Neglect is defined as the refusal or failure to fulfill any part of a person’s obligations or duties to an elder.  In general, neglect can be categorized as the refusal or failure of a caregiver to fulfill his or her obligations or duties to an older person, including duties such as providing any food, clothing, medicine, shelter, supervision, and medical care and services that are essential for the well-being of a person.

In a practical sense, neglect is often characterized not by intentional acts of violence or cruelty, but rather by simply failing the meet the standard of care that senior citizens are entitled to and require.  In the context of nursing homes, long-term care facilities or assisted living facilities, this often occurs due to the operation of such facilities without enough or properly trained staff.

Nursing Home Neglect Statistics:

• 11.6% of nursing home residents or their families reported nursing home neglect in a study conducted by the World Health Organization.  Interestingly, 12% of nursing home staff reported the neglect of these vulnerable adults.

• 21% of nursing home residents were found to be neglected on one or more occasions in a 2011 study conducted on this issue.

• 14% of the abuse reported from nursing homes involves the gross neglect of residents.

Warning Signs of Nursing Home Neglect

There are several categories of neglect that can affect our senior citizens.  In each category, there are several warning signs that you can look for with your loved ones.

General Neglect can be categorized as failing to provide residents with enough food or water, failing to maintain a clean and safe environment for senior citizens and failure to help elderly residents maintain their overall hygiene. Warning signs of general neglect of a resident of a nursing home or long-term care facility can include the following:

• Dehydration
• Malnutrition
• Dirty bedding or clothing
• Poor hygiene such as unclean teeth, dirty clothing, matted hair, and/or an unwashed body
• Unsanitary conditions
• Wandering from the facilities without the knowledge of staff
• Reports of neglect from your loved one

Medical Neglect can be defined as when employees of a nursing home/long-term care facility or assisted living facility fail to properly attend to a resident’s medical concerns or prevent medical concerns from occurring in the first place. Warning signs of medical neglect of an elderly individual can include the following:

• Bedsores
• Unnecessary or unexplained falls
• Undiagnosed illnesses
• Misdiagnosed illnesses
• Medication errors
• Mishandling of breathing or feeding tubes
• Secondary infections
• Sepsis
• Reports of being medically neglected by your loved one

Emotional Neglect of an elderly resident of a nursing home can be categorized as leaving senior citizens alone for prolonged periods of time and generally failing to provide residents with sufficient social or emotional support. Warning signs of emotional neglect may include the following:

• Loss of mobility due to being left alone sitting or in bed for prolonged periods of time
• Depression of your loved one
• Emotional withdrawal/sudden changes in behavior
• Reports of being ignored or left alone for long periods of time by your loved one

Physical abuse is defined as the use of physical force that may result in bodily injury, physical pain, or impairment.  The Administration on Aging, in its instructions to long-term care ombudsmen, defines abuse as “the willful infliction of injury, unreasonable confinement, intimidation or cruel punishment with resulting physical harm, pain, or mental anguish or deprivation by a person, including a caregiver, of goods or services that are necessary to avoid physical harm, mental anguish, or mental illness” 

In the context of a nursing home or long-term care facility, physical abuse can occur either from the staff or from other residents.  Such abuse can take the form of physical violence such as punching, hitting, grabbing, or pulling; however physical abuse can also take other forms such as unnecessarily rough handling of a senior citizen during routine events such as bathing or dressing.  Finally, physical abuse can also take the form of the unnecessary restraint of an elder either through actual restraints or the inappropriate use of medication.

Nursing Home Abuse Statistics:

• 14.1% of complaints in a 2019 review of nursing home complaints were found to be of physical abuse
• 9.3% of nursing home staff reported committing acts of physical abuse against nursing home residents in a study conducted by the World Health Organization.
• 1 in 5 high risk ER hospital admissions of the elderly from nursing homes was the result of potential abuse/neglect in a 2019 study conducted by the Office of Inspector General

Warning Signs of Nursing Home Abuse

There are several possible warning signs that your loved one has been the victim of physical abuse. Some of those warning signs may include the following:

• Bruises
• Broken bones/fractures
• Internal injuries
• Head injuries
• Cuts/Abrasions/Lacerations
• Dislocations
• Pronounced fear when around certain staff member(s) or resident(s)
• Burns/Scalds
• Restraint marks upon wrists and/or ankles
• Sudden changes in behavior
• Medication overdose or chemical restraints
• Wrongful death
• Reports of physical abuse by your loved one

If you see any of these warning signs, you should take them seriously…

Financial, or material, exploitation is defined as the illegal or improper use of an elder’s funds, property, or assets. Financial exploitation can include the theft of a senior citizen’s items/money, coercing or tricking an elderly individual into signing a legal document, or the improper use of guardianship or Power of Attorney.

