Expert witness in elder abuse and nursing home negligence

How does elder abuse happen?


I know it seems hard to believe that people regularly take advantage of the sick and infirm. It’s not something we like to acknowledge. That said, there are complex reasons why elder abuse happens in care facilities or at home. For example:

1. Failure to follow care plans

Care plans are the most important document in a patient’s chart. They outline patient needs on a daily basis, and show changes in care concerns and interventions. To better understand how this can lead to abuse, see News and Views.

2. Residents come to all levels of care facilities sicker than ever before as hospitals try to discharge patients quickly.

Care facilities are under pressure to get their census numbers up, especially those with Medicare coverage, and sometimes take residents they should not. If care facilities do not accept residents from the hospitals within 10 to 15 minutes, the patient will be sent to another care facility. With this kind of pressure, a facility hardly has time to assess whether they can actually deliver the care someone needs. End result: the best choices are not always made. (I have witnessed this many times. Revenue drives decision-making more than care). 

3. Not enough trained staff

Because trained nurses can earn more elsewhere, facility owners turn to agencies to fill the gap. Agency workers work multiple jobs in multiple settings; they don’t know the residents well, and have no time to be onboarded. Also, in most facilities, “staffing ladders” are used to calculate the amount of care staff needed. When  patient count is low, staffing is adjusted downward. State laws require each facility to keep a specific number of staffed hours per resident per day. For example, a resident may receive 3.5 hours of care per day, including turning, feeding, toileting, walking, and therapy. When staff is at a bare minimum levels, residents are the ones who suffer.

4. Poor planning to meet the needs of short-term rehabilitation

Since Baby Boomer knee and hip replacements are on the rise, most facilities have a dedicated post-acute wing to provide more service and therapy. But this response is poorly thought out, and many places are ill-equipped to provide the necessary care. While some nursing homes increase staff, it is not nearly enough, in my opinion. The need for extra attention, pain management, etc. is extensive, and caregivers are overloaded. Many times call lights do not get answered in a timely manner, leaving residents neglected.

5. Caregiver burnout

Many caregivers and nurses work two or more jobs. This can cause stress, fatigue, poor attitude, and drastically affect care delivery. Another common practice is working overtime or doing double shifts, which causes its own unique challenges for the facility and, ultimately, the residents. Stress and burnout results in poor judgment; studies have shown that caregiver burnout can lead to serious medication errors, falls, and decubitus ulcers. When staff is pushed to work to the point of physical and mental exhaustion, they are no longer able to provide competent care. 

6. Lack of thorough background check

Facilities that are short-staffed and desperate to fill caregiver slots may not do thorough background or reference checks, resulting in the hiring of individuals with past records of abuse or criminal activity.

What are the signs of elder abuse?


Physical Abuse

  • Signs of physical trauma such as bruises or grip marks around the wrist, arms or neck (scratches, cuts or burns)

  • Repeated unexplained injuries

  • Refusal to talk about how an injury occurred

  • Not wanting to talk about an injury for fear of retaliation

  • Refusal to seek medical treatment

  • Time lapse between time of injury or fall and medical treatment

Sexual Abuse

  • Unexplained vaginal or anal bleeding or trauma to the genital area

  • Torn or bloody underwear

  • Bruised breasts

  • Sexually transmitted diseases

  • Infections or unusual discharge or smell

Emotional or Psychological Abuse

  • Emotional or psychological distress

  • Depression, helplessness, suicidal thoughts and ideations

  • Unresponsive or uncommunicative

  • Lack of interest in socialization

  • Chronic physical and mental health problems

  • Anxious, suspicious or fearful

  • Lack of eye contact

  • Confused or disoriented

  • Evasive

  • Trembling or being clingy

Financial Abuse or Exploitation

  • Large withdrawals from bank accounts, unusual ATM and banking activity

  • Personal belongings are missing

  • Caregiver’s name added to a bank account

  • Documents are drawn up for the elder to sign but the elder cannot explain or understand the purpose of the papers

  • Numerous unpaid bills

  • Bank statements and credit card statements are not given to the elder

  • People who are normally not close to the elder suddenly show concern


  • Signs of malnourishment (e.g., weight loss and sunken eyes)

  • Dehydration

  • Pressure ulcers

  • Chronic health problems

  • Soiled clothing and bedding

  • Personal care is neglected (teeth brushing, bathing, the same clothing worn over and over, unwashed hair)

  • Bedding dirty, smelly and not changed