Nursing home residents who report abuse are often met with retaliation rather than protection, according to a new report from The Schiller Kessler Group examining elder care data nationwide, which found that fear of retaliation is the primary reason residents stay silent about mistreatment, even as researchers estimate that between 10% and 20% of nursing home residents experience some form of abuse each year.
The report cites research from the Long Term Care Community Coalition identifying retaliation fear as the leading barrier to reporting, a fear the report’s authors describe as frequently justified. Residents who file complaints against an abuser often remain entirely dependent on that same person, or that facility’s staff, for their daily care, and reporting an incident does not guarantee a transfer to a safer facility or an end to the mistreatment. Instead, residents who do speak up commonly describe retaliatory responses: withheld or delayed pain medication, ignored call lights, late meals, and deliberately neglected basic care needs.
That dynamic helps explain why the report finds different forms of abuse vary widely in how easily they can be identified. Physical abuse is often the most visible, leaving bruises, burns, fractures, or injuries inconsistent with a resident’s condition or mobility level; in a survey of family members cited in the report, 24.3% said they had personally witnessed a physical abuse incident. Understaffing compounds the risk of resident-on-resident physical altercations as well: in 2024, 72% of nursing homes were operating below pre-pandemic staffing levels, leaving fewer staff available to intervene or supervise vulnerable residents.
Emotional and psychological abuse proves far harder to confirm, the report notes, since symptoms like withdrawal, anxiety, appetite changes, or reluctance to speak around staff are easily misattributed to aging or illness. Yet surveys referenced in the report found that 81% of long-term care nurses and other facility staff had personally witnessed emotional abuse, and 40% admitted to committing at least one emotionally abusive act themselves, a striking acknowledgment from within the industry.
Financial exploitation represents another significant risk, particularly for cognitively impaired residents. Adults over 65, especially those with dementia, face elevated risk of financial abuse, and the report advises families to watch for unexplained bank withdrawals, sudden changes to legal or estate documents, and missing personal valuables as potential warning signs.
Sexual abuse remains among the most underreported and hardest to detect forms of mistreatment. The report cites National Ombudsman Reporting System data showing 1,816 sexual abuse complaints from long-term care facilities in 2024, a 60% increase over 2017 levels. Roughly 60% of nursing home sexual abuse victims have dementia or another cognitive impairment, the report notes, making both detection and reporting exceptionally difficult; families are advised to watch for unexplained injuries, torn clothing, and sudden behavioral changes as potential indicators.
The report also highlights the widespread use of psychotropic medications and chemical restraints, substances used to sedate or subdue residents rather than address underlying care needs, as a related and long-documented problem. Despite the Nursing Home Reform Act of 1987 explicitly establishing residents’ right to be free from unnecessary chemical restraints, improper psychotropic medication use accounted for 883 federal citations in the most recent inspection cycle. An April 2025 classification change now allows citations for sedating residents purely for staff convenience to be treated as immediate jeopardy-level violations, though the report notes it remains unclear whether that change will meaningfully alter behavior at facilities with a history of repeat citations.
“The data shows a system that documents failure after failure but rarely follows through with consequences that actually change behavior,” said an attorney with the legal team behind the report. “Families are often the last line of defense, and residents who do speak up deserve real protection, not retaliation.”
The report’s authors argue that because nearly 70% of all federal abuse citations originate from resident or family complaints rather than routine inspections, empowering families to recognize warning signs, and protecting residents who come forward, may be just as important to addressing the crisis as any regulatory reform.