In the context of a nursing home or assisted living facility, financial exploitation of your loved one can take several forms.  It can be as simple as a staff member or another resident stealing an elderly person’s possessions or taking money from their room.  It can involve the improper use of a senior citizen’s credit/debit card without their knowing consent or involve the forgery of an elderly person’s signature upon their check for an unauthorized purchase. Finally, it can involve pressuring a senior citizen into changing their will or signing another legal document such as a power of attorney.

Nursing Home Financial Exploitation Statistics:

• 13.8% of nursing home complaints involve financial abuse as shown in a study conducted by the World Health Organization
• Only 1 in 44 cases of financial abuse of a senior citizen is reported
• 1 in 20 older adults has reported some form of financial mistreatment in the recent past according to the National Adult Protective Services Association

Warning Signs of Financial Exploitation

Several of the possible warning signs that an elderly person is being financially exploited can consist of the following:

• Missing possessions
• Missing money
• Sudden changes in bank account or banking practices
• Unexplained credit card/debit card transactions
• Forged checks
• Fraudulent billing for services not received
• New Power of Attorney not discussed with family
• Abrupt changes to wills or other legal documents
• Reports of financial abuse by your loved one

Emotional abuse is defined as the infliction of anguish, pain, or distress.  Emotional abuse is often committed through verbal acts including, but not limited to, yelling, verbal assaults, cursing, threats, insults, intimidation, and humiliation.  Emotional abuse can also occur in nonverbal acts such as isolating an elder from friends, family, or other social connections.

Notable Emotional Abuse Statistics:

• 33.4% of nursing home residents or their family report emotional abuse in a study conducted by the World Health Organization.
• Psychological abuse has been found to be the most prevalent form of abuse among older adults, with estimates ranging from 27.9% to 62.3%.
• A survey of a nursing home showed that 81% of the staff had observed and 40% of the staff had committed at least one instance of emotional abuse within the last year.

Warning Signs of Emotional Abuse

Some of the warning signs that your loved one has been the victim of emotional abuse can include the following behaviors to watch for:

• Anxiety
• Depression
• Fearfulness, especially when you are leaving a visit
• Sudden changes in personality
• Withdrawal
• Fear of certain staff member(s) or another resident (s)
• Uncommunicative or nonresponsive
• Reports of emotional abuse by your loved one

Sexual abuse is defined as non-consensual sexual contact of any kind with an elderly person.  The sexual abuse may be committed through force, threats, or the use of authority.  Sexual abuse can include, but it not limited to, unwanted sexual touching, sexual assault, sexual harassment, and sexual interaction of any kind with elders who lack the capacity to give consent.

Nursing Home Sexual Abuse Statistics:

• Sexual abuse is, fortunately, the least reported form of abuse of vulnerable adults, with 1.9% of older adults or their families reporting sexual abuse in a 2020 study conducted by the World Health Organization.
• Women are 6 times as likely to be victims of elder sexual abuse than men.
• A study of sexual abuse victims found that 60% of the elderly victims suffered from cognitive impairment or dementia.

Warning Signs of Sexual Abuse

If you fear your loved one has been the victim of sexual abuse at a nursing home or other long-term care facility, please look for some of the following warning signs:

• Recurrent UTIs
• Unexplained pelvic pain or bleeding
• Pain when sitting down or walking
• Bruising/Skin irritation, particularly in the region of the inner thighs, breasts, and/or genitals/buttocks
• Torn, stained, or bloody underclothing
• Diagnosis of an STD
• Emotional withdrawal
• PTSD symptoms
• Fearfulness, particularly in the presence of a particular staff member of resident
• Reports of sexual abuse by your loved one

The Illinois Nursing Home Care Act is the law in Illinois that establishes the rights of nursing home patients and defines the types of violations of the Illinois Nursing Home Care Act.

