Introduction to Nursing Home Abuse Investigation

(Content Under Development : Coming soon)

Accepted in: NC, SC, TN, KY, NM, KS, GA, IA, MN, OK (approved for 2 hours)

This training course is designed to provide the investigator with a better understanding of elder abuse and how nursing home abuse investigations are conducted. We share the best techniques used while conducting nursing home abuse investigations.

Purpose and Goals

Upon successful completion of the course, the student will be able to do the following:

  1. Identify the signs and symptoms of elder abuse
  2. Define the difference between neglect and abuse
  3. Discuss factors that contribute to elder abuse by caregivers
  4. Describe factors contributing to institutional abuse of elders
  5. Understand the documents a nursing home should file and where those are found (and may not have filed) to report incidents of abuse
  6. Gain the ability to prepare and identify a nursing home abuse investigation action plan
  7. Understand which techniques are most effective in the different aspects of a nursing home abuse investigation

Signs and Symptoms of Elder Abuse

The most common warning signs of elder abuse are strange and sudden changes to an elderly loved one’s mental, physical, or financial well-being. Specific signs of elder abuse vary depending on what type of elder abuse is affecting the victim.

The one factor most likely to increase the risk of being victimized is cognitive impairment. Even in the early stages of dementia, seniors are particularly vulnerable to financial abuse while family members, including spouses, may be more likely to engage in physical intimidation or neglect if they feel overwhelmed by the responsibility of care involved with conditions such as Alzheimer’s disease.

Signs and symptoms of elder abuse can include:

  1. Injuries such as bruises, cuts, or broken bones
  2. Malnourishment or weight loss
  3. Poor hygiene
  4. Symptoms of anxiety, depression, or confusion
  5. Unexplained transactions or loss of money
  6. Withdrawal from family members or friends

2.1 Abuse and Neglect: How Are They Different

Neglect: According to the federal Centers for Disease Control and Prevention, hundreds of thousands of seniors are intentionally neglected by family members and caregivers each year. Many victims are people who cannot help themselves and depend on others to meet their most basic needs.

Self-neglect occurs when an elderly person cannot care for themselves and engages in behavior that threatens their own safety, such as failing to provide themselves with adequate food, water, clothing, shelter, personal hygiene, medication, and safety precautions.

Caregiver neglect occurs when the caregiver fails to meet the needs of an elderly person who cannot care for themselves.

States define abuse differently. Elder abuse prevention laws include an established reporting system. Generally, Adult Protective Services (APS) agencies receive and investigate reports of suspected elder abuse or neglect.

According to the CDC, one in 10 elderly persons reported physical, sexual, or emotional abuse or potential neglect in 2008. However, many possible cases are not reported because the elderly person is unwilling or unable to tell family, friends, or authorities about their experiences.

Studies suggest that only 1 in 14 domestic elder abuse incidents come to the attention of authorities. Almost four times as many new incidents of abuse, neglect, and/or self-neglect are unreported than are reported to and substantiated by Adult Protective Services agencies.

The one-year prevalence of various kinds of abuse is:

  • Emotional abuse, 4.6 percent
  • Physical abuse, 1.6 percent
  • Sexual abuse, 0.6 percent
  • Potential neglect, 5.1 percent
  • Current financial abuse by a family member, 5.2 percent

Overall, 10 percent of respondents report emotional, physical, or sexual mistreatment, or potential neglect in a given year.

Persons aged 80 years and older suffer abuse and neglect at a rate two to three times greater than their proportion of the older population.

3.1 Nursing Home Abuse

  1. Staff Coverup: This can be your greatest challenge. This is where being a great investigator can make a difference.
  2. Staff Lies: Should a staff member fail to put up a bed rail and a patient fall, often the lies begin immediately. These situations are difficult and often impossible to prove.
  3. Incident Report: Medicare requires nursing home personnel to report incidents that involve a suspected crime within two hours if it results in serious bodily injury. If there was no serious bodily injury, personnel are required to report the case within 24 hours.

4.1 Reviewing Nursing Home Records

Another way that nursing homes can cover up nursing home abuse or neglect is through their documentation. Nursing homes must keep detailed records about the care that they provided to the patient, including information regarding:

  • Input of liquids
  • Identifying how many times the patient had a bowel movement
  • Measuring the output of urine
  • Recording vital metrics
  • Noting injuries
  • Not examining a patient for changing physical injuries such as bed sores, dehydration, or injuries

Changing records can require a paper or computer forensic examination. (See our class on forensics.)

4.1 How to Investigate a Nursing Home

  1. Nursing home regulations
  2. Examining the financial ratios for patient census and budgets
  3. Working with the expert
  4. Detecting fraud in the nursing home records
  5. Proving and evaluating understaffing
  6. Gathering the evidence for compensatory and punitive damages

6.1 Elder Abuse in North Carolina

North Carolina Statute Article 6, 108A-99- 111 is the Protection of the Abused, Neglected, or Exploited Disabled Adult Act.

North Carolina law does not differentiate between adults and older adults. The law pertains to all “disabled adults” who are “abused, neglected, or exploited.”

North Carolina Statutes apply to 1) domestic settings; 2) caretakers; 3) disabled adults; 4) willful or intentional acts; 5) physical, emotional and social abuse and neglect.

NC Law Chapter 108A, Article 6

7.1 Additional Resources

  1. Elder Mistreatment, UNC
  2. Elder Justice Initiative,
  3. Elder Justice Working Group, the Civil Rights Division, and the
  4. Elder Justice Task Forces

Course Information

Adult Education Methods Utilized

  • Downloadable handouts
  • Narrated slides
  • Case Studies

Textbook and Course Materials

  • Articles
  • On-demand video
  • Downloadable materials
  • Certificate of Completion

Course Requirements

  • Internet connection (DSL, LAN, or cable connection desirable)
  • Access to the internet
  • Ability to use a personal computer

Course Offerings

  • Certificate of Completion
  • 60-day unlimited course access

Course Structure

This course will be delivered entirely online through the website. Participants will use website credentials to log in and access their accounts. Participants will access online lessons, course materials, and resources. The course will be broken down into modules for self-paced learning. Access to the course is limited to 60 days. Following the completion of the course, students will receive a certificate of completion for Continuing Education Credits and licensing renewal. *Make sure this course is approved by your state for licensing renewal.

  • This course will be delivered online through a course management website named
  • To access this course online, you will need to access the Internet and a supported Web browser such as Internet Explorer, Firefox, Safari, and Chrome.

Technical Assistance

If you require technical assistance at any time during the course or to report a problem: