Nursing Home Neglect vs. Abuse: What's the Difference, and What Does It Mean for Your Case?

Nursing Home Neglect vs. Abuse: What's the Difference, and What Does It Mean for Your Case?

One of the most challenging decisions you’ll make is when to transition a loved one to a nursing home. You’ll do plenty of research: Is their staff well-trained? Can you trust them? Do they have good reviews? You want to believe you chose well, and that your elderly family member is in good hands. But what if you start to suspect neglect or abuse?

It may be more common than you think. According to the World Health Organization, nearly 1 in 6 people over age 60 experience abuse in a community setting each year. Numbers like these can leave you wondering: Is there a difference between neglect vs. abuse? And what can you do if you suspect your loved one isn’t being properly cared for?

What is nursing home neglect?

According to the CDC, nursing home neglect is “the failure of a caregiver or fiduciary to provide the goods or services that are necessary to maintain the health or safety of an older individual.” In other words, it’s when nursing home staff don’t do their jobs well, and it harms or injures a resident. Examples of neglect include:

  • Not providing proper nutrition and hydration
  • Allowing residents, clothing, and bedding to become dirty
  • Allowing residents to live in an unsafe environment
  • Ignoring emergencies that call for a doctor or nurse
  • Failing to move residents with mobility issues
  • Not providing routine care such as dental and medical checkups
  • Failing to treat illnesses or injuries, like bedsores or pneumonia
  • Disregarding residents’ emotional needs, such as the need for social interaction

What is nursing home abuse?

The CDC defines elder abuse as “the willful infliction of injury, confinement, intimidation, or punishment with resulting harm, pain, or mental anguish.” Like neglect, it can involve both an act or a failure to act. Examples of nursing home abuse include:

  • Sexual abuse
  • Financial abuse
  • Healthcare fraud
  • Physical injury, such as excessively restraining a resident
  • Psychological injury, such as making threats or insults
  • Withholding food, medical care, or other necessities

What’s the difference between neglect and abuse?

The main difference between neglect and abuse is the intent. Nursing home neglect can be either passive or intentional – that is, the caregiver may cause harm out of ignorance, rather than willfully. Nursing home abuse is always intentional. It’s a willful act that directly causes harm.

Intentional or not, nursing home neglect is just as serious as abuse. Putting a stop to it can make a big difference in residents’ quality of life.

What causes nursing home neglect?

Generally, neglect occurs in poorly operated nursing homes that don’t have enough staff, don’t train their staff well, and don’t have good hiring practices.


Understaffing has been an issue for years and worsened during the pandemic. A June 2021 survey from the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) found that 94% of nursing homes and 81% of assisted living communities said they had a staff shortage in the past month. A majority also agreed their staffing situation has deteriorated since 2020. Bottom line: When facilities don’t have enough staff to provide proper care, neglect increases.

Lack of training

The Code of Federal Regulations has training requirements for Medicare- and Medicaid-certified nursing homes. The code says “a facility must develop, implement, and maintain an effective training program” for its staff that includes topics such as residents’ rights, abuse, neglect, and ethics, among others. It also requires that nurse aides receive performance reviews and at least 12 hours per year of continuing education. However, corporations seeking to cut costs may ignore these requirements – and poorly trained staff are more likely to make mistakes and create unsafe environments for residents.

Poor hiring practices

Like inadequate training, poor hiring practices are sometimes the result of corporations putting profits over people. A facility may hire caretakers with little or no experience because they don’t have to pay them as much. Or, they may not make the effort to perform background checks and confirm training and certifications. All of these practices can result in hiring unqualified or even dangerous individuals and increasing the risk of neglect.

Signs of nursing home neglect and abuse

While the definitions of neglect vs. abuse are different, the signs are similar. Look out for these red flags:

  • Unexplained injuries like bruises, cuts, and broken bones
  • Conflicting explanations from staff about how injuries occurred
  • Poor hygiene, such as dirty hair, clothes, or teeth
  • Unsanitary living conditions
  • Weight loss, hair loss, and other signs of malnutrition
  • Mobility loss
  • Confusion or anxiety, especially around staff
  • Social withdrawal and depression
  • Unexplained anger toward you or staff
  • Refusal of staff to let you be alone with your loved one
  • Unauthorized bank transactions or loss of valuables

The Oklahoma State Department of Health and US Department of Health and Human Services inspect long-term care facilities like nursing homes at least once a year. Facilities that have violations or complaints have more frequent inspections at random. Officials can also take immediate action if the facility is unsafe, including shutting it down. Still, nursing home neglect persists.

What to do if you suspect nursing home neglect or abuse

If you suspect nursing home neglect or abuse, first file a complaint with the Oklahoma Department of Health. Be specific, and file separate claims for every instance. The health department will investigate and issue a citation if they find a violation. If the nursing home doesn’t correct the violation or if they have a lot of complaints against them, the health department can take additional action.

You can also collect your own evidence. In 2016, Oklahoma passed Title 63, The Nursing Home Care Act and Long-Term Care Security Act, which allows you to place recording devices in your loved one’s room, as long as you have their consent. You don’t need consent from the facility, but you do need to notify them in writing. Audio and video recordings can be very helpful and are usually admissible in court.

You may also be able to bring a civil or even criminal case against the nursing home. Aides, doctors, nurses, management, and even the entire corporation could be held liable and ordered to pay damages. Criminal charges can even lead to jail time.

The bottom line

Many nursing homes and assisted living facilities are part of big corporations with deep pockets. They’ll be well-prepared for complaints of neglect or abuse, and you should be, too. If your loved one was physically injured or passed away, contact us to start building your case. We won’t let those responsible get away with it.