The decision to place an aging loved one in a long-term care facility is one of the most difficult families face. It is a choice born from a desire to ensure their safety, health, and quality of life. We place an immense amount of trust in nursing homes, believing they will provide the professional, compassionate care our family members deserve.

Unfortunately, that trust is sometimes broken. While many facilities provide excellent care, others fail to meet the basic standards. This failure often manifests not as overt, intentional abuse, but as neglect.

Nursing home neglect is the failure of a caregiver or facility to provide a resident with the care, services, or goods necessary to avoid physical harm, mental anguish, or illness. It is often a passive act—a failure to provide, rather than an active intent to harm. Because it can be subtle, neglect is often harder to detect than physical abuse. It may begin slowly and worsen over time, leaving residents to suffer in silence.

For families, this reality is frightening. The key to protecting your loved one is vigilance. Knowing the specific, observable signs of nursing home neglect is the first and most important step toward intervention. This guide details the physical, emotional, and environmental warning signs that demand your attention.

The Difference Between Nursing Home Abuse and Neglect

Before identifying nursing home neglect, it is helpful to distinguish it from abuse. While both are harmful and unacceptable, they are not the same.

• Nursing Home Abuse is generally defined as an intentional act that causes harm or creates a serious risk of harm to a vulnerable elder. This can be physical (hitting, restraining), emotional (yelling, threatening), sexual, or financial (theft).
• Nursing Home Neglect is a failure to act or a breach of duty. It is the omission of care that a reasonable person would provide. Neglect is often the result of systemic issues, such as chronic understaffing, poor training, or negligent management.

A resident with a bedsore may be a victim of neglect because staff failed to reposition them. A resident with a broken bone from being shoved is a victim of abuse. Both are serious, but neglect in long-term care facilities can be pervasive and impact many residents at once. These are not just isolated incidents; they are often symptoms of a facility-wide breakdown in the standard of care.

Recognizing Nursing Home Neglect: The Four Main Categories

Neglect can be difficult to pinpoint because it often looks like a gradual decline in health, which families may mistakenly attribute to normal aging. However, these declines are often preventable. The warning signs of nursing home neglect can generally be broken down into four primary categories:

1. Medical Neglect
2. Personal Hygiene Neglect
3. Basic Needs Neglect
4. Emotional or Social Neglect

Knowing what to look for in each category, you can build a clearer picture of your loved one's daily reality.

Medical Neglect: Elder Neglect Symptoms to Monitor

This is one of the most dangerous forms of neglect. It occurs when the facility fails to provide for a resident's medical needs, either by failing to provide treatment or by failing to protect them from harm.

Untreated Bedsores (Pressure Ulcers)

Bedsores are one of the most common and telling signs of neglect. These injuries, also known as pressure ulcers or decubitus ulcers, are caused by prolonged pressure on the skin, often from remaining in a bed or wheelchair for too long without being repositioned.

• Why it is neglect: In most cases, bedsores are entirely preventable. Nursing home staff are trained and required to have a "turning" schedule for immobile residents, typically every two hours. They must also ensure residents have proper nutrition and hydration to maintain skin integrity.
• What to look for: Pay attention to complaints of pain, especially around the tailbone, hips, heels, and shoulder blades. Look for red, purple, or discolored skin that does not turn white when pressed. In advanced stages, these become open, infected wounds. The presence of a Stage 3 or Stage 4 bedsore is a powerful indicator of severe, ongoing neglect.

Frequent Infections or Illnesses

While elderly individuals may be more susceptible to illness, a pattern of recurring infections can signal a breakdown in care. This may include urinary tract infections (UTIs), pneumonia, or skin infections like cellulitis or sepsis.

• Why it is neglect: These infections are often linked to other forms of neglect. UTIs can be caused by dehydration or poor hygiene. Pneumonia can develop if a resident is left immobile for too long or if staff fails to identify and treat a simpler respiratory infection.
• What to look for: Sudden changes in behavior, such as confusion or agitation (a common UTI symptom in the elderly), persistent coughing, or fever. Ask pointed questions about the facility's infection control and hygiene protocols.

