How to Recognize Nursing Home Abuse in a Nonverbal Resident

Nursing home residents who cannot speak, because of advanced dementia, stroke, traumatic brain injury, or developmental disability, are among the most vulnerable people in long-term care. When a resident cannot tell you what’s happening, families and care teams must rely on observation, medical knowledge, and a healthy skepticism to spot nursing home abuse and neglect early. In this blog, we explain common signs of nursing home abuse, practical steps to investigate and document concerns, and answer frequently asked questions.

“When a nursing home resident cannot speak, families must become their voice,” says John J. Malm, Naperville nursing home abuse lawyer. “Abuse hides in silence. The smallest bruise, the slightest change in behavior, or the quiet withdrawal of a once-cheerful loved one can be a cry for help. Families should never hesitate to question care, demand answers, and take action. Your loved one’s safety and dignity depend on it.”

Why This Matters

Abuse and neglect of older adults in institutional settings are not rare one-off events. International reviews and surveys show high rates of mistreatment in long-term care: for example, one World Health Organization review found that rates of abuse in institutions are alarmingly high, and that many staff report having committed some form of abuse or neglect. In the United States, roughly 1.3 million people lived in nursing homes in 2020, giving a sense of the scale and the number of people at risk.

A study of nursing home populations found that a substantial proportion of residents reported abuse and neglect (one review reported figures such as 44% reporting abuse and a very high proportion reporting neglect or witnessing neglect), underscoring that the problem often goes beyond isolated incidents. These numbers are imperfect because abuse is frequently underreported, especially when residents cannot speak for themselves, but they are a clear warning that vigilance is necessary.

Common Forms of Abuse and Neglect in Nonverbal Residents

• Physical abuse: hitting, grabbing, rough handling, unnecessary restraint.
• Neglect: failing to provide food, fluids, hygiene, turning and repositioning to prevent pressure ulcers, or timely medical care.
• Emotional or psychological abuse: yelling, isolating, ignoring, or humiliating a resident.
• Financial exploitation: stealing money or property, inappropriate use of power of attorney.
• Sexual abuse: any nonconsensual sexual contact; particularly difficult to detect in nonverbal residents.
• Medication misuse: over-sedation to control behavior or withholding necessary medications.

How Abuse Looks When the Nursing Home Resident Can’t Tell You

Because nonverbal residents can’t describe what’s happening, signs are often behavioral or physical. Look for patterns and clusters of symptoms rather than reacting to a single change.

Physical clues:

• Unexplained bruises, cuts, fractures, or burns, especially in unusual locations (back, inner thighs, face). Multiple injuries at different stages of healing are especially suspicious.
• New or worsening pressure ulcers (bedsores): these are often a sign of poor turning/positioning or prolonged neglect.
• Frequent infections (UTIs, aspiration pneumonia) that suggest poor hygiene, feeding problems, or aspiration during feeding.
• Weight loss, dehydration, poor dentition, or untreated medical problems: signs of nutritional neglect or failure to provide basic care.
• Signs of sexual contact (bruising in genital areas, STIs): in nonverbal residents these can be subtle and require medical exam.

Behavioral and emotional clues:

• Sudden withdrawal, increased agitation, or new fearfulness around specific staff members.
• Unusually high sedation or decreased responsiveness: may indicate overuse of sedatives.
• Changes in sleep pattern, appetite, or toileting that cannot be explained medically.
• Avoidance behaviors: flinching, pulling away when touched, or refusing feeding from certain carers.

Environmental and staff-related clues:

• Poor facility hygiene, unwashed sheets or clothes, or bed linens with fecal stains.
• Staff shortage patterns (frequent staff turnover, caregivers assigned to too many residents).
• Inconsistent explanations for injuries or delays in reporting incidents to the family or physician.
• Reports from other residents or staff that a caregiver has acted roughly or yelled at residents. Studies of long-term care settings have documented that staff report witnessing or perpetrating various forms of mistreatment. These reports can be an important route to detection.

Practical Steps to Investigate and Document Abuse Concerns

When you suspect abuse or neglect, take clear, careful steps. Documentation and timely reporting can be critical for stopping harm and preserving evidence.

• Document everything immediately.
  • Date and time of each observation.
  • Exact description of physical findings (size, color, location of bruises) and behaviors (what you saw and who was present).
  • Photograph injuries or conditions when possible (follow facility rules about photography).
• Request a medical evaluation.
  • Ask the facility to have the resident examined by the nurse and, if needed, a physician. Insist on written medical notes.
• Talk to others.
  • Ask other family members, visitors, or residents if they’ve noticed similar problems. Ask staff for explanations — and note their responses.
• Preserve evidence.
  • Save clothing, soiled linens, or items you suspect may be involved. Note any gaps in charting or missing medical records.
• Report to the right authorities.
  • Notify the facility administration and the state’s long-term care ombudsman. File a report with the Illinois Department of Public Health.
• Follow up in writing.
  • Send an email or letter to the facility documenting your concerns and the steps you’ve taken; keep copies of all correspondence.

What Families Can Do Proactively

• Visit at different times (mealtimes, evenings, weekends) to see how care varies.
• Know the care plan and medication list; review charting for missed care.
• Arrange meaningful activities and social contact; isolation increases vulnerability.
• Be part of care routines when possible (assist with feeding, grooming) so staff know family is engaged.
• Build relationships with staff: respectful, collaborative relationships can improve care and make staff more likely to raise concerns.

Red Flags That Require Immediate Action

• New fractures, head injuries, or signs of sexual assault.
• Deep, malodorous pressure ulcers or rapidly worsening wounds.
• Repeated unexplained infections or persistent dehydration.
• Sudden, unexplained weight loss.
• A staff member who becomes defensive, avoids questions, or refuses medical evaluation.

If you see any of these, document, request immediate medical care, and report promptly to the facility, ombudsman, and IDPH or law enforcement.

Frequently Asked Questions about Abuse of Nonverbal Nursing Home Residents

Q: How common is nursing home abuse?
Estimates vary because abuse is underreported, but authoritative reviews show substantial rates: community surveys suggest roughly 1 in 6 older adults experience abuse in community settings, and institutional settings often report higher or different patterns of mistreatment.

Q: My loved one is nonverbal and has a new bruise. What should I do first?
Document the bruise (photo, date/time), ask for an immediate nursing and physician evaluation, obtain written medical notes, and report the incident to facility leadership. If the explanation is unsatisfactory or delayed, file a complaint with the IDPH.

Q: Can behavior changes in nonverbal residents indicate abuse?
Yes. Sudden increases in agitation, new fear of certain staff, or withdrawal can indicate mistreatment or distress. Always explore new behavioral changes with medical staff and consider the environment and care practices as possible causes.

Q: Will reporting make things worse for my loved one?
Retaliation is a legitimate concern. Many laws and regulations prohibit retaliation and require facilities to protect residents who report abuse. To reduce risk, document everything, and consult an attorney who can advise on protective steps.

Contact the Compassionate Illinois Nursing Home Abuse Lawyers at John J. Malm & Associates

Nonverbal residents rely on others to see, speak, and act for them. If you suspect that your loved one has suffered harm due to nursing home abuse or neglect in Illinois, our dedicated Illinois nursing home abuse attorneys at John J. Malm & Associates are here to help. We have decades of experience holding negligent nursing homes and their corporate owners accountable for the injuries they cause. Our firm investigates each case with urgency and compassion, ensuring your loved one’s voice is heard and their rights are protected.

Contact John J. Malm & Associates today for a free consultation. Let us help you uncover the truth, stop the abuse, and pursue the justice your family deserves.