Warning Signs of Nursing Home Abuse and Neglect in California

The clearest warning sign of nursing home abuse or neglect is a sudden, unexplained change in your loved one — physically, emotionally, or financially. Injuries no one can account for, rapid weight loss, a person who has gone quiet, money moving in ways that make no sense. Any one of these is worth asking about.

Most families do not walk in and see abuse happening. They notice something small that does not add up, dismiss it, and then notice it again. This is a guide on what signs to look for and what to do next if you suspect abuse or neglect.

What are the most common physical warning signs?

Look for injuries no one can explain, and for the conditions that develop when someone is not being cared for. Facilities often have an explanation ready, so what matters is whether the explanation fits the injury and whether the same thing keeps happening.

Broken or fractured bones, particularly repeated fractures, often caused by falls or assault
Head injuries, brain bleeds, or concussions
Pressure marks and bedsores, especially on the lower back, hips, or heels, most often found in individuals who are bed bound
Rapid weight loss, malnutrition, or signs of dehydration such as dry mouth and confusion
Sleepiness, shivering, confusion, hallucinations, cloudy urine, severe diarrhea, fever, boils, or sores caused by infections such as sepsis, urinary tract infections, E. Coli, or MRSA
Uncontrollable itching or bite marks, which could indicate infestations of scabies or bed bugs
Constant sleeping, hallucinations, confusion, change in personality, or constipation caused by medication errors, overmedication, or chemical restraint through the use of psychotropic medications
Poor hygiene — unwashed hair, soiled clothing, dirty bedding, being left for long periods of time in soiled diapers, long fingernails, fungal infections, dental issues, mouth sores
Bruises, welts, skin tears, cuts, scrapes, or burns that nobody can account for
Missing glasses, hearing aids, dentures, or medications

Some of these symptoms develop without families becoming aware until a loved one’s condition is severe. Even the most involved families can be taken off guard by symptoms that manifest quietly or out of sight. Bed sores, for example, can start developing within just a couple of days if a person is bed bound, and sometimes the pain they cause can be masked by other general pain a loved one is experiencing, such as musculoskeletal back pain. Loved ones with dementia or Alzheimer’s can be especially at risk, because they may struggle to express or describe the pain they are experiencing.

How is neglect different from abuse?

Abuse is something that is done to a resident. Neglect is care that should have been provided and repeatedly did not. Neglect is far more common, and it is harder to spot because there is no single moment to point to — it shows up gradually, day after day, as care is not administered, in the form of decline.

A resident who is losing weight, developing sores, falling repeatedly, or sitting in a wet bed for hours at a time is showing you the results of care that is not being delivered. Families often blame these on aging. Sometimes that is right, but often it is not, and the difference is worth asking about directly.

What emotional or behavioral changes should worry you?

Watch for a personality that changes without explanation, and for fear attached to a specific person or time of day. A resident who cannot report what is happening — because of dementia, a stroke, or a condition affecting speech — may show you instead of telling you directly.

Sudden withdrawal from conversation, activities, family, or friends
New anxiety, fear, hysteria, agitation, anger, or depression
Flinching, tensing, or going quiet when a particular staff member comes near
Unusual lethargy or exhaustion, or seeming heavily sedated
Reluctance to speak freely while staff are in the room
Constant crying or extreme emotional behavior

If your relative will not talk in front of staff, that is worth noticing on its own. Ask to take them outside, to a garden, or to a private area, and see whether your relative feels more comfortable confiding in you privately.

What are the signs of financial abuse?

Financial abuse usually shows up in paperwork rather than in a person’s appearance, which is why it can continue for a long time undetected, especially if your loved one retains sole access to their own financial accounts. It is worth reviewing statements periodically even when nothing seems wrong.

Withdrawals, transfers, or purchases that your relative cannot explain
New names appearing on accounts, cards, or checks
Sudden changes to a will, deed, power of attorney, or beneficiary designation
Bills going unpaid while money is leaving the account
A new person becoming closely involved in your relative’s finances
Statements and records that become difficult to get hold of
Unusual or inexplicable changes to your loved one’s Social Security benefits

Why is abuse so often missed?

