Asking the right Questions  |  Signs of Nursing Home Neglect

One of the most difficult decisions a family may have to make is to decide whether to put a loved one in the care of a nursing home. Today approximately 1.6 million elderly and disabled Americans are cared for in nearly 17,000 U.S. nursing homes. According to the Health Care Financing Administration (HCFA), which administers Medicare and oversees the state Medicaid programs, nursing homes care for about one in 20 Americans over the age of 65. As the percentage of our population over age 65 increases, the percentage of elderly people entering nursing homes will likewise increase.

While we work hard to get the best care possible for our family members, it’s often difficult to be sure our loved ones aren’t falling prey to problems such as psychological, emotional, and physical abuse or financial abuse, found in some the nation’s senior care facilities. It is believed that most nursing home neglect cases are the result of high staff turnover and poorly skilled staff. Another cause of neglect is under-staffing which results in too few health care aides who are forced to work long shifts.

A good source of information for finding out about staffing and other issues at your local nursing home is your long-term care ombudsman. The ombudsman visits nursing homes regularly, investigates complaints, advocates for residents, and mediates disputes. There are more than 500 local ombudsman programs across the country. While the ombudsman is not allowed to give recommendations for nursing homes, he or she can provide information about specific facilities.

Some of the questions you should ask include:

  • What are the results of the latest ombudsman survey of the facility?
  • How many outstanding complaints are there?
  • How many complaints were lodged in the last year?
  • What was the nature of the complaint(s)?
  • What were the results of recent investigations?
  • What is the staff/resident ratio?
  • How many residents are in the facility?

Asking these questions does not guarantee a problem-free nursing home experience, but it will increase your chances of finding a facility that is responsible and well-equipped to handle your family member’s needs.

HCFA is well aware that problem nursing homes exist. At the end of 1999, HCFA Administrator Nancy-AnnDeParle said that nursing homes that fail to protect residents from harm would face immediate penalties. In addition to instructing states to impose sanctions, HCFA has enhanced its consumer Internet resource called Nursing Home Compare, which can be found at Users can search facilities by state, county, or zip code. The information allows you to compare the prevalence of health problems, such as bedsores and weight loss, among various nursing homes. The difficult task of finding a quality nursing home facility is made much easier for today’s decision makers because of the wide range of resources now available.

For a printed copy of HCFA’s Guide to Choosing a Nursing Home, call the Medicare Choices Help line at 1-800-633-4227. Other organizations to call include the American Association of Retired Persons (AARP) at or 1-800-424-3410 and the National Citizens Coalition for Nursing Home Reform which can be reached at (202) 332-2275 or via the Web at

Signs of Nursing Home Neglect:

  • Bedsores/Pressure Sores,
  • Dehydration (one sign is a lack of skin elasticity),
  • Rapid weight loss,
  • Poor personal hygiene,
  • Unsanitary and unclean conditions,
  • Infections,
  • Open wounds, cuts, bruises or welts,
  • Caretaker cannot adequately explain condition,
  • Elder has sudden change in behavior,
  • Unexplained injuries

Pressure Sores

The incidence of pressure sores is sufficiently high to warrant concern among health care providers. Studies reveal that pressure sores are prevalent in our nation’s nursing homes. Pressure sores, also known as decubitus ulcers, usually occur over bony prominences and are graded or staged to classify the severity of the wound.

 Stage 1: A defined area of persistent redness in lightly pigmented skin, or may appear as persistent red, blue or purple hues in darker skinned individuals.
Stage 2: The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.
Stage 3: The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.
Stage 4: Extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures.