Nursing homes are meant to be a safe haven for the elderly and disabled, yet abuse and neglect remain far too common behind their doors. About 1.2 million people live in Medicare- and Medicaid-certified nursing facilities in the United States, and a long record of federal inspection findings shows a substantial share of facilities have been cited for abuse or neglect at some point. Knowing what the different forms of abuse look like, how to report them in Illinois, and which deadlines apply is how families stop it.
Types & Signs of Nursing Home Abuse
Abuse in a nursing home can take many forms, from overt violence to quiet neglect. Most of it traces back to the same problems: understaffing, poorly trained staff, and poor management. Federal research suggests roughly 1 in 10 adults age 60 and older experience some form of abuse, a figure drawn largely from people living in the community rather than in facilities, and mistreatment inside facilities is widely believed to be underreported. Knowing what each type looks like is the first step to stopping it.
Physical Abuse and Assault
Physical abuse can be intentional physical harm or the denial of basic needs, and it is not limited to overt acts of violence. Many cases go unreported because victims are afraid to speak up or simply cannot, and family members are frequently unaware. Physical assault, including slapping, kicking, unnecessary force, pushing, shaking, or pinching, is one of the most egregious types and is most commonly committed by staff or other residents. When residents assault one another, it usually signals that they are being neglected and left unsupervised.
Physical abuse can include:
- Excessive force during routine care, leaving bruised wrists or arms, internal bleeding, cuts, broken teeth, or hair loss
- Battery such as slapping, kicking, or hitting
- Withholding prescribed medication, or administering medication that was never prescribed
- Overuse of physical or chemical restraints for discipline or convenience, which the federal Nursing Home Reform Act of 1987 prohibits
- Withholding food or water, which can lead to malnutrition or dehydration
Warning signs of physical abuse or assault include sudden behavior changes, emotional outbursts, unexplained bleeding, fractures, bruises, burns, or other marks, signs of restraint, sudden depression or fear of staff, social withdrawal, torn clothing, drowsy or confused behavior, weight loss or dehydration, staff refusing to let you be alone with your loved one, and direct accusations of abuse. If you believe your loved one is in immediate danger, call 911.
Emotional Abuse
Emotional abuse is any abuse that causes a resident emotional harm or anguish. It can be verbal or nonverbal, and while most is perpetrated by staff, it can also come from other residents. It is dangerous because of the lasting psychological damage it causes and the decline it can trigger in physical health. Emotional abuse can be difficult to observe, and residents may not even recognize that it is happening.
Some types of emotional abuse include:
- Intimidation and threats
- Insulting and ridiculing a resident
- Yelling
- Threatening to withhold food or water
- Preventing a resident from attending social events, or isolating and ignoring them
Signs of emotional abuse include withdrawal, agitation, excessive fear, nervousness, sudden changes in personality, unusual behaviors such as rocking, biting, or thumb-sucking, and refusal to interact with others. As stress weakens the immune system, physical indicators can follow, including loss of appetite, insomnia, weight loss, refusal to take medications, and infections or injuries. Residents who require extra care, such as those with cognitive dysfunction or memory impairment, and those who are older and more vulnerable are most at risk.
Sexual Abuse
Sexual abuse of nursing home residents is among the least often reported forms of abuse, which is part of what makes it so dangerous. Elderly residents are vulnerable in many ways, whether physically weak or lacking the capacity to alert anyone, as is often the case with advanced Alzheimer’s or dementia. Abuse typically comes from a co-resident or a staff member, but the facility itself may be at fault. Staff duties allow intimate contact with residents, which is why facilities need thorough background investigations of potential employees and real supervision of the people they hire. Inadequate screening lets people with violent or deviant histories work closely with an extremely vulnerable population.
Illinois does not leave reporting to chance. Under the Abused and Neglected Long Term Care Facility Residents Reporting Act, facility administrators, agents, and employees, along with physicians, nurses, and other listed professionals, must report immediately once they have reasonable cause to believe a resident has been abused or neglected (210 ILCS 30/4). A facility that fails to prevent abuse, or to respond appropriately once it is discovered, may be found negligent and can have its license revoked. Warning signs include bruises, sudden behavior changes, and a sexually transmitted infection.
Physical or Chemical Restraints
Restraints aim to restrict or prevent a resident’s movement. They may be used to protect the safety of residents and staff, but they are often overused. The Nursing Home Reform Act of 1987 states that residents have:
“The right to be free from … any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms.”