Rights of Illinois Nursing Home Patients:

• Constitutional Protection – All nursing home residents are entitled to the protections provided by both Illinois and the Federal Constitution
• Spousal Impoverishment Rights – All nursing home residents and their spouses upon admittance shall be advised of their spousal impoverishment rights under Illinois law
• Financial Control – All nursing home residents, or their guardian, is entitled to manage the elder’s financial affairs
• Personal Freedom – All nursing home residents are allowed to keep and use or wear their personal property(unless deemed medically inadvisable).  Nursing homes are directed to maintain adequate storage space for a resident’s personal property.
• Nursing homes are also directed to provide a method of safeguarding the small valuables of residents.  Nursing homes are also directed to make reasonable efforts to prevent the loss or theft of resident’s property
• Medical Freedom – All nursing home residents are entitled to keep their own personal physician at their own personal cost.  Residents are free to refuse medical care they do not wish to have.  
• Residents and their guardian shall be allowed to inspect and copy all of the resident’s clinical records and other records regarding the resident’s care and maintenance kept by the nursing home
• Right to Be Free From Restraint – Neither restraints nor confinement can be used on a nursing home resident for mere convenience of the nursing home staff or as punishment.  
• If a restrain is ordered by a doctor as medically necessary, it must be the least restrictive means necessary and with the informed consent of the resident or their guardian (except for in certain emergency medical situations).
• Freedom from unnecessary drugs – Nursing home residents shall not be given unnecessary drugs.  Psychotropic drugs shall not be given to residents without the informed consent of the resident or their surrogate decision maker (except for in emergency situations).  
• Freedom from abuse – An owner, administrator, employee, or agent of a nursing home shall not abuse or neglect a resident.  Any such employee or agent who becomes aware of abuse or neglect is mandated to report said abuse.
• Right to Communicate – All nursing home residents are entitled to uninterrupted and private communication by the resident’s choice of mail, public telephone, and visitation.  Mail is to be promptly mailed and delivered to residents.  Telephones are to be made readily accessible.  And visitation shall be allowed at all reasonable hours, with space provided by the nursing home for such visitation.
• COVID Communication Relief —  During a period of time in which the Governor has declared a disaster, nursing homes shall make every reasonable effort upon request to facilitate at least one phone or video call each day between a resident and a single family member of the resident.
• Freedom of Religion – All nursing home residents shall be permitted the free exercise of religion.
• Right to Electronic Monitoring – All nursing home residents shall be allowed to conduct electronic surveillance of their room pursuant to the Authorized Electronic Monitoring in Long-Term Care Facilities Act.

Types of Violations of the Illinois Nursing Home Care Act

• Type AA Violations – A violation of the Act which creates a condition that proximately caused the death of a nursing home resident.
• Type A Violations – A violation of the Act which creates a condition that either creates a substantial probability that the risk of death or serious mental or physical harm to a resident will result or has resulted in actual physical or mental harm to a resident.
• Type B Violations – A violation of the Act which creates a condition that is more likely than not to cause more than minimal physical or mental harm to a resident.
• Type C Violations – A violation of the Act which creates a condition that creates a substantial probability that less than minimal physical or mental harm will result to a resident. 

The Authorized Electronic Monitoring in Long-Term Care Facilities Act is a relatively new law that allows nursing home residents, or certain other authorized individuals on their behalf, to request in writing on the proper official forms that an electronic monitoring device be placed in the resident’s room.  

• The resident first must obtain written permission from any roommate the resident may have.  Once such a device has been placed in a resident’s room, the resident may request the device stop monitoring at any time.  
• If a resident chooses to install electronic monitoring, the costs of such installation and maintenance must be paid by the resident.
• It is unlawful for a person to knowingly hamper, obstruct, tamper with or destroy such an electronic monitoring device.  If a person does this to conceal the commission of a felony, the person may be guilty of a Class 4 Felony offense in the State of Illinois.
• A nursing home may not access any video or audio recording created by such electronic monitoring without the written consent of the resident or the person who consented on behalf of the resident.

