Nursing home neglect is a huge and under-reported problem in the U.S. Based on reported cases alone it is estimated that upwards of five million older Americans have experienced some sort of exploitation, abuse, or neglect of their physical or psychological needs.

In elder care environments such as assisting living facilities, nursing home neglect may be evident in obvious or not so obvious ways.  Bed sores or pressure sores may be one sign of nursing home neglect that can be somewhat hidden depending upon the location of the sores.

Pressure sores are ulcers in the skin caused by staying in one position too long. These sores are most commonly found on the skin covering bony areas of the body such as the hip bones or sides of the pelvic cage. Pressure sores are common in elderly who may have limited ability to ambulate and who stay in a bed or wheelchair for most of the day.

According to a Mayo Clinic article, the location of pressure sores can vary depending upon whether an elder is wheelchair-bound or bedridden. In a wheelchair-bound senior, pressure sores are likely to develop on the tailbone or buttocks, on the shoulder blades or along the spine, or on the backs of the arms or legs where the limbs constantly are in contact with the chair. Pressure sores in a bedridden elder can also appear on the tailbone, buttocks, hips, lower back, and shoulder blade region, but other areas such the back, and sides of the head, heels, ankles and skin behind the knees could also be affected.

A skilled nursing facility should be aware of their client’s level of mobility and have staff take the time to move them regularly to avoid this often-painful ulceration of the skin. A certain amount of nursing home neglect can be assumed if pressure sores in these areas are constantly developing or getting worse.

Dehydration is also a sign of nursing home neglect. Many skilled nursing facilities are grossly understaffed and have a poor patient to caregiver ratio. This factor combined with others such as poor staff training, difficulties communicating needs, problems with swallowing, and incontinence can lead to under hydrated seniors with minor to major secondary physical problems.

Most of the body’s physical processes are reliant upon a certain level of hydration in the body. Elders may show a poor ability to think and express their thoughts clearly, and this can be attributed to age. In fact, a big sign of not getting enough water or other fluid is delirium, disorientation, or inability to think.

An additional factor for potential nursing home neglect can occur due to workload convenience for the staff. If a senior client has tendencies toward incontinence, it becomes easier for the staff to withhold fluids to reduce the workload involved in changing bedsheets, clothing, and adult diapers.