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Tips for Detection

Protecting Elder Citizens**

Below are some tips for recognizing possible abuse or neglect.  But remember,  even when you are not sure, sometimes the best recourse may be to contact a private attorney at WLF to investigate.  

But you must act quickly!   In Missouri Chapter 198 of the Revised Statutes provides residents, and their families, with a powerful tool to force compliance with federal and state law. But to be effective, the resident, the former resident, or the estate of the former resident must make a formal complaint to the Attorney General's office within 180 days of the conduct giving rise to the cause of action. So if your family member is assaulted, neglected, abused, or emotionally damaged by conduct of a nursing home employee, a 180-day clock starts running on the day the assault or emotional abuse takes place. At the end of the 180 days the resident may have common-law rights to file an action, but the statutory right that provides for punitive damages will be gone. For this reason it is imperative to act promptly. A WLF attorney should be contacted as soon as possible to permit an investigation and, if necessary, litigation.

Detecting Patient Abuse 

Detecting abuse in nursing homes requires vigilance and it requires being a bit of an “amateur detective.” These tips should help you spot potential abuse of your loved one .

Physical Abuse

Here are some classic indicators, derived from the medical literature, of signs of possible physical abuse:

Damage to skin integrity including:

Cuts and lacerations

Puncture wounds, particularly from fingernails,etc.

Belt marks, or ligature marks (particularly around legs, feet, hands, or around the neck).

Poor skin condition

Poor skin hygiene

Bruises, welts, discoloration

Look under clothing

Search for bruising under arms and near the neck.

Any injury incompatible with patient history

Any injury which has not been properly cared for (injuries are sometimes hidden on areas of the body normally covered by clothing)

Absence or loss of hair (absent chemotherapy or radiation therapy) and/or hemorrhaging below scalp

Dehydration and/or malnourished without illness-related cause

Loss of weight

Burns (chemical or thermal)

Soiled clothing or bed linen

Psychological or Emotional Abuse

Nursing home patients need to be cared for. That means more than just bathing, nutrition and hydration. It means taking a moment to calm a troubled mind, and answering gently when a patient doesn't know where they are. All too often, however, residents receive no such support. Or worse, the resident is actively abused emotionally by staff members who threaten, cajole, intimidate, or harass their elderly charges. Possible indicators of Psychological and Emotional Abuse include:


Hesitation to talk openly

Implausible stories used to explain events ("I was bitten by a dog" when no dog exists at the facility).

Confusion or disorientation unassociated with clinical condition


Fear of family, nursing home staff, or strangers





Neglect by Caregivers

Sometimes nurses and certified nurses assistants don't set out to abuse the elderly, they simply run out of time in a day to care adequately for all the elderly patients assigned to them. This results in neglect. Possible indicators of neglect by caregivers would include:

Dirt, fecal/urine smell, or other health and safety hazards in elder's living environment.

Rashes, sores, lice on elder

Elder is inadequately clothed

Elder is malnourished or dehydrated

Elder has an untreated medical condition.

One of the best ways to document neglect is to look at what the nursing home says it will do, and compare it to what it actually does.  Every nursing home has forms that it must fill out to take care of patients.   Please note, every family has access to medical records under 42 CFR 483.10 unless the resident, while competent, blocked that access.

Abuse Generally

Some aides and nurses are more than just bad tempered or overworked. Some are simply evil people who believe they have the right to do with residents as they see fit. Possible indicators of abuse from the caregivers includes:

The elder may not be given the opportunity to speak for him or herself, or see others, without the presence of the caregiver (suspected abuser)

Attitudes of indifference or anger toward the dependent person, or the obvious absence of assistance

Caregiver blames the elder for accidents (e.g. accusation that incontinence is a deliberate act)

Aggressive behavior (threats, insults,harassment) by caregiver toward the elder

Previous history of abuse to other patients or a criminal record

Problems with alcohol or drugs

Inappropriate display of affection by the caregiver

Flirtations, coyness, etc as possible indicators of inappropriate sexual relationship

Conflicting accounts of incidents by staff

Unwillingness or reluctance by the caregiver to comply with service providers in planning for care

Inappropriate or unwarranted defensiveness by the resident's caregiver

Sexual Abuse

Rape is not a sexual crime – it is a crime of power.  All too often the elderly are shockingly attacked in the beds that family members think are safe.  Indicators of sexual abuse include:

difficulty in walking or sitting without evidence of muscular-skeletal disease;

bruising on the inner thighs;

vaginal bleeding not associated with menses;

presence of sperm in the vagina or anus;

unexplained venereal disease or infection.

How To Report Abuse

If you find evidence that your nursing home resident may be abused, you need to report this information to the state agency responsible for investigating nursing home abuse. In Missouri that agency is the Missouri Department of Health and Senior Services. A call should be placed immediately upon discovering the abuse.

If there are witnesses to the fact that a particular aide or nurse caused harm to a patient, then that information should likewise be transmitted to local police agencies. Nurses, aides, and healthcare workers in nursing homes are subject to the same laws as others, and can be arrested and prosecuted for assaulting or battering elders.

How to Spot A Cover Up

Frequently when a nursing home is guilty of neglect or abuse, rather than admit the problem and deal with the negligence of its employees, the home will attempt to cover up the negligence. Examples of this include:

Telling the family that the resident "died in her sleep" (usually indicates they don't know what happened to the resident).

Telling the family that an autopsy is not required.

Placing clothing, towels, blankets, orother items of equipment or clothing in such a way as to obscure the results of physical injuries.

Telling the family that clothing was soiled, and therefore not available (may indicate that there are bloodstains or similar evidence on the clothing).

Telling the family that the elder fell from a bed (whenever signs of physical abuse are present.)

When these things occur, press for answers and insist that any unusual injury be explained or reported to the Division ofAging or similar state agency.  Do not accept "we don't know" for an answer.  Homes have a duty to provide 24 hour a day protective oversight, and that means preventing accidents.  However, staffing may often be so short that they can't meet this requirement, and therefore cover up incidents of abuse and neglect in order to protect their license.  Insist on speaking directly to caregivers when there is an injury; do not let administrators or nursing personnel explain away an incident.  Early and thorough investigation frequently forces changes that result in better care for everyone.

When To Seek Legal Counsel

Sometimes the abuse simply does not stop. Or worse, the neglect -- often a product of short staffing and poor working conditions and wages -- multiplies. If this happens the police and the state government may be unable to do enough to rectify the situation. In those situations the best recourse may be to see a private attorney at WLF.  But you must act quickly!  Remember the 180-day time limit mentioned in the first graph of this article.

At the end of the 180 days the resident may have common-law rights to file an action, but the statutory right that provides for punitive damages is gone. For this reason it is imperative to act quickly. A WLF attorney should be sought out as quickly as possible to permit an investigation and, if necessary, litigation.

Contact our firm.

**Adapted from article by Tim Dollar.

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