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Signs and Symptoms of Nursing Home Abuse

California Nursing Home Abuse Lawyer, Ingrid Evans, Explains the Signs and Symptoms of Nursing Home Abuse

The number of California residents who are 65 years of age or older is projected to double through 2030. Now, more than ever, families are turning to nursing homes and long-term residential care facilities to provide their elderly loved ones with the medical attention and daily assistance they need which, unfortunately, cannot easily be provided at home. We hope and believe, of course, that our elderly loved ones are being looked after at these centers by an experienced and caring staff. However, our California nursing home abuse law firm is sad to say that the truth about nursing homes is often a far cry from the idyllic image these facilities attempt to portray. 

According to the State of California Department of Justice, over 400,000 elderly Californians reside in a nursing home, residential care or assisted living facility. The state also reports that 13% of the complaints filed against California’s long-term care facilities involved some form of abuse, neglect or exploitation – more than twice the national rate. What’s even more alarming is the fact that many incidents of abuse go unreported. Statistics show that the top three types of nursing home abuse are physical abuse, emotional abuse, and neglect. If you have an elderly loved one residing in a nursing home or long-term care facility, it’s important to recognize the warning signs of abuse and how to fight back.

What Leads to Nursing Home Abuse?

A significant portion of nursing home abuse that occurs is not a result of maliciousness (although this does unfortunately happen), but rather neglect. Lack of sufficient staffing or lack of training for staff members is a primary cause of this neglect and can result in poor or improper care for residents. Senior citizens who reside in nursing homes have the right to receive a certain number of hours of care from registered nurses, according to state and federal requirements. However, some facilities cut back on these hours in an effort to cut costs.

Such cutbacks leave senior citizens with less attention and care, usually at the hands of tired and overworked nurses and staff members who cannot adequately perform their jobs. In some facilities, nurses’ aides are doing the work that should be done by registered nurses, in violation of regulations. These practices place residents in danger of not receiving proper medical care and attention, as well as at risk for bedsores, decubitus ulcers, pressure sores and other injuries that stem from neglect and improper care — all of which constitutes nursing home abuse.

Along with neglect, abandonment and assault are other, more malicious types of nursing home abuse that continue to threaten senior citizen residents. Abandoning a nursing home resident can be as simple as leaving him or her alone in a room for hours on end with no company or visitors. Humans need interaction with other people in order to keep their minds and spirits going. This is especially important for older people who may not get to see their families or friends often. Abandonment can go so far as to a facility denying outside visitors to a resident or leaving residents in the facility altogether for long periods of time.

Assault is fairly self-explanatory and can cause permanent damage to older people who are frailer and find it harder to heal. Physical assault can manifest in broken bones and facial injuries such as black eyes or scratches, bruises, etc. Verbal assault can also occur and may be happening without much evidence. Another resident or a staff member could be hurling insults and talking down to a senior citizen resident who is powerless to stop the bullying and abuse. 

Warning Signs: How to Spot Them

While the effects of physical abuse are often noticeable, other types of abuse can be subtle and not as easy to distinguish. However, there are numerous signs that can help victims’ loved ones recognize that an elder has been hurt or mistreated at their nursing residence. Below are some of the common warning signs of nursing home abuse:

  • Bruises and marks on the victim, including burn marks
  • Loss of personal property or money
  • Signs of fear when certain staff members or other residents are around the victim
  • Victim is afraid to report needs or requests to the caretaker
  • Sudden changes in appetite or sudden weight loss
  • Drastic change in personality, or emotional withdrawal (i.e. the victim is quiet and reserved when previously outspoken)
  • Depression, anxiety and anger
  • Deteriorating health despite caretakers insisting the victim receives medical attention
  • Poor personal hygiene
  • Bed sores, ulcers, rashes and other skin disorders
  • Untreated injuries
  • Victim’s room, bedding and personal items are not kept clean
  • Caretaker fails to respond when the victim needs assistance, or the caretaker simply ignores the victim

If you notice any of these signs, do not hesitate to report them and then contact a California nursing home abuse attorney. Far too many times, nursing home abuse victims continue to suffer at the hands of a perpetrator because the warning signs were missed or ignored. The faster you seek help, the sooner the abuse can cease and the safer your loved one will be.