Medication Errors

A resident's complex medication schedule requires meticulous management. Failure to adhere to it constitutes medical neglect.

• Why it is neglect: This failure can stem from disorganization, understaffing, or poor training. Staff may give the wrong medication, the wrong dose, or miss doses entirely.
• What to look for: Observe your loved one's condition. Are they suddenly over-sedated, dizzy, or confused? Are the symptoms their medication is supposed to treat suddenly returning? Check pill bottles if possible, or ask a nurse to walk you through their medication chart.

Common Signs of Elder Neglect in Daily Living

This category involves the failure to provide residents with the basic assistance they need for activities of daily living (ADLs). These are often the first warning signs of elder abuse and neglect that a family member will notice.

Poor Personal Hygiene

When you visit, take a close look at your loved one's personal appearance. A decline in hygiene is a major red flag.

• Why it is neglect: Many residents require assistance with bathing, dressing, and grooming. When staff fails to provide this help, the resident's dignity and health suffer.
• What to look for:
  • Persistent body odor
  • Unwashed or unkempt hair
  • Overgrown or dirty fingernails and toenails
  • Soiled clothing, bedding, or incontinence briefs
  • Poor oral hygiene, such as unbrushed teeth or new dental problems

Malnutrition and Dehydration

Unexplained weight loss is never a "normal" part of aging. It is almost always a sign of an underlying medical issue or, in this context, neglect.

• Why it is neglect: The facility is responsible for providing appealing, nutritious meals and ensuring residents get the fluid they need. Neglect occurs when staff fails to provide food, does not provide assistance to residents who cannot feed themselves, or fails to offer water regularly.
• What to look for:
  • Significant, unexplained weight loss
  • Sunken eyes, dry skin, or cracked lips
  • Complaints of persistent thirst
  • Weakness, dizziness, or new-onset confusion
  • Food being left untouched on meal trays

Unexplained Falls, Fractures, or Bruising

Falls are a leading cause of injury and death among older adults. While not all falls are preventable, many in a nursing home setting are.

• Why it is neglect: Facilities are required to assess each resident's fall risk and implement a safety plan. This may include bed rails, non-slip flooring, adequate lighting, and assistance with walking. Neglect occurs when the facility fails to create this plan, fails to follow it, or fails to properly supervise a high-risk resident.
• What to look for: Any fall should be taken seriously. Ask for a detailed incident report. Look for bruising, especially on the arms or wrists, which could indicate improper handling or a fall.

Environmental and Social Red Flags of Nursing Home Neglect

Sometimes, the clearest signs of neglect are not on the resident's body but in their environment and interactions.

Unsafe or Unsanitary Living Conditions

The state of your loved one's room is a direct reflection of the facility's operational standards.

• Why it is neglect: The facility is legally obligated to provide a safe, clean, and habitable environment. A failure to do so endangers all residents.
• What to look for:
  • Dirty floors, soiled carpets, or foul odors
  • Pest infestations (insects or rodents)
  • Hazardous conditions like wet floors, poor lighting, or exposed wiring
  • Broken or missing safety equipment, such as call buttons or bed rails
  • Rooms that are consistently too hot or too cold

Staffing Issues as Elderly Neglect Indicators

Chronic understaffing is the root cause of most nursing home resident neglect. When caregivers are responsible for too many residents, standards of care inevitably collapse.

• Why it is neglect: A facility that prioritizes profits over patient safety by intentionally understaffing its floors is committing a form of systemic neglect.
• What to look for:
  • Call lights that go unanswered for long periods
  • Staff who seem overworked, stressed, or dismissive of your concerns
  • A high rate of staff turnover
  • Staff who cannot answer basic questions about your loved one's condition or recent activities
  • A reluctance to let you see your loved one or attempts to restrict visiting hours

Emotional and Social Withdrawal

Emotional or social neglect is the failure to provide a resident with the social stimulation and interaction necessary for mental well-being.

