On January 9, a report of neglect and abuse at St. Louis-area nursing homes was released. In response to the Freedom of Information Act requested by investigative journalism group ProPublica, the documents include results from three years of inspections by the Department of Health and Human Services’ Center for Medicare and Medicaid Services. Findings include allegations of rape, physical and verbal abuse, and neglect. In total, 513 nursing homes in Missouri were cited for inadequacies, with 99 out of this amount having “serious deficiencies.”

Specifically, the report showed that St. Louis-area nursing home facilities used lock-downs for punishment, did not notify physicians regarding a resident’s chest condition, have staff members that yell vulgarities at residents, did not protect residents from sexual abuse, and were lax in notifying police.

The results, however, are not exclusive to Missouri. In 2009, a congressional report indicated that one-third of all nursing homes on a national level were cited for abuse violations, including physical, sexual, and verbal.

As 2 million Americans live in long-term care facilities, and this amount is likely to grow, how do family members spot abuse or neglect? Communication is key, especially as physical signs are not always apparent.

Common neglect in nursing homes covers four areas: personal hygiene, in which residents do not receive adequate help caring for themselves; basic needs, including refusal of food and water and keeping an unsanitary environment; medical neglect, or not providing residents with proper medical attention; and emotional neglect.

But while neglect, in a legal sense, is considered both intentional and not, abuse pertains to an intentional cause of injury, resulting from use of intimidation, refusal of care or basic services, and punishment. Residents may suffer from assault and battery, unreasonable physical restraint or seclusion, or non-prescribed chemical restraint.

Common signs of nursing home neglect and abuse include asphyxiation, bed injuries, malnutrition or dehydration, emotional upset or withdraw, fall-related injuries, infections, history of wandering off premises, bed sores, significant weight changes, unexplained injuries or death, unsanitary living conditions, and significant changes in behavior, such as isolation.

On a federal level, nursing home residents have “the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion.” In Connecticut, abusing a person 60 years of age or older is considered a crime, one punishable up to 10 years in prison or fined up to $10,000. In instances of neglect and abuse, staff are required to report abuse or neglect suspicions of reasonable cause to the Department of Social Services within a 72-hour time frame.