Most Common Types of Nursing Home Abuse

Nursing home abuse can take many forms, including physical, emotional, sexual and financial abuse, as well as neglect, abandonment and improper restraint. Warning signs may include unexplained injuries, sudden behavioural changes, poor hygiene, pressure injuries, missing money or a resident appearing frightened around a particular caregiver.

Not every injury or change in behaviour proves that abuse occurred. However, unexplained patterns, inconsistent explanations and repeated failures to meet a resident’s needs should be documented and investigated promptly.

If your loved one may be in immediate danger, call 911. You can also report suspected abuse or neglect to Virginia Adult Protective Services and the appropriate state licensing agency.

Atkinson Law helps families understand the most common types of nursing home abuse, the warning signs to watch for and the steps they can take to protect a vulnerable resident.

What Is Nursing Home Abuse?

Nursing home abuse is an intentional act, unreasonable confinement, intimidation, punishment or failure to provide necessary care that causes or threatens physical harm, pain, emotional distress or loss to a resident.

Abuse may be committed by an employee, administrator, contractor, visitor, family member or another resident. In some cases, the harm results from an individual’s deliberate conduct. In others, unsafe staffing, inadequate supervision, poor training or repeated failures to follow a resident’s care plan may contribute to neglect.

Under Virginia regulations, nursing home abuse can include verbal, sexual, physical or mental abuse, unreasonable confinement and depriving a resident of goods or services needed to maintain physical, mental and psychosocial well-being.

1. Physical Abuse

Physical abuse occurs when someone intentionally uses force against a nursing home resident or handles the resident in a way that causes pain, injury or physical distress.

Examples may include:

• Hitting, slapping, kicking or punching a resident
• Pushing, shaking or handling a resident roughly
• Pulling a resident out of bed or a wheelchair improperly
• Using unnecessary force during bathing, dressing or transfers
• Force-feeding a resident
• Using medication to sedate or control a resident without a proper medical purpose
• Applying restraints improperly or excessively

Warning signs of physical abuse

• Unexplained bruises, burns, cuts or abrasions
• Fractures, sprains or dislocations without a clear explanation
• Injuries at different stages of healing
• Marks around the wrists, ankles or torso
• Repeated emergency-room visits
• A delay between an injury and medical treatment
• Conflicting explanations from staff members
• The resident appearing afraid of a particular employee

Some residents bruise easily or experience falls because of existing health conditions. A single bruise does not necessarily prove abuse. Families should look for patterns, changes in behaviour and explanations that do not match the resident’s condition or medical records.

2. Emotional or Psychological Abuse

Emotional abuse involves words or behaviour that cause fear, humiliation, anxiety or mental anguish. It may occur without leaving visible injuries and can therefore be difficult for families to detect.

Examples may include:

• Yelling, insulting or swearing at a resident
• Threatening punishment, eviction or withholding care
• Mocking a resident’s disability, appearance or confusion
• Humiliating the resident in front of staff or other residents
• Ignoring repeated requests for help
• Preventing the resident from speaking privately with family members
• Using intimidation to discourage complaints
• Isolating the resident from friends or social activities

Warning signs of emotional abuse

• Sudden withdrawal or loss of interest in normal activities
• Anxiety, depression or unusual agitation
• Fearfulness around a particular caregiver
• Changes in sleep or eating habits
• Rocking, mumbling or other repetitive behaviours
• A resident becoming unusually quiet when staff enter the room
• Statements suggesting that the resident has been threatened

Residents with dementia or communication difficulties may be unable to provide a detailed account. Changes in behaviour should therefore be considered alongside staff explanations, medical records and observations made during different visits.

3. Sexual Abuse

Sexual abuse includes any unwanted sexual contact or activity involving a resident who did not consent or could not provide valid consent. Residents with cognitive impairments, limited mobility or communication difficulties may be particularly vulnerable.

Potential perpetrators may include employees, visitors, contractors or other residents. Facilities are responsible for responding appropriately to known risks and allegations involving resident safety.

Warning signs of sexual abuse

• Unexplained bruising around sensitive areas
• Torn, stained or bloody clothing
• Unexplained bleeding, pain or infection
• Sudden fear of being touched or examined
• Withdrawal, panic or emotional distress
• A sudden fear of a particular person or location
• Statements indicating unwanted contact

Seek immediate medical assistance when sexual abuse is suspected. Avoid washing clothing or other potentially relevant items until law enforcement or a medical professional provides instructions.