• Why it is neglect: Residents are not just there for medical monitoring; they are there to live. Leaving residents isolated in their rooms all day or treating them as objects rather than people is a profound form of neglect.
• What to look for:
  • Your loved one seems unusually withdrawn, non-communicative, or depressed
  • They express feelings of being a burden
  • Staff members are heard yelling, scolding, or talking down to residents
  • The resident seems fearful of a particular caregiver
  • A previously social resident now refuses to participate in activities

How to Spot Nursing Home Neglect When You Visit

Your visits are your most powerful tool. To be effective, you must be more than just a visitor; you must be an inspector.

• Vary your visit times. Do not always come on Sunday afternoon. Show up at mealtime on a Tuesday or early on a Saturday morning. This provides you a more accurate view of the facility's typical operations, not just the "show" they put on for weekend guests.
• Observe staff-resident interactions. Do staff members make eye contact with residents? Do they speak to them respectfully? Or do they ignore them and treat them impersonally?
• Ask your loved one open-ended questions. Instead of "Did you have a good lunch?" Ask, "What did you have for lunch today?" Instead of "Are they treating you well?" ask "What did you do this morning?" or "Who helped you get dressed today?"
• Use your senses. Do you smell urine or feces? Does the room feel clean? Is the food palatable?
• Evaluate for yourself. Gently check your loved one's skin for pressure sores. Look in the bathroom to see if it is clean. Check the call button to ensure it works.

What to Do if You Suspect Nursing Home Resident Neglect

If your observations raise serious concerns, you must act. Do not dismiss your intuition.

1. Document Everything. This is the most important step. Take notes of your observations with dates and times. Take photographs of injuries (like bedsores), unsanitary conditions, or soiled bedding. Obtain the names of the staff members you speak with. This documentation is vital.
2. Raise Your Concerns with Management. Schedule a formal meeting with the facility administrator or the Director of Nursing. Present your documented concerns calmly and firmly. Put your complaints in writing in a follow-up email so there is a paper trail.
3. File a Formal Complaint. If management is unresponsive or the problem persists, escalate the issue. You can file a formal complaint with your state's Department of Health, which is responsible for licensing nursing homes. You should also contact your state's Long-Term Care Ombudsman program. An ombudsman is a resident advocate who investigates and resolves complaints.
4. Contact a Legal Professional. If your loved one has suffered a significant injury, illness, or a severe decline in health due to these failures, it is time to seek legal advice.

Taking Legal Action: When to Contact an Attorney for Nursing Home Neglect

Filing a complaint with the state can help fix the facility's systemic problems, but it will not compensate your loved one for the harm they have already suffered. That is the purpose of a civil lawsuit.

Filing a lawsuit for nursing home neglect is a way to hold the facility and its parent corporation financially accountable for their negligence. A successful claim can provide compensation for:

• Medical bills to treat the resulting injuries (e.g., hospital care for a fall or infection)
• The cost of moving to a new, safer facility
• Pain and suffering
• Disability or disfigurement
• Wrongful death, if the neglect led to your loved one's passing

An attorney with experience in nursing home neglect can investigate your case, gather evidence (like staffing records and medical charts), and determine if the facility breached the standard of care, leading to your family member's injuries.

Need Legal Help? Brandon J. Broderick, Attorney at Law, is One Phone Call Away

Discovering that a loved one has been harmed by the very people entrusted with their care is a devastating experience. You may feel angry, guilty, and unsure of what to do next. You do not have to face this situation alone.

At Brandon J. Broderick, Attorney at Law, we have seen firsthand the heartbreaking consequences of nursing home neglect. We are dedicated to fighting for the rights and dignity of vulnerable seniors and their families. We believe in holding negligent facilities accountable and securing the justice and compensation your family deserves.

If you suspect nursing home neglect, do not wait. Contact us today for a free, confidential consultation. We will listen to your story, review your evidence, and explain your legal options. We are available day or night to assist you.