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While often unrecognized as a significant problem, elder abuse is, in fact, quite prevalent in the U.S It may even be occurring in your long term care facility. This comprehensive guide will cover the various forms of elder abuse in long term care and help you identify its causes. You will learn its signs, preventative measures, and appropriate actions to take should elder abuse occur in your facility. By the end of this article, you should be able to identify five forms of abuse and know the immediate actions to take when you suspect a problem. You will also become aware of resources and preventive tools and gain ideas for combating elder abuse through innovative educational programs. 

What is Elder Abuse?

Before we examine the specifics of elder abuse in long term care facilities, we must first define the term generally. “Elder abuse” refers to an instance, or several instances, of family members or caregivers performing harmful and inappropriate acts toward older adults. These acts range from financial exploitation to neglect to physical abuse to sexual assault.

The conversation surrounding elder abuse has thus far been insufficient. It is, indeed, a growing crisis. According to Carol Silver Elliot, the president and CEO of Jewish Home Family, “There are between three and a half and five million victims of elder abuse in the United States alone every year.” Further, she noted that the victims are typically women over the age of eighty-five and that there is often a link to cognitive impairment. The abuse Elliot remarked, is “almost always financial in nature.” Indeed, the financial loss among all victims of elder abuse totals at least $36.5 billion annually, according to the National Council on Aging

Elliot joined Peter Murphy Lewis on the LTC Heroes podcast to speak about elder abuse, its signs, and resources to combat it. She reflects on her own experiences in identifying elder abuse and how her own facility, Jewish Home Family, created a shelter for those suffering from abuse.

Elder Abuse in Long Term Care Facilities

Elder abuse in long term care facilities, also known as “nursing home abuse,” occurs when a nursing home staff mistreats a resident in its facility. According to the Nursing Home Abuse Center, a shocking one in three U.S. nursing homes have been cited for abuse. In a 2017 study by the WHO, members of 64% of nursing home staffs confessed to elder abuse. To make matters worse, many cases of nursing home elder abuse simply are not reported. This means that even if your facility has not been cited for abuse, it may very well still be occurring.

The Types of Nursing Home Abuse

Caregivers at nursing homes may be guilty of harming the bodies, psyches, or finances of your residents. It is then important to familiarize yourself with the various forms of abuse committed at LTC facilities: 

Neglect –  This occurs when a nursing home staff ignores the needs of its residents, failing to provide food, toileting, and other personal care necessities. Consequently, residents will experience malnutrition, dehydration, and poor hygiene.

Physical abuse – This occurs when a caregiver hits, pushes, kicks or otherwise harms a resident physically. Physical abuse can ultimately leave residents with bruises, scars, and even broken bones and fractures.

Emotional nursing home abuse – This occurs when nursing home staffs insult residents or speak to them in a condescending or manipulative manner. Emotional abuse can cause elders to feel anxious, lonely, and fearful. Long term emotional abuse can lead to psychological damage, including mental illness in the form of anxiety or depression.

Financial exploitation – Caregivers who serve residents in close proximity may get their hands on their checks or credit cards and use them as their own. The resident is then left with an empty bank account and the trauma of seeing a lifetime’s worth of  wealth and assets vanish.

Sexual abuse – This not only harms residents physically but also affects their mental health, resulting in trauma and anxiety disorders.

Causes of Nursing Home Abuse

The causes of elder abuse in long term care facilities are often related to the nursing facility’s working conditions, which may include:

Understaffing – When a facility is low on staff members, tasks cannot be delegated in a reasonable manner, and caregivers lose the ability to keep track of their responsibilities. As a result, caregivers find themselves unable to provide top-quality care and serve their residents’ needs. Consequently, residents are more likely to face neglect.

An overworked staff – An additional consequence of understaffing and another common reason elders are abused in long term care facilities is that the staff is overworked. This emotional strain may induce caretakers to project irritation and anger onto the residents, whether verbally or physically.

nursing water

An underpaid staff- When caregivers are paid insufficiently for their hard work, they may feel frustrated or unmotivated. This results in a lack of drive that causes staff members to provide only minimal care, as they do not feel they are being valued.

Weak management- If a facility’s management fails to actively supervise its staff and hold abusers accountable, caregivers are more likely to act inappropriately toward residents. 

Lack of training- Nursing home staff members should be well-informed as to how to treat the various illnesses from which residents may suffer. Caregivers who are poorly-educated on nursing practices and resident rights will not know how to  correctly serve their residents, resulting in low-quality, abusive treatment.

How to Recognize Elder Abuse In Your LTC Facility

Knowing the warning signs of elder abuse in long term care facilities is the first step to protecting residents from hurting further and ensuring that your facility is providing quality care to all. Nursing Home Abuse Justice provides these warning signs of the five aforementioned categories of elder abuse:

Signs of Neglect

  • Poor personal hygiene
  • Messy living quarters
  • Weight loss
  • Bed sores
  • Constant infections
elderly being hugged

Signs of Emotional Abuse

  • Fearful behavior
  • Lack of confidence
  • Withdrawal from social scenarios
  • No longer taking medication

Signs of Physical Abuse

  • Bodily injuries– broken bones, fractures, bruises, scars, scrapes, etc.
  • Nervous and tense behavior
  • Lack of social behavior

Signs of Financial Abuse

  • Missing financial documents
  • Expenditures that the resident does not recognize or recall
  • Unexpected secretive behavior

Signs of Sexual Abuse

  • Injury to genitals or breasts
  • Damaged underwear
  • Social isolation

What to Do When You See Elder Abuse

Whether you recognize or simply suspect elder abuse occurring in your facility, it is imperative that you take action at once. You should report immediately, and consider making alterations within your facility to eliminate further risk of abuse. Continue reading for information on the steps that you should take.