4. Financial Abuse and Exploitation

Financial exploitation occurs when someone improperly uses, takes or controls a resident’s money, property, benefits or personal information for someone else’s advantage.

Financial abuse may be committed by a caregiver, employee, family member, legal representative or another person who has access to the resident’s finances or belongings.

Examples may include:

• Stealing cash, jewellery or personal possessions
• Using a resident’s bank card without permission
• Forging signatures on cheques or financial documents
• Pressuring a resident to change a will or power of attorney
• Adding an unauthorised person to a bank account
• Charging for services that were not provided
• Withholding access to the resident’s own funds
• Coercing the resident into giving gifts or money

Warning signs of financial exploitation

• Unexplained withdrawals or transfers
• Missing valuables or personal belongings
• Sudden changes to financial or legal documents
• Unpaid bills despite sufficient available funds
• Unfamiliar names appearing on accounts
• A resident expressing confusion about recent transactions
• A caregiver showing unusual interest in the resident’s finances

Families should preserve bank statements, receipts, account alerts and communications relating to suspicious transactions. Financial exploitation may occur alongside physical or emotional abuse.

5. Nursing Home Neglect

Neglect occurs when a nursing home or caregiver fails to provide the timely and consistent care, treatment, supervision, goods or services needed to protect a resident’s health, safety and comfort.

Neglect may be intentional, but it may also result from inadequate staffing, poor training, weak supervision, communication failures or repeated disregard of a resident’s care plan.

Examples may include:

• Leaving a resident in soiled clothing or bedding
• Failing to assist with bathing, grooming or oral hygiene
• Not providing sufficient food or fluids
• Failing to administer medication as prescribed
• Ignoring call buttons or requests for assistance
• Failing to reposition residents who are at risk of pressure injuries
• Not providing necessary mobility devices, glasses, dentures or hearing aids
• Failing to monitor a resident who is at risk of falling or wandering
• Delaying medical evaluation after an injury or change in condition

Warning signs of nursing home neglect

• Poor hygiene, dirty clothing or unchanged bedding
• Dehydration or unexpected weight loss
• Pressure injuries or worsening wounds
• Repeated falls or unexplained injuries
• Medication errors
• Untreated infections
• Unsafe or unsanitary living conditions
• Strong odours in rooms or common areas
• Residents repeatedly calling for help without a response

A pressure injury, fall or infection does not automatically establish neglect. The surrounding circumstances matter, including the resident’s risk assessment, care plan, staffing records, monitoring and the facility’s response after the condition was identified.

6. Abandonment

Abandonment occurs when a person responsible for a vulnerable resident leaves that person without appropriate care, supervision or arrangements for their safety.

In a long-term care setting, abandonment may involve:

• Leaving a resident alone in an unsafe area
• Failing to supervise a resident who is at risk of wandering
• Leaving a resident at a hospital or another location without arranging continued care
• Failing to respond when a resident needs assistance
• Improperly discharging or transferring a resident without a safe care plan

Warning signs of abandonment

• A resident found outside or in an unsafe area without supervision
• Repeated wandering or elopement incidents
• A resident left in a wheelchair, bathroom or common area for extended periods
• Missing supervision records
• A sudden transfer without adequate information or follow-up care

7. Improper Restraint or Isolation

Physical or chemical restraints may sometimes be used for legitimate medical and safety purposes. However, using restraints as punishment, for staff convenience or as a substitute for appropriate treatment may constitute abuse.

Improper restraint or isolation may include:

• Tying a resident to a bed or wheelchair
• Using bed rails or equipment to prevent movement without proper justification
• Locking a resident alone in a room
• Using medication primarily to make a resident easier to control
• Preventing a resident from receiving visitors or making private calls
• Restricting movement without appropriate assessment, monitoring or documentation

Warning signs of improper restraint

• Marks on the wrists, ankles or torso
• Sudden or unexplained excessive sleepiness
• A rapid change in alertness after medication changes
• Reduced mobility or muscle weakness
• A resident being kept alone without a documented reason
• Staff refusing to allow private conversations with the resident

What Should You Do If You Suspect Nursing Home Abuse?

