resident)
  • Night Shift: 1 full-time employee for each 15 residents (0.53 hours/resident)

For licensed nurses providing at the unit level there must be at least:

  • Day Shift: 1 full-time employee for each 15 Residents (0.53 hours/resident)
  • Evening Shift: 1 full-time employee for each 20 Residents (0.40 hours/resident)
  • Night Shift: 1 full-time employee for each 30 Residents (0.27 hours/resident)

The best way to protect a loved one in a nursing home is to be present, vigilant and proactive in his or her life and care. Make sure that involved family members' contact information is up to date and readily available to both the resident and the staff.

Develop relationships with the staff. Good care begins with the nursing home staff. By building relationships and staying in communication with nursing assistants, charge nurses, the director, social worker, administrator and other nursing home staff, you can help keep problems from becoming serious and lessen the likelihood of abuse.

Establish visitation routines. Residents who have regular visitors and active family members are less likely to be abused.

  • Stagger family and friends' visits at different times, including mealtimes, nights and weekends, to make sure there are eyes and ears on all aspects of the residents' lives.
  • If possible, place a video camera in the room that is connected to a family member's home.
  • Most nursing homes are required by law to allow families to form family councils that can meet privately in the facility to talk freely among themselves and present concerns or complaints to the staff.

Participate in plan of care. The law requires that each resident have an individualized plan of care (what care is to be provided and how it will be provided) that is developed at the time of admission and reassessed quarterly or whenever there is a change in their condition. Residents, their families and other representatives should participate in these meetings.

Learn the signs of abuse. Educating yourself and family members on the following signs of abuse can help minimize the potential for harm.

  • Cuts, bruises, scars and unexplained injuries
  • Confusion, agitation and depression
  • Torn, bloody or stained underwear
  • Weight loss, malnutrition and dehydration
  • Unexplained bank withdrawals
  • Missing money or property
  • Pressure sores

If you suspect abuse, it is important to report it immediately to prevent further harm. Learn more about reporting nursing home abuse. If you would like to learn more about different types of nursing home abuse, please refer to our article focusing on this subject.

Contact a Lawyer

Under the law, nursing homes are required to provide services and activities to "attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care." If you or your family member has been injured or is experiencing medical issues in a nursing home setting, an attorney can review the circumstances surrounding the injury to determine if your loved one and your family may have grounds for a nursing home abuse lawsuit seeking monetary compensation.

Did You Know?

Placing a picture of a resident on his or her medication chart will reduce the possibility of medication errors.


According to a recent government study, it takes nursing assistants a minimum of 2.8 to 3.2 hours per day to provide essential services such as dressing and grooming, exercising, feeding, toileting, changing wet clothes, and repositioning.

Source: Centers for Medicare and Medicaid