Physical Abuse in Nursing Homes

Physical elder abuse is one of the most frequently reported forms of abusive conduct in nursing homes and elderly residential facilities, and can involve a wide range of actions. It is characterized by the use of physical force (often unnecessary roughness) against an elder that results in pain or bodily harm. The abuse may manifest itself as a flagrant transgression, such as hitting an elderly person in front of several witnesses, or can involve less blatant actions, like shaking an elderly person to get their attention. Below are some examples of physical abuse that nursing home victims may suffer:

  • Unnecessary or excessive restraint
  • Pushing or shoving
  • Dragging
  • Hitting or slapping
  • Severe beatings
  • Sexual assault or rape

Though the above are the signs physical signs of abuse, other abuse may be harder to spot:

Emotional Abuse Explained by a California Nursing Home Abuse Attorney 

Emotional abuse is another recurring problem across California’s nursing facilities and can take a large toll on a victim. Victims of this form of abuse suffer intentional psychological anguish or pain resulting from either verbal or nonverbal actions. Unlike an incident of physical abuse, which can have immediate and obvious consequences (making it easier to find and stop perpetrators), emotional abuse tends to be more prolonged and its effects can be gradual, yet residual and deeply traumatizing. Examples of emotional elder abuse can include:

  • Intimidation
  • Verbal harassment
  • Humiliation
  • Blatant insults or derogatory comments
  • Verbal or written threats
  • Repeated use of harsh language or tone


While both physical and emotional abuse is nearly always intentional acts, lack of action, known as neglect, is also considered a form of nursing home abuse. Neglectful conduct at nursing homes can be both intentional and inadvertent, but regardless of the reason, it can affect both the emotional and physical health of the victim. Incidents that can fall under the umbrella of elderly neglect include:

  • Failure to provide medical care and medication
  • Failure to provide adequate and expected food, clothing and shelter
  • Failure to treat injuries
  • Failure to provide prompt assistance or care
  • Failure to acknowledge complaints of pain or abuse

How Families Can Protect Loved Ones From California Nursing Home Abuse

There is no excuse for nursing home abuse and perpetrators can be held  liable for their misconduct and may incur both civil and criminal charges for it. If you suspect your loved one has been hurt or neglected at a nursing facility, it is imperative you take action right away. Call 911 and report the matter to the facility where the victim resides, local law enforcement, the Licensing and Certification Division of the California Department of Public Health (DPH), the Bureau of Medi-Cal Fraud & Elder Abuse (BMFEA), your county’s long-term care ombudsman office. While immediate reporting to law enforcement is critical, also contact an experienced California elder abuse attorney for legal advice on how to proceed with filing a claim against the long-term care or assisted living facility, staff or other perpetrators. Law enforcement agencies are not able to pursue all the remedies to which the victim and his or her family may be entitled. That’s where a California elder abuse attorney can help.

Loved ones who notice any of the warning signs of nursing home abuse are encouraged to seek assistance immediately to stop the mistreatment and prevent further occurrences. Keep a log of evidence that supports your elder abuse claim, such as dates and names of those who refused to assist the victim or who displayed aggressive, emotional or neglectful behavior toward your loved one. Take plenty of photos of the facility’s conditions and any bruises or injuries the victim sustained. Ask the facility to provide you with a log of those who are in service on any given day and who have direct access to your loved one or who have previously interacted with them. Check records of medical treatment, including the medications that have been given to your loved one. Also, ensure the victim obtains medical treatment with a different doctor or facility and ask for a detailed report of their current conditions.

Don’t Let Nursing Home Abuse in California Continue to Go Unreported

Despite the prevalence of nursing home abuse throughout California, the unfortunate truth is that many of these incidents go unreported. According to The National Center of Elder Abuse, only one in every 14 cases of nursing home abuse is reported, but the actual number may be higher. Sometimes, the victim is physically unable to report the abusive treatment because health conditions such as dementia or a speech impediment prevent him or her from doing so. Other times, victims are threatened by the perpetrator to remain quiet and fear retaliation if they file a complaint. Perpetrators may tell the victim that the abuse will increase in frequency or worsen if they report it, even worse, the victim’s life and the lives of their loved ones may be threatened.

Additionally, the victim may not have any family or a support system to turn to. Even if the victim does have someone to talk to, their complaints may not be taken seriously – especially if the victim suffers from dementia and if they do not show physical signs of abuse. Or, the victim may not want to burden their loved ones. They may already feel as though they have been a burden to their loved ones and do not wish to upset their families any further.

Finally, another reason why victims of elder abuse fail to report their circumstances is because they feel shame. This is often the case when sexual abuse has occurred. However, the longer the abuse goes unreported, the more the victim will continue to suffer. While the victim may not be able to report the matter themselves, loved ones can – and are encouraged to – act on their behalf.

The Top 5 Ways to Know if a Nursing Home Has a History of Abuse

Nursing home abuse is not always easy to spot, but in some cases, there are very clear warning signs. However, the warning signs discussed above generally apply to individual residents who are already living in nursing homes. But what about nursing home abuse on a wider scale? For example, if you are considering entrusting the care of a loved one to a nursing home, how do you know that whichever one you choose does not have a history of abuse? Our California nursing home abuse attorney shares a few tips and tricks below.  

