What Are the Causes of Nursing Home Abuse and Neglect
Updated October 31, 2026.
Short answer: Nursing home abuse and neglect usually trace back to understaffing, poor training and supervision, high staff turnover and weak oversight. In California, a facility that abuses or neglects a resident can be held responsible under the Elder Abuse and Dependent Adult Civil Protection Act and the residents’ rights law in the Health and Safety Code.
Abuse in long-term care is common. According to the World Health Organization, about 1 in 6 people aged 60 and older experienced some form of abuse in community settings in the past year, and in institutions such as nursing homes and long-term care facilities, 2 in 3 staff reported that they had committed abuse in the past year.
Common Causes of Nursing Home Abuse and Neglect
- Understaffing. Too few nurses and aides means residents may not be turned, fed, toileted or monitored on time, which can lead to bedsores, falls, dehydration and malnutrition.
- Poor training and supervision. Aides who have not been trained in fall prevention, wound care or dementia care, or who are not supervised, are more likely to make harmful mistakes or mistreat residents.
- High turnover and burnout. Hard work, stress and frequent staff changes make it harder to know each resident’s needs and easier for warning signs to be missed.
- Weak hiring practices. A facility that does not screen employees adequately may hire people who should not care for vulnerable adults.
- Gaps in oversight and reporting. Abuse can continue when staff do not report it and inspections do not catch it.
None of these causes excuses abuse. A facility is responsible for staffing, training and supervising its employees so residents are kept safe.
How California Law Defines Elder Abuse and Neglect
The Welfare and Institutions Code defines elder abuse to include physical abuse, neglect, financial abuse, abandonment, isolation and abduction (W&I Code section 15610.07; see the definitions starting at section 15610). Neglect includes failing to help with personal hygiene, food or clothing, failing to provide medical care, and failing to protect a resident from health and safety hazards (section 15610.57). An “elder” is a California resident aged 65 or older.
Legal Remedies for Residents and Families
- Enhanced remedies under W&I Code section 15657. When a defendant is proven liable for physical abuse, neglect or abandonment and acted with recklessness, oppression, fraud or malice, the court must award reasonable attorney fees and costs, and the usual limit on recovering a deceased resident’s pain and suffering damages does not apply. The standard of proof is generally clear and convincing evidence; as amended effective January 1, 2026, some cases may proceed under a preponderance standard under section 15657.02 (section 15657).
- Residents’ rights under H&S Code section 1430. A current or former resident of a skilled nursing or intermediate care facility, or the resident’s representative or successor, can bring a civil action against the licensee for violating the resident’s rights. For violations on or after March 1, 2021, the licensee can be liable for up to $500 per violation, plus costs and attorney fees, and can be ordered to stop the violation (subdivision (b); section 1430(b)).
- Negligence and wrongful death claims. Ordinary negligence and, if a resident dies, wrongful death claims may also apply.
Facility staff, caregivers, and health practitioners are mandated reporters. For most abuse in a long-term care facility, Welfare and Institutions Code section 15630 requires a verbal report to law enforcement within two hours and a written report within 24 hours. Abuse elsewhere can be reported to county Adult Protective Services or local law enforcement.
Warning Signs and What to Do
- Unexplained bruises, fractures or falls; bedsores; sudden weight loss or dehydration; poor hygiene;
- Changes in mood, fear of certain staff, or withdrawal;
- Missing money or property.
If a resident is in immediate danger, call 911. You can also report concerns to the facility administrator, the local Long-Term Care Ombudsman program and the California Department of Public Health, which licenses nursing homes. Keep notes, photos and copies of medical records.
If you suspect a loved one has been abused or neglected, learn more on our San Diego elder abuse attorney page, or call Injury Trial Lawyers for a free case evaluation.