The Act does not ban restraints entirely, but it sets strict guidelines: residents may only be restrained to ensure safety, and only under the written orders of a doctor specifying the duration and reason, except in an emergency. When restraints are used for control, discipline, laziness, or because of understaffing, it is abuse.
Physical restraints are any manual, physical, or mechanical device that prevents freedom of movement and cannot be removed by the resident. Examples include hand mitts, restrictive chairs, wrist and ankle restraints, vests tied to the bed, sheets tucked too tightly, belts, wheelchairs pushed against a wall, and bed rails. Bed rails are not always a restraint, but a resident restrained to one may be injured or strangled trying to climb over, under, or through it.
Chemical restraints are psychoactive drugs used to control behavior such as restlessness, pacing, wandering, and uncooperativeness. The most commonly used include antipsychotics, which carry severe side effects including life-threatening heart conditions, along with benzodiazepines and dissociative anesthetics.
Restraining a resident can cause bedsores, increased agitation, loss of muscle function and balance, fractures, urinary incontinence, decreased daily activity, increased cognitive dysfunction, edema, and death. Research has not shown restraints to be effective at preventing falls, and federal safety regulators have linked bed rail entrapment to deaths among older adults in facilities and at home.
Malnutrition
Malnutrition is a widespread problem in nursing homes. Studies of the roughly 1.2 million residents nationwide have put the share affected anywhere from a small fraction to a third or more, depending on which facilities were studied and how malnutrition was defined. Most causes trace back to staffing. Homes are frequently understaffed, and high turnover leaves inexperienced, poorly trained employees responsible for more residents than they can properly feed and monitor.
Physical symptoms of malnutrition include skin that becomes yellow, dull, and heavily wrinkled; cognitive difficulties such as confusion, listlessness, and dementia-like symptoms; mouth issues such as bright red gums, oral yeast infections, and canker sores; weaker, flaccid muscles that tire easily; and worsening vision with red, glassy eyes or swollen corneas.
Unsanitary Conditions
Unsanitary conditions and a lack of clean water or handwashing facilities put residents at serious risk. Poor sanitation can contribute to urinary tract infections, along with other infections and diseases spread by microbes and parasites. Dirty, bloody, or stained clothing and soiled bedding are a common red flag that a facility is not providing adequate care.
Urinary Tract Infections (UTIs)
A urinary tract infection is an infection in any part of the urinary tract, most often the lower tract of the bladder and urethra, when bacteria in the urine multiply. Left untreated, a symptomatic UTI can lead to kidney infections and a life-threatening blood infection (sepsis). Elderly residents are at increased risk due to age-related changes that weaken bladder muscles and reduce kidney efficiency, making it harder to fully empty the bladder. When homes are understaffed or poorly trained, the symptoms are easy to miss.
Early signs in the elderly are often behavior-related, including new incontinence, confusion, and difficulty completing simple tasks. Other symptoms include a persistent need to urinate, cloudy urine, burning urination, brown, pink, or red urine, strong-smelling urine, and pelvic or rectal discomfort. If the infection reaches the kidneys, fever, chills, nausea, vomiting, and side pain may appear. A UTI that is causing symptoms is treated with antibiotics, and severe cases may require hospitalization. Bacteria found in the urine of a resident with no symptoms is a different situation, and current infectious disease guidelines advise against screening for or treating it in long-term care residents, since antibiotics in that situation carry risk without benefit. What matters for families is that real symptoms are evaluated and treated promptly rather than ignored.
Pressure Sores (Bedsores)
Pressure sores, also called pressure ulcers, are wounds caused by unrelieved pressure on the skin, typically on the elbows, heels, hips, back, and scalp. Federal survey data has found that more than 1 in 10 nursing home residents had a pressure sore. They can range from simple redness to a crater deep enough to expose muscle or bone, causing serious complications.
Because pressure sores are largely preventable, nursing homes and hospitals have procedures meant to stop them from forming, including turning schedules for bed-ridden residents. A common failure is that caretakers do not turn residents on schedule, allowing sores to form. If a caretaker acted negligently and a loved one died from extreme pressure sores or their complications, the family may be able to pursue a wrongful death case based on that negligence.
Inadequate Supervision and Neglect
Nursing home staff are responsible for keeping residents safe, and inadequate supervision is one of the most common causes of injury. The Illinois Nursing Home Care Act (210 ILCS 45) sets the rules facilities and residents must follow, and it covers inspections, complaints, and violations. Once a resident is admitted, it is the home’s duty to provide care and supervision appropriate to that resident.
