A groundbreaking new analysis from High Rise Financial highlights a severe and escalating crisis inside U.S. nursing homes, where tens of thousands of elderly residents experience abuse, neglect, and substandard care every year. With older adults now making up 14.9% of the U.S. population, the findings carry enormous implications for families, healthcare systems, and state regulators.
National data shows that 10% of elderly adults are abused annually, and 16% of nursing home residents report being mistreated while in professional care. Women are disproportionately affected, reflecting a longstanding pattern in elder-abuse research. Experts warn that because many residents cannot communicate abuse, or fear retaliation, the true scale may be substantially higher.
The Types of Abuse Affecting America’s Seniors
The report outlines five major categories of abuse prevalent in nursing homes:
- Physical abuse (38%) — hitting, rough handling, or improper use of restraints
- Gross neglect (24%) — failing to provide food, hygiene assistance, medication, or basic safety
- Psychological abuse (16%) — intimidation, humiliation, coercion, or isolation
- Financial exploitation (14%) — theft, fraud, or manipulation of assets
- Sexual abuse (8%) — a deeply disturbing category affecting incapacitated residents
The consequences of these abuses extend far beyond immediate injury. Victims suffer long-term physical decline, emotional trauma, financial loss, and in extreme cases, premature death.
Where Nursing Home Abuse Is Most Common
The 10 states with the highest number of abuse-related citations are:
- California – 3,251
- Illinois – 2,875
- Texas – 2,091
- Ohio – 1,780
- Missouri – 1,351
- Pennsylvania – 1,310
- New York – 1,101
- Michigan – 1,058
- Wisconsin – 974
- Maryland – 744
These states demonstrate severe, systemic failures, from understaffing to poor training and weak regulatory enforcement. California’s high citation count reflects a chronic statewide struggle with facility oversight and staffing shortages, while Illinois and Texas face similar challenges compounded by population size and inspection backlogs.
The States With the Fewest Citations Aren’t Necessarily the Safest
The states reporting the fewest citations include Alaska (12), New Hampshire (58), North Dakota (59), Vermont (61), and Hawaii (64). While these figures might suggest higher-quality care, analysts caution that they may also reflect:
- Fewer facilities
- Smaller populations
- Underreporting by residents
- Limited inspection resources
- Variability in how states classify “abuse”
Low numbers alone do not indicate low risk; many states simply lack comprehensive reporting systems.
The Most Common Nursing Home Deficiencies
In 2023, inspectors issued 94,449 total citations to long-term care facilities. The top deficiencies included:
- Infection prevention failures
- Lack of supervision
- Food-handling violations
- Poor medication management
- Failure to assist with daily living
- Unsafe facility conditions
- Incomplete care plans
In total, the top 10 deficiency categories added up to 144,542 citations, demonstrating that many facilities fail multiple critical standards at once.
The Path Forward: A Crisis That Demands Action
Experts say the findings highlight an urgent need for policy reform, including:
- Increased staffing ratios
- Mandatory abuse reporting protocols
- Better pay and training for caregivers
- Regular surprise inspections
- Harsher penalties for repeated violations
- Expanded family access to inspection records
With America’s senior population rapidly increasing, the consequences of inaction will be devastating.
High Rise Financial believes every elderly adult deserves dignity, safety, and compassionate care. When a nursing home fails to uphold its duty, legal action is often the most powerful tool families have to demand accountability and justice.