In 1997 the Federal Government passed the Nursing Home Reform Act, which set forth essentially a Bill of Rights for each resident of a nursing home.  The rights of nursing home residents as set forth in Federal Law are:

• The right to freedom from abuse, neglect, and mistreatment
• Freedom from physical restraints
• The right to privacy
• The right to accommodation of medical, physical, psychological, and social needs
• The right to participate in resident and family groups
• The right to be treated with dignity
• The right to exercise self-determination
• The right to communicate freely
• The right to participate in the review of one’s care plan
• The right to be fully informed in advance about any changes in care, treatment, or change of status of the facility
• The right to voice grievances without discrimination or reprisal

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In Illinois, nursing home neglect is defined as, “a facility’s failure to provide, or willful withholding of, adequate medical care, mental health treatment, psychiatric rehabilitation, personal care, or assistance with activities of daily living that is necessary to avoid physical harm, mental anguish, or mental illness of a resident”.

There are several different categories of negligence in the context of a nursing home, such as general neglect, medical neglect, and emotional neglect.  Some, but certainly not all, of the warning signs of nursing home neglect are:

• Dehydration
• Malnutrition
• Dirty bedding or clothing
• Poor hygiene such as unclean teeth, dirty clothing, matted hair, and/or an unwashed body
• Unsanitary conditions
• Wandering unattended
• Bedsores
• Unnecessary or unexplained falls
• Undiagnosed illnesses
• Misdiagnosed illnesses
• Medication errors
• Mishandling of breathing or feeding tubes
• Secondary infections
• Sepsis

In a study of nursing home residents, 44% of residents said they had been abused and 95% said they had either been neglected or seen another resident neglected.

In Illinois, abuse is defined as, “any physical or mental injury or sexual assault inflicted on a resident other than by accidental means in a facility”.

• Bruises
• Broken bones/fractures
• Internal injuries
• Head injuries
• Cuts/Abrasions/Lacerations
• Dislocations
• Pronounced fear when around certain staff member(s) or resident(s)
• Burns/Scalds
• Restraint marks upon wrists and/or ankles
• Sudden changes in behavior
• Medication overdose or chemical restraints
• Wrongful death
• Recurrent UTIs
• Unexplained pelvic pain or bleeding
• Pain when sitting down or walking
• Bruising/Skin irritation, particularly in the region of the inner thighs, breasts and/or genitals/buttocks
• Torn, stained or bloody underclothing
• Diagnosis of an STD
• Emotional withdrawal
• PTSD symptoms

1. If you believe your loved one is in immediate and urgent danger, remove your loved from the facility immediately.  Your loved one may require emergency medical treatment.
2. In all other situations, document as best you can the conditions that concern you.  Photographs and/or videos are ideal in terms of documentation, as well as careful notations as to date and time and what observations were made.
3. One possible avenue would be to pursue an administrative complaint against the nursing home.  The Illinois Department of Public Health licenses, regulates, inspects and certifies nursing homes. Administrative complaints are made through the Illinois Department of Public Health. When filing a complaint you will need to answer some of the following matters:
   • Name of the resident
   • Name of the nursing home employee(s) or resident(s) involved
   • Name and location of the nursing home
   • Date and approximate time of the alleged incident
   • Nature of the incident – the exact allegations need to be made
   • The way your loved one was hurt or could have been hurt
   • Whether, or how, the nursing home responded to your concern
4. Contact Olson & Reeves. We will evaluate your case, walk you through the law and procedure, and aggressively investigate your case for you.

Contact Olson & Reeves.  In the course of investigating your case, we will analyze the available data to make this determination.

The Illinois Department of Public Health (IDPH) publishes quarterly reports for Nursing Home violators. If you’re interested in viewing this data, simply follow this link to the IDPH Quarterly Reports webpage for more information.

A 2021 study found an increase in 83.6% of the prevalence of elder abuse reports since the COVID-19 pandemic.

Due to the most recent study’s findings, during this period of time it would be prudent to watch as closely as possible for warning signs of abuse or neglect.

COVID Communication Relief — It is now law in Illinois that during a period of time in which the Governor has declared a disaster, nursing homes shall make every reasonable effort upon request to facilitate at least one phone or video call each day between a resident and a single family member of the resident.