There are several ways to report elder abuse:

ways report abuse
  • If the elder is facing fatal mistreatment, call 911
  • If you suspect elder abuse and would like a professional investigation, you can reach out to any of the following:

Click here for a state-by-state list of elder abuse resources

Never hesitate to contact the appropriate agency when you sense it is needed. It is important that you report anything that seems suspicious. As Elliot said on LTC Heroes, “The worst that could happen is that you’re wrong.”

Actions to take within your facility

If you discover elder abuse within your facility, you must evaluate the causes of the abuse and adjust your facility’s practices accordingly. For example, if you determine that staff burnout was a key contributor to the abuse, you should take action to ensure that their workload is not overly intense. Similarly, if you find that your facility does not have policies about elder abuse, you must rewrite policies and clearly state your intolerance of any form of resident mistreatment. Then, provide staff with additional training so that they are aware of any new practices.

Elder abuse shelter programs

Consider going above and beyond in combating elder abuse by creating your own shelter program. That means you agree to open up your facility to elders being abused at home or in other facilities. A shelter, Elliot noted, functions as “a waypoint on the journey from abuse to safety.” When an abused elder enters a shelter, he or she is being removed from a dangerous situation and given the comfort and security needed for recovery.

Providing shelter may sound like a daunting task, but Elliot assured LTC Heroes listeners that it is rather simple. “The core of shelter is a bed,” she said. “And if we run long term care facilities, we can always find a bed.” 

Preventative Measures 

Ideally, your LTC facility has never had cases of elder abuse. That, however, does not mean it will not have cases in the future. To ensure that your residents remain safe from abuse, you must take certain preventative measures.

Existing Tools for Preventing Elder Abuse

The following tools will decrease the likelihood of elder abuse occurring in your facility:

  • Abuse registries – Scan these state resources to confirm that prospective staff members are not listed. Click here to access HireRight’s Adult Abuse Registry Check.
  • Monitoring systems – Investing in these will increase surveillance and provide you with video evidence that you can use for reporting purposes should any sort of abuse occur.
  • Visits from social workers – These are an opportunity to receive a professional evaluation of the state of your facility and an assessment of the likelihood of abuse.

Long Term Care Advocacy   

woman with elder

Consider joining a long term care advocacy group to promote the rights of elders and raise awareness of elder mistreatment. By becoming an advocate, you can help prevent elder abuse from occurring not only in your own facility but also in other LTC facilities across the nation. Encouraging your staff members to join these groups along with you can also be a great way of educating them on elders’ rights.

Unsure of how to get started? Here are several organizations dedicated to ending elder abuse through nursing home reform:

  • Ageless Alliance – An association of individuals of all ages who have joined together to eradicate elder abuse through advocacy and community building
  • National Consumer Voice for Quality Long-Term Care – Advocates for policies that enhance the well-being of those living in long term care facilities and educates the public on issues related to LTC
  • Long Term Care Community Coalition (LTCCC) – An activist group that works with policymakers to ensure that people living in nursing homes, assisted living, and other residential settings receive the best possible care.

Long Term Care Innovation 

In addition to making use of existing tools and programs, you might consider being innovative and creating your own initiatives as an extra measure of prevention. Here are a few ideas to get you started:

A training program that raises awareness for staff members – Raising awareness among your care providers is one of the most effective methods for preventing incidents. Use your creativity to design an engaging training program that provides your staff members with detailed information about elder abuse and its signs.

An educational program for residents – Those in your care must know about their rights and the resources available to them. In her appearance on the LTC Heroes podcast, Elliot revealed that, unfortunately, “most victims of elder abuse do not get help.” As a nursing home administrator, it is important to encourage your residents to speak up and reach out to someone when they feel unsafe. 

An outlet that allows residents to anonymously report their concerns to administrators – As much as you are on the lookout for signs of abuse, a great deal of responsibilities may deter you from noticing important signals. The best eye-witnesses are the residents themselves, so you should create a system where they can safely report any issues they have with their caregivers.


Elder abuse is a pressing matter that can be prevented or stopped when you know the warning signs and take appropriate actions. By utilizing background checks and sufficiently training your staff on elders’ rights, you will be able to avoid incidents of abuse in your own facility. On a larger scale, advocacy is a great means by which elder abuse can be reduced across the long term care community. Thus, while elder abuse is largely prevalent now, through a combination of work within individual facilities and at a greater policy level, we can effectively minimize its severity. In making these efforts, you will be actively protecting the wellness of vulnerable seniors and be able to take pride in knowing that you have made a real difference in their lives.

To gain insight into other issues in long term care from leaders in the industry, subscribe to the LTC Heroes podcast.