You do not need to determine exactly who is responsible before raising a legitimate safety concern. Focus first on protecting the resident and preserving accurate information.

1. Call 911 when there is immediate danger. Obtain emergency medical assistance when the resident has a serious injury, is in immediate danger or may have experienced sexual assault.
2. Speak privately with your loved one. Ask open-ended questions and avoid suggesting the answers you expect.
3. Document what you observed. Record dates, times, injuries, living conditions, staff names and explanations provided by the facility.
4. Photograph visible conditions when appropriate. Preserve the original files and avoid editing or posting them on social media.
5. Request relevant records. These may include the resident’s care plan, medication records, incident reports, treatment records and communications with the facility.
6. Report the concern. Notify the appropriate authorities rather than relying only on the facility’s internal investigation.
7. Speak with an attorney. Legal counsel can help identify responsible parties and preserve records that may be relevant to the resident’s safety or a potential claim.

How to Report Suspected Nursing Home Abuse in Virginia

Virginia Adult Protective Services

Virginia Adult Protective Services investigates reports involving adults who are 60 or older and incapacitated adults who are 18 or older.

To report suspected abuse, neglect or financial exploitation, call the 24-hour Virginia APS hotline at 888-832-3858. Non-emergency reports may also be submitted through the Virginia Adult Protective Services online reporting portal.

Virginia Department of Health

The Virginia Department of Health Office of Licensure and Certification investigates complaints involving nursing homes, skilled nursing facilities and other licensed healthcare facilities.

Complaints involving a Virginia nursing home may be submitted through the OLC complaint portal or by calling 1-800-955-1819.

Facility administration

You may also notify the nursing home administrator or director of nursing. Ask for the concern to be documented and request written confirmation of the facility’s response.

Reporting the matter internally should not prevent you from contacting emergency services, Adult Protective Services, law enforcement or a state licensing agency when appropriate.

What Evidence May Help Document Nursing Home Abuse?

The evidence needed will depend on the type of mistreatment alleged. Potentially relevant evidence may include:

• Medical records and hospital reports
• Photographs of injuries or room conditions
• The resident’s care plan and assessments
• Medication administration records
• Staffing schedules and assignment sheets
• Fall, wound and incident reports
• Facility surveillance footage
• Witness statements
• Emails, text messages and written complaints
• Bank statements and financial documents
• Inspection reports and previous facility complaints

Do not remove original medical records, destroy physical evidence or secretly record conversations without first understanding the applicable law. Preserve copies of records and communications in their original form.

Frequently Asked Questions

What are the most common types of nursing home abuse?

Common categories include physical abuse, emotional or psychological abuse, sexual abuse, financial exploitation, neglect, abandonment and improper restraint or isolation. More than one form of abuse may occur at the same time.

Is nursing home neglect different from abuse?

Abuse usually involves an intentional act that causes harm or distress. Neglect generally involves failing to provide necessary care, treatment, supervision or services. However, both can seriously endanger a resident and may create legal consequences.

Can nursing home abuse occur without visible injuries?

Yes. Emotional abuse, financial exploitation, isolation and some forms of neglect may not produce immediate physical injuries. Behavioural changes, fearfulness, missing money and unexplained changes in care may indicate that further investigation is needed.

What if my loved one has dementia and cannot explain what happened?

Families can look for changes in behaviour, repeated injuries, fear around particular people and inconsistencies between the resident’s condition and staff explanations. Medical records, care plans, witness accounts and facility documentation may also help clarify what occurred.

Should I confront the suspected caregiver?

Avoid a confrontation that could place the resident or another person in danger. Document what you observed and report urgent concerns to emergency services or the appropriate authority.

Talk to a Norfolk Nursing Home Abuse Lawyer

Suspected abuse or neglect can leave families uncertain about whom to trust and what steps to take next. Atkinson Law can review the circumstances, help preserve important records and explain the legal options that may be available.

Speak with a Norfolk nursing home abuse lawyer about injuries, neglect, financial exploitation or other suspected mistreatment involving your loved one.

Call Atkinson Law at 757-648-8579 to request a free consultation.

This page provides general information and does not constitute legal advice. Reading this page or contacting the firm does not create an attorney-client relationship.