As our country’s population ages, it is inevitable that many will need additional care. While some may be able to care for their elderly family members themselves, others may need to hire home health aides or move loved ones into nursing homes or other assisted living facilities. Although no one wants this day to come, those of us who realize we can no longer take care of our family members at home must entrust the care of our loved one to professional care facilities.

The two key words are “professional” and “care.”

While often discussed under the heading of elder abuse, nursing home neglect presents itself in different ways. Nursing home abuse occurs when a caregiver intentionally harms a patient.  Nursing home neglect, however, occurs when a caregiver provides substandard care or commits a breach of duty.  Negligence is the failure to provide the proper level of care. This includes failure to give residents proper food, shelter, hygiene, medicine, and wound care.

Potential neglect and prolonged isolation may have caused serious harm to many people in nursing homes in the United States during the Covid-19 pandemic.  Before the pandemic, the Nursing Home Abuse Center, “Nursing home neglect is the most common type of elder abuse in nursing facilities, with 95 percent of nursing home residents reporting neglect in the past year.”  The Centers for Disease Control and Prevention reports that approximately 500,000 adults over the age of sixty are abused or neglected each year, and it is likely there are many cases that are never reported. 

There is a legitimate fear of elder abuse for nursing home residents and others who have loved ones living in nursing homes during this time.  Even before the COVID-19 pandemic, the US government failed to ensure that nursing homes were adequately staffed and regulated.  Staffing shortages, a longstanding issue that was a significant problem during the pandemic, and the absence of family visitors, many of whom nursing homes rely on to help staff with essential tasks, may have contributed to possible neglect and decline.

Though many of these facilities offer quality care to their residents, it is important to recognize signs of neglect.  Diminished mental capacity is the most common reason that the elderly become victims because they may not fully understand daily matters, especially those involving their health care and finances.   The surge of COVID cases within already short-staffed nursing homes created many opportunities for staff to become so consumed with COVID patients, that they may have neglected the basic needs of residents who did not contract it, often because overburdened workers haven’t been able to give them the care they need.

A nursing home expert who analyzed data from the country’s 15,000 facilities for The Associated Press estimates that for every two COVID-19 victims in long-term care, there is another who died prematurely of other causes. Those “excess deaths” beyond the normal rate of fatalities in nursing homes could total more than 40,000 since March. These extra deaths are roughly 15% more than you’d expect at nursing homes already facing tens of thousands of deaths each month in a normal year.

Unfortunately, this increase is not shocking, since elder abuse occurs in the first place due to the vulnerability of the elderly population. Due to the isolation brought on by quarantining and other tactics used to slow the spread of the virus, this population has become even more vulnerable.


Nursing home neglect varies based on individual cases. There are four major categories:

  • Medical Neglect – when a nursing home fails to appropriately attend to or prevent medical issues of the residents, such as diabetes care, bed sores, infections, mobility, and cognitive disorders.  Negligent hiring. Failure to do proper background checks before hiring someone who has a past record of negligence or abuse. This may also prove that the nursing home improperly trains and supervises its employees.   Negligent supervision. Residents should be properly supervised to avoid falls and other accidents.  Medication errors and inadequate medical treatment. When incorrect medical treatment or medicine is given to a resident and harm results, there may be a malpractice case filed against the facility or the patient’s physician.
  • Neglect of Basic Needs – when a facility fails to ensure that patients have a clean, safe environment, such as appropriate food, water, and shelter. Additionally, nursing home neglect can include failure to keep the premises safe and maintain health and safety policies. This includes preventing falls, protection from other residents, and keeping clean living conditions. Unplanned weight loss and severe bed sores worsened among residents during the pandemic.
  • Neglect of Personal Hygiene – when a nursing home fails to provide satisfactory aid to residents who need assistance with tasks, such as cleaning, bathing, tooth brushing, laundry, or other types of hygiene.
  • Social or Emotional Neglect – when staff members demean patients, such as consistent rejection, abandonment, or verbal insults. Human Rights Watch revealed concerns after a surge in reports from independent monitors included severe mental and physical decline, as well as inappropriate use of psychotropic medications among nursing home residents.