Activities that require supervision include bathing, which is dangerous for those with diminished balance, walking, where staff should assess each resident’s fall risk, and eating and drinking, where staff must ensure proper hydration and nutrition and prevent burns from hot food. Residents also need supervision when dressing, taking medication, and even sleeping.
Signs of inadequate supervision include malnutrition, dehydration, unexplained falls, bone fractures, untreated wounds, pressure ulcers, poor hygiene, medical errors and poor notification, missing records, residents wandering from the facility, a lack of formal care plans, insufficient staffing, and inadequate protection measures.
Recognizing the Signs of Poor Care
Moving a loved one into a nursing home requires a great deal of trust. Families who live far away often must rely on updates from staff, so maintaining consistent communication and asking direct questions is important. In-person visits remain the best way to assess your loved one’s condition, and it is essential to trust your instincts when something does not seem right.
Watch for these conditions and circumstances, which may signal a deeper problem of abuse or neglect:
- Sudden changes in mood or behavior, such as anger, anxiety, depression, or withdrawal
- The development of bed sores, particularly on the buttocks or heels
- Dirty, bloody, or stained clothing and soiled bedding
- Stiff or unmoving joints
- Bruises, burns, cuts, or fractures
- Sudden or rapid weight loss, dehydration, or malnutrition
- Poor hygiene
- A sexually transmitted infection
- Fatigue, exhaustion, or an overly medicated demeanor
Also pay attention to how staff act around you and your loved one. Do they seem impatient, annoyed, or burdened by your presence? Does your loved one behave differently around particular staff members? Have they ever delayed or refused your request for a visit? Making surprise visits on different days and at different times helps ensure staff are not simply putting on a good show when they know you are coming.
Reporting Nursing Home Abuse
Nursing home abuse and neglect is a serious problem, and far too many cases go unreported. Surveys of residents, families, and staff have repeatedly found rates of mistreatment well above what shows up in official complaint data. If you suspect a loved one has been a victim, the first step, if possible, is to remove them from the situation and report the abuse to authorities.
To file a complaint, keep it brief and include your name, contact phone number and address, the name, address, and phone number of the nursing home, and a description of the problem or incident. The complaint should go to the government agency responsible for investigating claims against nursing homes. In Illinois, that is the Illinois Department of Public Health (IDPH). The agency usually contacts the person who filed to discuss the details, then makes a surprise visit to the facility to conduct its investigation.
Surprise visits are performed both by state inspectors and by family members. The IDPH will perform a surprise visit when a family member files a claim of abuse. If you ever suspect that your loved one is not receiving proper care, make a report with the IDPH at 800-252-4343.
Deadlines That Can End a Case Before It Starts
Do not wait to get legal advice. More than one clock can be running at the same time, and the shortest one controls:
- Two years from the date the injury occurred for most negligence and Nursing Home Care Act claims against a facility (735 ILCS 5/13-202)
- Two years from the date of death for a wrongful death claim, measured from the death rather than from the neglect that caused it (740 ILCS 180/2)
- One year for a claim against a county, township, or other publicly operated facility or its employees, a deadline that bars the claim on its own no matter how strong the case (745 ILCS 10/8-101)
- A two-year discovery period with a four-year outer cutoff for claims against a physician, registered nurse, or hospital (735 ILCS 5/13-212), which may or may not reach the facility itself depending on how the claim is pleaded
Because which deadline applies turns on who is being sued and how the claim is framed, treat the shortest one as your real deadline and let a lawyer sort out the rest. Assuming you have four years when a flat two-year clock is running is how good cases get lost.
Getting Legal Help
Once your loved one is safe and authorities have been notified, speak with an experienced personal injury attorney about enforcing your loved one’s rights. An attorney can gather evidence, determine whether background checks were performed and protocol was followed, establish whether the facility knew of the abuse, and hold those responsible accountable so future abuse is prevented. The Nursing Home Care Act also allows a resident whose rights were violated to recover actual damages plus costs and attorney’s fees from the licensee (210 ILCS 45/3-602), which can make a claim worth pursuing that might otherwise be too small to bring.
844-SEE-MIKE represents victims of nursing home abuse and neglect throughout Illinois. We will keep you informed at every step and are prepared to take a case to trial when that is what it takes. You pay no attorney’s fees unless we recover money for you.
Talk With 844-SEE-MIKE
If you believe a loved one has been abused or neglected at a nursing home, you do not have to work it out alone. This is general information, not legal advice for your specific situation. Contact 844-SEE-MIKE for a free, no-pressure consultation.
