Nursing Home Issues / Elder Abuse Law

Because senior citizens, particularly those residing in assisted care facilities, are often in a position of physical and/or cognitive disadvantage relative to their caretakers, elder abuse is an unfortunate common reality. Two million seniors in the U.S. are affected by elder abuse annually, and 36% of nursing homes have been found in violation of their duty to their residents.

Bedsores, for example, are a clear warning sign that something has gone wrong in the care of a wheelchair or bed-bound individual. They are often the first visual indicator of deeper issues.

Elder abuse can manifest in several forms:

  • Neglect
  • Physical abuse
  • Emotional abuse
  • Sexual abuse
  • Financial exploitation

Of these, neglect is the most common occurrence. Many facilities fail to train their staff to the levels required to care for the complex medical issues that individuals of advanced age possess — or they simply lack sufficient staff to care for the residents they are responsible for.

Caretaker neglect is not always easy to detect, but some common warning signs include:

  • Bedsores
  • Sudden onset of depression symptoms
  • Residents that are withdrawn, afraid, unusually quiet, or frequently crying
  • Residents that are agitated, angry, or accusatory
  • Rapid weight loss, malnutrition, or chronic dehydration
  • Over or under medication
  • Unexplained injuries, bruises, or broken bones
  • Failures in diagnosing of new conditions


Bedsores, also known as decubitus ulcers, pressure ulcers, or pressure sores, are the clearest sign of neglect in senior citizens because they are almost entirely preventable. These lesions occur when residents are left unattended in the same position for lengthy periods of time. When pressure on a specific area is not alleviated, it eventually forms a minor wound.

That minor wound, if left untreated, will eventually deteriorate and become infected. The tissue will become necrotic (meaning it will die and rot) and the sore will slowly but surely expand both in diameter and in depth. Eventually, the bedsore will reach down to the individual’s bones (which are often the point of pressure) and even to internal organs.

The bony prominences (areas of bone that are close to the skin) from which bedsores often emanate include:

  • Shoulder blades
  • Heels
  • Elbows
  • Sacrum
  • Hips

The Four Stages of Bedsores

  • Stage I: A small patch of reddened but not painful skin about the size of a quarter forms.
  • Stage II: The patch grows in diameter and depth.
  • Stage III: The patch continues to grow in diameter and depth and the wound becomes necrotic as the tissue dies and rots.
  • Stage IV: The necrotic tissue becomes infected, discharges pus and other fluids, and emanates a foul odor.

According to research by the CDC, up to 10% of nursing home residents have bedsores, 20% of residents with recent weight loss had bedsores, and 35% of residents with Stage II or higher bedsores required special wound care services.

Caretaker Responsibilities

Many individuals in assisted care facilities like nursing homes lack the ability to physically reposition themselves. They are entirely dependent on caretakers to ensure that they do not develop bedsores — or that any sores they do have don’t worsen.

Caretakers of the elderly are required by federal and state laws to assess all new residents for their risk of forming bedsores. They must turn and reposition patients prone to bedsores every two hours at a minimum — and they have a duty to remain vigilant for the formation of bedsores so that they can be treated promptly.

Other interventions, such as specialized cushions, air mattresses, and other medical technologies that reduce pressure on the affected region, may also be required.

Nursing Home Resident Rights

There are numerous state and federal laws regulating the treatment of individuals under the care and supervision of an assisted living facility such as a nursing home.

In Pennsylvania, for example, residents are entitled to:

  • Be informed of their conditions and any changes in their care
  • Written copies of any policies of the facility
  • Be free of restraint unless medically necessary
  • Manage their own finances
  • Choose their own doctor
  • Confidentiality of their medical and personal records
  • Refuse treatment
  • Voice their concerns without fear of retaliation
  • See their family members and visitors

Staffing Obligations

Because a lack of staff is the most common cause of neglect, nursing homes have legal requirements for staffing levels based on the number of residents at the facility:

  • 59 or fewer: One daytime Registered Nurse (RN), one evening RN, and one nighttime RN or Licensed Practical Nurse (LPN)
  • 60 to 150: One RN at all times
  • 151 to 250: One RN and one LPN at all times
  • 251 to 500: Two RNs at all times
  • 501 to 1000: Four daytime RNs and three evening RNs
  • 1001 or more: Eight daytime RNs and six evening RNs

Failure to maintain these levels can be a sign that the facility is breaching its duty to its patients and not providing adequate care.

Protecting the Elderly From Abuse and Neglect

When senior citizens are entrusted to an assisted living facility or nursing home, there is an expectation that they will be cared for, protected, and treated with dignity and respect, but sadly that confidence is sometimes misplaced. Individual caretakers or entire facilities at times take advantage of, neglect, or abuse their residents.

Our legal team has extensive experience in protecting vulnerable senior citizens. Our attorneys can help you determine if elder abuse or neglect has occurred and win the care and compensation necessary to correct that wrong.

If you have reason to believe that a senior citizen is not receiving proper care, contact Pond Lehocky Giordano immediately at 1-800-568-7500 or fill out the form on this page.