Because the people most likely to be harmed are the people least able to report it. Research from the National Institute on Aging indicates that as many as one in ten older adults experiences some form of abuse each year, and the World Health Organization has reported that only about one case in twenty-four is ever reported.

Residents with dementia or Alzheimer’s disease may not be able to describe what happened or may not be believed when they do. Residents who are isolated — few visitors, no family nearby — are more vulnerable for the simple reason that nobody is checking. Visiting often, unannounced, and at different times of day, is one of the most protective things a family can do.

What should you do if you notice these signs?

Start by writing down what you saw and when. Dates, photographs of visible injuries, the names of staff you spoke to, and what you were told. Memory fades and staff come and go; a contemporaneous record does not. You can ask that staff document the injuries in your loved one’s chart or request copies of your loved one’s medical records to check whether the injuries you notice are being properly documented. A lack of thorough and accurate documentation can signify that staff are too overwhelmed to have time to document conditions and injuries, or can even be an attempt to cover up neglect.

If someone is in immediate danger, call 911. In California, concerns about a resident’s care can also be raised with Adult Protective Services, with the Long-Term Care Ombudsman program, and with the California Department of Public Health, which licenses Skilled Nursing Facilities, or the California Department of Social Services, which licenses Assisted Living Facilities. Ask the facility for a copy of your relative’s chart and care plan.

Whether a particular situation involves conduct the law treats as abuse or neglect depends on the specific facts and on how the facility is licensed. That is a question for an attorney who can look at the details of your relative’s circumstances.

Frequently asked questions

What is usually the very first sign of nursing home abuse?
An unexplained change. You may notice your relative sleeping more than they usually do, complaining of a new pain, or losing weight unintentionally. The pattern matters more than any single incident. If the same unexplained thing happens twice, treat it as a signal rather than a coincidence.

Are bedsores always a sign of neglect?
Not always, but they present a serious health concern and should be proactively followed up on by relatives. Pressure sores develop when a person stays in one position too long, and turning and repositioning is the basic care needed to prevent most of them. Turning and repositioning is something that care staff should be doing regularly for a bed bound patient; if you do not see your bed bound loved one being turned and repositioned every two hours, this is cause for concern. Some residents are more prone to developing bed sores than others. A sore that appears, worsens, or is discovered late is worth speaking up about directly with the facility.

My mother has dementia and cannot tell me what happened. What can I do?
Watch behavior instead of relying on an account. Fear of a specific person, flinching, new agitation, or withdrawal can all indicate something is wrong. Visit at unpredictable times, including evenings and weekends when staffing is often thinner, and write down what you observe each time. If your loved one has a roommate, the roommate or their family may have witnessed certain events and might be able to provide you with information.

The facility gave me an explanation for an injury. Should I accept it?
Ask whether the explanation fits the injury and whether it was documented when it happened. Facilities are generally expected to record and report incidents. Requesting the incident report and your loved one’s care plan is a reasonable thing to do, and how a facility responds to that request can tell you something in itself. Do the oral accounts from facility staff match each other? Do they match with what was written in the incident report sent to a licensing body such as the California Department of Public Health or the California Department of Social Services? Any inconsistencies across different tellings, reports, and stories can be an indication of concealment.

Does my relative have to be over 65 for this to be taken seriously?
No. California law also recognizes adults between 18 and 64 who have physical or mental limitations that restrict their ability to carry out normal activities or protect themselves — which includes many adults with developmental disabilities living in licensed facilities. Whether a particular person falls into that category is a question for an attorney.

About the author. Ben Yeroushalmi is an elder abuse attorney at Yeroushalmi Law in Beverly Hills, California, representing families in nursing home abuse and neglect matters throughout the state.

This article is general information only and is not legal advice. Reading it does not create an attorney-client relationship.