Nursing Home Abuse and Neglect

As a lawyer who handles nursing home abuse and neglect cases, I have seen first hand the various types of abuse and neglect in nursing homes.  I have handled cases involving bone fractures, inadequate hygiene, unclean living conditions, pressure ulcers, severe weight loss, sepsis, falls, drops, and wrongful death.  In my experience, neglect does occur because the staff does not care enough but because there is not enough staff to care.  The following are the most prevalent indicators of abuse and neglect:

Repeated Falls

Accidents happen. However, residents in nursing care require supervision and the assistance of devices to help the move about. Residents should not fall repeatedly, and if a resident is falling and getting injured, this is an indication of neglect.  Consider these statistics from the Center of Disease Control (CDC) analyzing elderly fall risks and prevention strategies:

  • One out of five falls causes a serious injury such as broken bones or a head injury.
  • Each year, 2.8 million older people are treated in emergency departments for fall injuries.
  • Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.
  • Each year at least 300,000 older people are hospitalized for hip fractures.

A majority of the nursing home neglect cases we see involve fractures connected to understaffing and failure to supervise, failure to toilet or implement interventions to prevent wandering.

Fractures of Unknown Origin

Although nursing homes will contend that bones just spontaneously break, this is just not true. Almost all the time, a fracture is the result of trauma and most of the time, trauma is the result of negligence. When a nursing home tells the family they do not know how a resident broke a bone, this should be an obvious warning sign.


Hydration is critical to health, particularly of the elderly and failure to properly hydrate residents can be an obvious sign of neglect.  Does your loved one exhibit any of these warning signs for dehydration:

  • Headaches
  • Fatigue
  • Dizziness
  • Dark urine
  • Electolyte imbalance (Sodium, BUN, Creatine)
  • Difficulty in swallowing
  • Painful urination

Because the elderly are already more prone to illness, dehydration only increases such chances of illnesses as it weakens the overall body. This report, Dehydration in Geriatrics, highlights the serious consequences, including: “Mortality of patients with dehydration is high if not treated adequately and in some studies exceeds 50%.” If dehydration is not quickly and properly treated, it can be fatal. Unless a resident is terminal and non-responsive, there is no excuse for a resident becoming dehydrated and certainly no excuse for not detecting it and properly treating it.


Pressure ulcers are an epidemic among bed bound populations, with a reported prevalence as high  43% among those in nursing homes.  Bedsores (also referred to as pressure ulcers and decubitus ulcers) are a serious health risk, with the most serious complication being sepsis resulting in death.  This is so because the most significant risk factor of developing a bedsore is immobility–someone who cannot move or get out of bed on their own and must depend on the care of another. Because most bedsores are preventable, the mere existence of one may indicate medical negligence and a failure by the nursing home to properly reposition a resident, among other failures.  Once again, understaffing is a primary culprit.

Weight Loss

Malnutrition is the silent epidemic in our nursing homes. Studies have shown that from 35 to 85 percent of nursing home residents in the United States are malnourished. The effects of malnutrition are devastating. Malnutrition can lead to infections, bedsores, slow healing, bones fractures, and fatigue.  So, not only are malnourished residents in nursing homes are being deprived of one of life’s great pleasures, but nutrients and calories necessary to thrive and even just survive.

Once again, one of the most significant causes of this is understaffing. It takes 30 to 60 minutes to feed a resident, who cannot feed themselves, safely and adequately.  Studies have shown a clear correlation between patients with dementia who are unable to feed themselves and malnutrition.  Prevention of malnutrition is simple in most circumstances-take the time and care to feed the resident.

Untreated Pain

Pain is preventable. No one should have to suffer unnecessarily. Just because many residents cannot speak does not mean they cannot communicate. Look for signs of pain: Increased confusions, facial expressions, sensitive to touch, moaning, and depression. The Nursing Home Quality Campaign has published this fact sheet on pain assessment and pain management.  Become an advocate.

The Primary Cause:  UNDERSTAFFING

The most expensive line item on a nursing home budget is labor.  Controlling labor costs is a path to profits, and for some companies, profit is more important than care.  So, when it takes 7 hours of direct care to provide adequate care to a resident who requires assistance with all of their “activities of daily living” (ADLs), but profits increase when a facility only pays for 6 hours of direct care, something gives.  This version of “Russian roulette” calculates that even if someone gets hurt, it is simply more profitable to understaff.

Consider:  The nation’s largest for-profit nursing homes deliver significantly lower quality of care because they typically have fewer staff nurses than non-profit and government-owned nursing homes.  That’s the finding of a University of California at San Francisco (UCSF) led analysis of quality of care at nursing homes around the country. It is the first-ever study focusing solely on staffing and quality at the 10 largest for-profit chains.  The report concluded:

“The top 10 for-profit chains had lower registered nurse and total nurse staffing hours than government facilities, controlling for other factors. The top 10 chains received 36 percent higher deficiencies and 41 percent higher serious deficiencies than government facilities. Other for-profit facilities also had lower staffing and higher deficiencies than government facilities.” 

To find about self-reported staffing levels at Greenville nursing homes or even Upstate nursing homes, lick on “Nursing Home Compare.” Use the information about a nursing home’s residents (such as number with incontinence) to see if the resident mix is one that will stretch the demands of the staff compared with other nursing homes under consideration.

Greenville Nursing Home Abuse Attorney

I am Andy Arnold.  I have handled cases involving all of the above types of nursing home abuse and neglect. He has created this website as a resource. Knowledge is power, and we have to protect our own. If not us, then who. However, sometimes circumstances spiral out of control, and we need help. I can help. Call me at the Horton Law Firm at 864.233.4351.