Abuse in Long Term Care Facilities

Nursing Homes (also called Skilled Nursing Facilities (SNF)

SNFs provide 24-hour nursing care, rehabilitation services, and other health and personal care services. There are approximately 15,600 SNFs in the U.S., which provide care to about 1.4 million older and disabled adults with funds from Medicare or Medicaid.

Homes that receive federal funds must meet federal quality of care standards—including the right of residents to be free from abuse, neglect, and exploitation. The Centers for Medicare and Medicaid Services (CMS) has agreements with state survey agencies to conduct annual evaluations to monitor compliance with the standards and investigate complaints about abuse by or within homes by staff, other residents, or others. Other state-based agencies are also charged with ensuring quality care.

Medicare can impose fines for particular violations, assess fines for each day that nursing homes are in violation, or deny payments for new admissions. Since 2013, nearly 6,500 nursing homes — four of every 10 — have been cited at least once for a serious violation. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores (also called pressure ulcers or decubiti).

Assisted Living Facilities (also called Residential Care Facilities)

Assisted living facilities (ALF) are residential care settings that provide lesser care than nursing homes. According to the National Center for Health Statistics, assisted living facilities have nearly tripled in number in the past 20 years to about 30,000 today.

The federal government exercises minimal oversight over ALFs, leaving it up to states to ensure that residents are protected through licensing standards, inspection procedures, and enforcement measures. States generally review reports of critical incidents, which include physical assault, emotional abuse, or sexual assault or abuse, as a part of their oversight responsibilities. However, research shows that more than half of applicable state Medicaid agencies were unable to report the number of critical incidents that had occurred due to limitations with their data systems.

"The irony of assisted living is, it’s great if you don’t need too much assistance... But if you have trouble walking or using the bathroom, or have dementia and sometimes wander off, assisting living facilities aren’t the answer, no matter how desperately we wish they were."

Geeta Anand, University of California, Berkeley

Abuse in Facilities

Government reports and the media have exposed systematic failings in the oversight of facilities and called for greater enforcement of laws, regulations, and penalties. Advocates attribute high levels of neglect in facilities to staff overload, lack of enforcement of laws and regulations, and fines that are too low to be deterrents. When abuse or neglect in SNFs or RCFEs reflects systemic problems like inadequate patient care, fraud, poor supervision or management, lack of adequate training by staff, and negligence, offenders may include management or corporate owners that place profit over resident care.

Reports

Government Reports

Remarks of Consumer Financial Protection Bureau Director Rohit Chopra at the Elder Justice Coordinating Council Meeting on December 7, 2021
Incidents of potential abuse and neglect at skilled nursing facilities were not always reported and investigated. Office of the Inspector General, U.S. Department of Health and Human Services (2019).
Improved oversight needed to better protect residents from abuse (2019) Government Accountability Office (2019).
CMS’s Reliance on California’s Licensing Surveys of Nursing Homes Could Not Ensure the Quality of Care Provided to Medicare and Medicaid Beneficiaries. U.S. Department of Health and Human Services, Office of Inspector General (2014)

Non-governmental Reports

When Private Equity Takes Over a Nursing Home (August 2022)
A Framework for Nursing Home Reform Post COVID-19 (June 24, 2021)
The Nursing Home Vulnerabilities That Led to Disaster (Next Avenue, March, 2021)
Elder Justice: What “No Harm” Really Means for Residents (Center for Medicare Advocacy and the Long-Term Care Community Coalition, 2017).March 3, 2021
CALTCM White Paper on Nursing Home Staffing (California Association of Long Term Care Medicine, 2020)
CNN Investigative Report (2017)
Sick, Dying and Raped in America's Nursing Homes (2017). Chilling report on sexual assault in nursing homes by CNN.
Six women. Three Nursing Homes and the Man Accused of Rape and Abuse

Resources

National

Advocacy Organizations

The following organizations provide frequent updates and action alerts:

Other Resources

Fast Facts on Nursing Homes and Residential Care Communities. National Center on Health Statistics, Centers for Disease Control and Prevention).
- Fast Facts About Nursing Home Care
- Fast Facts about Residential Care Communities
Nursing Home Compare: Operated by the Centers for Medicare & Medicaid Services (CMS), this website has detailed information about Medicare and Medicaid-certified nursing homes. In 2019, CMS updated the information on the website with a consumer alert icon next to nursing homes on the list that have been cited for incidents of abuse, neglect, or exploitation.
Cost of Care by Region: Website operated by the Federal Long Term Care Insurance Program.
Nursing home Closures Toolkit for Ombudsmen and Advocates National Consumer Voice for Quality Long Term Care
CANHR Fact Sheets Long Term Care Justice and Advocacy
Defending Evictions from Nursing Homes and Assisted Living Facilities Issue Brief (2017) Justice in Aging.
How to Prevent, Detect, and Report Financial Exploitation in Assisted Living Facilities. National Consumer Voice for Quality Long-Term Care (available in English, Spanish, and Chinese).
Protecting Residents from Financial Exploitation: A Manual for Assisted Living and Nursing Facilities. Consumer Financial Protection Bureau, Office for Older Americans.
List of Nursing Homes With Serious Health and Safety Violations
Balancing Privacy & Protection: Surveillance Cameras in Nursing Home Residents’ Rooms: Consumer Voice.

Resources: California

How to File Complaints in California

California Long Term Care Ombudsman Program
Website of the California Department of Aging that describes the program and includes Find Services in My County page link to local Ombudsman programs.

Promising Practices

Bill of Rights for LGBTQ Seniors in Long-Term Care
In 2017, California's Governor Jerry Brown signed Senate Bill 219, strengthening protections for LGBTQ seniors living in long-term care facilities against discrimination, such as refusing to use a resident’s preferred name or pronoun, denying admission to a long-term care facility, transferring a resident within a facility or to another facility based on anti-LGBT attitudes of other residents, or evicting or involuntarily discharging a resident from a facility on the basis of their actual or perceived sexual orientation, gender identity, gender expression or HIV status.

A Nursing Home Forensics Center: The Pasadena Elderly and Dependent Adult Liaisons (PEDAL)
A cross-departmental working group that includes representation from the City of Pasadena’s City Manager’s Office; City Prosecutor's Office; Public Health, Fire, Police, ,Planning and Community Developments, the Long Term Care Ombudsman’s Office, and Huntington Hospital. PEDAL has already completed several coordinated inspections, bringing operational deficiencies to regulatory agencies and actively addressing enforceable violations. Work is also underway for outreach and education via multiple media channels.