Types of Nursing Home Abuse: A Complete Guide

Your loved one deserves to be safe. But when 64.2 percent of nursing home staff admit to some form of abuse, safety is not a given. Abuse does not always look the way families expect. It can be a bruise, but it can also be a missing bank deposit, a sudden mood change, or a bed sore that no one treated. Knowing the different types helps you see what might go unseen.

A nursing home abuse attorney can help you figure out what type of abuse your loved one may have been through and explain your legal choices. The call is free and private.

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What Are the Types of Nursing Home Abuse?

Federal law names five types of nursing home abuse. Each one is defined in 42 CFR 483.5 and banned under 42 CFR 483.12. Every nursing home that takes Medicare or Medicaid must follow these rules. That covers nearly every home in the country.

Physical abuse is the willful use of force that causes injury, pain, or harm. It means hitting, kicking, slapping, shoving, and rough handling. Misuse of restraints is also physical abuse. Learn more in our guide to physical abuse in nursing homes.

Sexual abuse is any sexual contact with a resident who has not agreed or cannot agree. This means unwanted touching, assault, and forcing a resident to watch sexual acts. See our full guide on sexual abuse in nursing homes.

Emotional abuse is verbal or nonverbal conduct that causes fear, pain, or distress. It means yelling, threats, shaming, cutting off contact, and ignoring a resident. Read more about emotional abuse in nursing homes.

Financial abuse is the misuse of a resident’s money, property, or assets without their consent. It means stealing, forging names, and pressing a resident to change legal papers.

Neglect is the failure to give the care, services, or watching over that a resident needs. This covers everything from skipping pills to leaving a resident in soiled clothing for hours.

One key fact: the home is also on the hook for stopping resident-on-resident abuse. A study of 10 New York nursing homes found a 20.2 percent rate of this kind of harm. When one resident hurts another, the nursing home may be liable for failing to protect them.

For an overview of the broader issue, visit our nursing home abuse resource page.

Warning Signs Across All Types

Each type of abuse leaves different clues. But families should watch for signs across all five types. Here are the red flags that research has found to be the strongest.

• Bruises, burns, or injuries in places that do not match a fall
• Mood changes: pulling away, fear, sudden sadness, or worry that no illness can explain
• Staff who cannot explain certain injuries or who tell clashing stories about what happened
• Rapid weight loss, dry skin and mouth, or worsening bed sores the home has not dealt with
• Genital or rectal injury, soreness, or bleeding with no medical reason
• A resident who seems afraid of a certain staff member or refuses to be alone with them
• Changes in bank accounts, missing items, or new papers the resident did not sign
• A resident who says they were yelled at, threatened, shamed, or cut off from others
• Restraint marks on wrists or ankles that are not in the care plan
• Other residents showing fear or worry around a certain staff member

For a deeper look at how to recognize these patterns, see our guide to signs of nursing home abuse.

When the Nursing Home Is Responsible

Federal law does not just ban abuse. It puts clear duties on nursing homes to stop it.

Under 42 CFR 483.12, homes must check workers before hiring, train staff to prevent abuse, and look into any suspected abuse right away. They must report suspected abuse to the state within 2 hours and turn in findings within 5 working days. These rules cover all five types.

The law also holds homes liable for resident-on-resident harm. If a nursing home knows a resident acts out and fails to step in, the home is at fault.

How widespread is the problem? A 2019 study found that 64.2 percent of staff admitted to some form of abuse. The breakdown: 32.5 percent named mental abuse, 12 percent neglect, 9.3 percent physical abuse, and 0.7 percent sexual abuse. Another study found that 22 percent of care workers reported misusing restraints, 22 percent admitted to verbal abuse, and 20 percent reported neglect.

This is not a few bad workers. The CDC points to short staffing, burnout, and stress as primary risk factors. When homes cut corners on staffing, abuse becomes likely. The causes of nursing home abuse run deeper than one person’s choices.

What Happens When Abuse Goes Unchecked

When abuse is not stopped, it gets worse. It also tends to pile up. A resident who is hit often suffers mental harm too. A resident who is neglected is more open to being taken advantage of.

Eighty percent of nursing home abuse never reaches any authority. Only 7 percent of cases are formally reported. The GAO found that abuse citations doubled from 430 to 875 between 2013 and 2017, but follow-up actions often fell short.

The human cost is huge. The CDC says elder abuse leads to more than 643,000 ER visits each year and costs the health system $33 billion a year. Mental abuse, the most common type, is also the hardest to spot. Victims may not show visible injuries. The harm – worry, sadness, fear, being cut off – builds over months and years.

Financial abuse strips residents of the money they need for their own care. A 2014 study found that stolen cash made up 78.4 percent of these cases, and family members were the ones doing it in 57.9 percent of them.

When no one is held to account, residents who go through one type of abuse are likely to face more. Without someone stepping in, the cycle goes on.