Because warning signs of neglect can be slight, they can be difficult to identify.  At times, depending on the type of negligence, there may be no outward signs of neglect. Often, behavioral changes in patients will be noticed only by those who see their loved ones frequently.

In March 2020, the Centers for Medicare &Medicaid Services (CMS), the federal regulator for nursing homes, restricted all visitation in response to the coronavirus, with the exception of end-of-life situations. CMS expanded visitation somewhat in September, though family members told Human Rights Watch that visits remained limited. In March 2021, amidst high vaccination rates among nursing home residents, CMS reauthorized most visitation.

Other policies contributed to reduced transparency into nursing homes’ operations. In March 2020, CMS barred long-term care ombudspersons from visiting facilities, with limited exceptions, and suspended all routine inspections by state surveyors except for infection control. Standard ombudsperson visits and state inspections were resumed in September, although some ombudspersons reported barriers to entry due to limited personal protective equipment or testing, and inspections have been inconsistent across states.

Because family members and independent monitors were restricted in their ability to visit loved ones during the pandemic, there were less opportunities to raise concern over the changes to the conditions of the elderly patients.  Many family members were forced to believe what the staff was relaying to them as their only option for updates, as they were not able to get into facilities.

As visitation policies begin to allow residents and their family members to visit again, be on the lookout for physical, sexual, and financial abuse. Look for signs of bruising, pressure sores, and broken bokes. Listen to complaints from your loved one. Watch for any fearful or changed behaviors.  Although neglect can be difficult to identify and prove, these are some of the most common signs:

  • Malnutrition, dehydration, or sudden weight loss
  • Bed sores and/or pressure ulcers
  • Falls that result in injury
  • Withdrawal from activities/socializing
  • Change in hygiene habits or physical appearance
  • Hazards such as slippery floors, bad lighting, or unsafe furniture and equipment


  • Falls – The nursing staff should assess each resident’s fall risk and take appropriate preventative measures. These measures include wheelchairs, walkers, bed rails, bed alarms, and nursing assistance.
  • Elopement – Some residents, particularly those suffering from dementia, are prone to wandering from the facility. The facility must assess for this risk and take appropriate precautions.
  • Dehydration – The medical conditions of some residents make them prone to dehydration. The nursing staff must assess for this risk and continually monitor the patient’s condition.
  • Choking – Some residents are at risk of choking, and thus must be assessed. Demented patients sometimes suffer from dysphagia, which alters the ability to swallow correctly. The nursing staff must take particular precautions, such as pureed food or assistance with eating.
  • Pressure sores – These are preventable. Residents whose mobility is restricted necessarily must lie in one position for long periods. This causes pressure on the skin, resulting in lack of blood flow to the tissue. The staff must continually assess the resident for signs of pressure injuries and take measures (turning, cushioning, nutrition) to prevent sores from developing.
  • Medication errors – This is caused when the nursing staff does not follow the physician’s orders, such as failing to give the prescribed medicines or administering the wrong dosage.


Let’s be candid. All residents of nursing homes are there for a reason. They are sick. They are injured. Many are enfeebled. Many are very old. Often the best care, the most professional care, is not enough. Sometimes, however, the nursing facility makes things worse. Sometimes the care is not professional.  Indeed, sometimes there is “no care.” It is these instances in which the law can provide a remedy.

The current lockdown rules due to COVID-19 can give abusers an opportunity to commit acts of abuse and prevent their victims from seeking help. Family and friends of nursing home residents play a crucial role in catching and reporting nursing home abuse and neglect. If the restrictions in place due to the pandemic keep people from their loved ones in nursing homes, this can just make matters worse.

If you believe your loved one is being neglected or abused, move him/her to a safe environment and call the police or Adult Protective Services.  The next step is to consider taking legal action. Nursing home negligence or abuse may be a crime and could be grounds for a civil lawsuit. The facility may be liable if it participated in negligent medical treatment, supervision, hiring, or safety practices.

When reviewing a potential nursing home case, I look for violations of professional standards. Has the facility failed to follow federal and state safety regulations? Has it failed to follow its own policies? Has it failed to do proper background checks on its employees? Has it failed to properly supervise its staff? Was there enough staff?