Making the decision to stay at a nursing home comes with many weighty questions and concerns. First and foremost, families worry about the quality of care offered by the facility and whether the facility will be able to properly manage health conditions, says Jung Baccam, board-certified family nurse practitioner at Atlas Ketamine. Cost and affordability is also often a concern.
Additionally, it’s common to feel anxious about the emotional well-being of the person entering the facility. “I hear a lot about adjustment anxiety — for both the seniors and the families,” Baccam shares. “It’s a big change, and there’s always that lingering fear of whether the person will feel ‘at home’ in a new place.”
One way to manage these fears is to be aware of some nursing home red flags — i.e., signs of a bad nursing home. Here, we’ll take a look at what you should watch for as you consider different nursing homes, how you might know a problem is occurring and what to do if you suspect nursing home abuse, neglect or have other concerns.
“It’s easy to get caught up in the shiny brochures and well-decorated rooms, but I encourage you to look beyond the surface.”
— Jung Baccam, family nurse practitioner, Atlas Ketamine
Nursing home red flags when touring communities
If you’ve decided to tour a nursing home, you’ll want to pay close attention to certain aspects of the facility so that you can be sure it lives up to expectations. “It’s easy to get caught up in the shiny brochures and well-decorated rooms,” Baccam says, “but I encourage you to look beyond the surface.”
Here are some things to carefully consider as possible signs of a bad nursing home:
1. Lack of patient care
When touring a potential nursing home, you should look for any signs of neglect, says Margo Marasa, a registered nurse and board-certified patient advocate. Indications of neglect might include:
- Poorly groomed residents.
- Residents with stained clothing.
- Broken equipment, such as wheelchairs and beds.
- Poorly maintained assistive devices like walkers and canes.
2. Understaffing
If there aren’t many staff members visible, this can be a potential cause for concern, Marasa says. Though staff members may be tending to individual residents throughout the day, there should be general staff oversight, she explains. If there are call lights going off on the floor, take note of how quickly staff members respond to them.
3. Poor staff attitudes or professionalism
Observe how staff members interact with patients, Marasa recommends. Ask yourself:
- Are staff members listening to resident concerns?
- Are staff members addressing issues and concerns as they arise?
- Are they talking to residents in a way that preserves their dignity?
How staff members treat residents is especially important in dementia units, Marasa shares. “Residents in dementia units often have unpredictable behaviors and preferences,” she explains. “You want to observe that the staff is addressing behaviors in a dignified manner while keeping the resident safe.”
4. Lack of daily activities
Daily activities are a key component to a nursing home resident’s well-being, Baccam says. “If the schedule looks sparse or they’re only providing passive activities like TV watching, that could be a sign that they aren’t focusing enough on engaging residents,” she notes. When in doubt, it can be helpful to ask staff for an upcoming schedule to give you a fuller picture as well.
5. A bad smell
Take note of the smell when entering a facility, says Marasa. “If an odor is present in the lobby, that can be cause for concern,” she adds. “Odors on the unit could be isolated to a room where care was recently provided.” However, if the entire unit has an odor, that’s also a cause for concern.
6. Poor overall atmosphere
Finally, look at the overall atmosphere and “vibe” of the facility, Marasa emphasizes. Consider the following:
- Do residents look happy and well cared for?
- Do staff members greet you when you pass them?
- Is there a general feeling of warmth and care?
If the answer to one or more of those questions is “no,” that may be a sign of a bad nursing home.
Signs of a bad nursing home: Spotting abuse and neglect
Even after your loved one has entered a nursing home, it’s crucial to stay alert to any changes in their behavior or health, Baccam stresses. Overall, nursing home red flags that could indicate abuse and neglect include:
- Distress, agitation and/or confusion.
- Unclean living spaces.
- Resisted visitation.
- Poor food quality.
- Health conditions not being tended to.
- Lack of privacy.
Here are some more specific signs of abuse to look out for once your loved one is receiving care.
Signs of physical abuse
When observing a loved one in a nursing home, be on the lookout for any concerning physical changes, including:
- Bruising.
- Bedsores.
- Unexplained injuries.
- Dirty hair or clothing.
- Lack of personal hygiene.
“These can sometimes happen, but if they’re frequent or severe, it might indicate neglect or abuse,” says Baccam. Additionally, dehydration or unexplained weight loss is a major red flag for neglect, Baccam points out.
Signs of emotional abuse
“Emotional abuse can be harder to spot, but if your loved one seems more withdrawn, anxious or scared when certain staff members are around, trust your instincts,” Baccam shares. “If you notice that your loved one is suddenly acting fearful or doesn’t want to talk when certain staff are nearby, they may be feeling intimidated or threatened.”
Financial abuse red flags
Financial abuse might involve the theft of cash, illegal banking transactions, scams or stealing personal items. Unfortunately, sometimes staff or even other residents manipulate or steal from vulnerable seniors. “It’s important to keep an eye on any unusual charges or missing personal items,” Baccam recommends.
Health and medication issues
Finally, it’s important to take note of whether your loved one’s medical issues are being tended to promptly, accurately and respectfully. If there are instructions staff isn’t following instructions related to their health, this is a major nursing home red flag.
“It’s also important to keep track of their medications — missing doses or regularly incorrect dosages can signal negligence,” Baccam says.
How to address and report nursing home red flags
So, what exactly should you do if you suspect abuse in a nursing home? Managing an abusive or unsafe situation in a nursing home can be very stressful. If you suspect something is wrong, it’s imperative that you act quickly, says Baccam. Here are her tips to deal with the issue:
Document everything
“Keep a detailed record of any incidents, concerns or changes you notice, including dates, times and what happened,” Baccam suggests. “This documentation will be helpful if you need to escalate your concerns.”
Approach the nursing home staff calmly, but firmly
Start by speaking directly to the head administrator or director of nursing to express your concerns. “It’s OK to ask them for specific answers and to see written policies on how they handle issues like abuse or neglect,” says Baccam.
“You know your family member better than anyone else, so don’t hesitate to speak up if something doesn’t feel right.”
— Jung Baccam
Ensure your loved one’s safety
Find senior care.
While you investigate the issues at hand, don’t wait to tend to your loved one. “If necessary, move them to a different facility,” Baccam recommends. “Your loved one’s safety and well-being are your priority.”
If the situation doesn’t improve, escalate your concerns
If the nursing home staff fails to address your concerns, you can reach out to your state’s ombudsman or your local elder abuse hotline, Baccam recommends.
You can also reach out to local or state regulatory agencies that monitor nursing homes, including Adult Protective Services (APS).
The bottom line
Choosing a nursing home for yourself or your loved one can be a stressful, emotional and overwhelming process, says Baccam, but staying informed and vigilant ensures that you or your loved one get the best possible care.
When it comes to nursing home red flags, “it’s always a good idea to trust your instincts, ask questions and advocate for them every step of the way,” Baccam underscores. “You know your family member better than anyone else, so don’t hesitate to speak up if something doesn’t feel right.”