Conduct General Research Into the Facility 

The first step when researching nursing homes is to conduct general research into the short list of facilities you are considering. While research at a high level like this may not uncover direct evidence of abuse, it can help you get a better feel for the facility and find out more about its general reputation in the community. Websites like Google and Yelp are good sources for nursing home reviews, but keep in mind that user-generated reviews are subjective and frequently subject to manipulation. Take any user-generated reviews you read online with a grain of salt. 

Another effective strategy for preliminary research is to talk to friends and family about the experiences they have had with nursing homes. If you know someone currently living in a nursing home, visit them and ask them directly about the care they are receiving. While any feedback you receive this way is anecdotal, it is likely to be more trustworthy than online reviews posted by strangers. 

You should also plan on visiting the facilities you are seriously considering. This will give you an opportunity to speak to staff and current residents and have your questions answered. It can also allow you to draw your own conclusions about the level of care being provided at the facility. Is the facility clean? Is the staff courteous and professional? Do the residents look well-fed and well-groomedAsk for specific references of families of residents and speak with them. 

Check the Nursing Home Rating via Medicare’s Nursing Home Comparison Tool

One of the best official sources for information related to nursing homes is Medicare’s nursing home comparison tool. It is an online tool that allows users to search and compare nursing homes they are considering. Like Google and Yelp, it rates facilities on a one-to-five scale, but the ratings are based on objective criteria derived from health inspections, staffing, and various other quality measures. 

Most importantly, it allows users to access each facility’s most recent inspection reports, which are based on both citations and complaints, as well as the number of citations and complaints that resulted in citations for the previous three years. A citation is a type of enforcement action that is issued when an inspection team finds that a nursing home does not meet a certain federal standard. A complaint is filed when a nursing home resident or a family member has a concern about the quality of care at the facility. Inspectors may visit a nursing home when a complaint is registered and, if the complaint is substantiated, may issue a citation. 

For example, assume that you are considering a certain facility for a loved one. You search the facility’s name using Medicare’s tool and find that it has received an overall rating of one star out of five. You then check the facility’s most recent inspection report and see that it was issued 15 citations, as well as the inspector’s findings regarding each citation. Furthermore, you see that there have been 21 complaints lodged against the facility in the last three years, three of which resulted in citations. Based on this review, you decide to remove the facility from consideration. 

Medicare’s tool also warns users about facilities that have recently been cited for resident harm or the potential harm of abuse or neglect with a consumer alert icon

Check to See if the Facility Has a History of Complaints or Citations (Including Financial Complaints) via the California Department of Public Health 

Another helpful official source for nursing home information is the California Department of Public Health’s Cal Health Find Database. Similar to the Medicare database, it allows users to find information about nursing homes located in the state of California. While the state tool shows citations and complaints related to residents’ physical health and safety (e.g., infection control measures, staffing issues, medication errors, etc.), it also contains information regarding potential financial elder abuse. A history of financial complaints could indicate that a facility may be engaging in financial elder abuse. If you suspect that someone you care about is the victim of financial elder abuse in a nursing home, please contact a California nursing home abuse attorney

Check the Facility on ProPublica’s Nursing Home Inspect Tool

Media company ProPublica also maintains a nursing home database called Nursing Home Inspect that allows users to search for nursing home citations and complaints. Nursing Home Inspect contains a wealth of information and allows users to sort through nursing homes based on several criteria, such as by number of serious deficiencies or the amount of fines that have been assessed against the facility. It also clearly labels each deficiency by its severity, giving users an easy overview of the most serious violations. 

Check the Facility’s Staff Licenses at the Department of Consumer Affairs

If you have narrowed your search down to one or two facilities, you should also research the facility’s staff using the search feature at the California Department of Consumer Affairs (DCA). DCA maintains a registry of all professional licensures issued in the state of California, including for registered nurses and other nursing home staff. A search for a nurse’s name or license number will reveal the status of his or her license and when it expires, as well as any disciplinary actions taken and their outcome. For more information about uncovering histories of abuse in nursing homes, please contact a California nursing home abuse attorney.

Let a California Nursing Home Lawyer from Evans Law Firm Help

Senior citizens in nursing homes have the right to be treated with dignity and respect, and to receive proper care free from poor treatment, abuse and neglect. If you believe that you or a loved one has been the victim of nursing home abuse, contact Evans Law Firm, Inc. for a free and confidential consultation by calling 415.441.8669 or completing our contact form

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