“Older person abuse is an intentional act or failure to act that causes or creates a risk of harm to an older adult. An older adult is someone aged 60 or older.” That’s how the CDC defines older person abuse (often called elder abuse). Greater demand for senior care, overwhelming turnover in staffing, and no-lift policies straining emergency services all contribute to lower quality care and create conditions that increase the risk of elder abuse.
Skilled care facility staffing makes a huge difference in the quality of care.
It’s no secret that senior care facilities experience high caregiver staff turnover (though in 2024 turnover among CNAs decreased from 44% to 42%). When turnover occurs, the replacement isn’t immediate. This delay, combined with already high staff-to-resident ratios, means insufficient staffing is the norm.
The result? Decreased quality of care. Long wait times for seniors who need help, less one-on-one time with caregivers, a lack of individualized care, and lower caregiver quality as facilities hire CNAs to meet staffing requirements over quality caregiving. The combination of the wrong people working under high-stress conditions also increases the risk of elder abuse and inappropriate behavior like talking down to residents or speaking negatively about them.
The physical environment impacts opportunities for abuse and neglect.
Broken equipment, tripping hazards, dirty linens, unpleasant smells, poor lighting, and unsafe bed heights are obvious red flags in skilled care facilities. There is more to the physical environment that makes a large impact on the quality of life and care for seniors.
Large buildings dominate the skilled care facility landscape. One downside of this common model is the presence of long hallways. While long hallways are common in large facilities designed to maximize resident capacity, they can leave residents feeling anxious about navigating facilities, increasing the distance they need to travel to shared areas. Combined with low staffing, this increases isolation and the potential for elder abuse.
The physical environment isn’t just about the interior space. Limited or no access to natural outdoor settings also affects the quality of care issues. While no resident should ever be forced into nature-based activities, every resident should have the opportunity to go outdoors or have views of the outdoors and activities that allow them to connect with nature (like tabletop gardening and birdwatching).
The layout of senior care facilities often makes a difference for the staff, as well. Supply closets located far away and locked up leave caregivers and seniors waiting longer to get what they need, or going without necessary supplies, which compromises resident care. Ask about caregiver access to supplies when touring facilities, including convenience and restrictions.
Administrative staff in senior care facilities have red flags, too.
The senior care industry isn’t immune to high-pressure sales tactics, illegal and unethical behaviors, or a lack of transparency. For many families, the decision to seek a skilled care facility comes in the wake of an episode that leaves no doubt about their loved one’s needs for skilled care. This often means families are seeking urgent placement and are vulnerable to unethical behavior from administrative staff.
Whether administrators are being evasive about fees and billing practices or putting additional pressure on families for commitments, these are signs a facility may largely be focused on finances rather than care. Other things to watch for include: hesitance to be transparent about inspections, HIPAA violations like staff discussing resident information inappropriately, and a history of poor record keeping for medications or care plans.
Signs a loved one in senior care may be abused.
A senior loved one may be too scared to tell their family about the abuse they’re experiencing or may be unable due to a disability or cognitive decline. During visits, observe how other residents appear and behave throughout the facility. Watch for changes in individual residents and facility-wide patterns.
While unexplained injuries and bedsores are top of mind for signs of abuse, they’re not the only indicators. Seniors experiencing elder abuse may show increased agitation, anxiety, or withdrawal. A lack of appetite and concerning weight loss can also indicate that the level of care is inappropriate. Often, a change in personal hygiene or an observed pattern among other residents of poor hygiene can indicate abuse or neglect, too.
Tools, tips, and resources for assessing senior care facilities (and investigating abuse).
Knowledge is your best defense when choosing a skilled care facility. Start by researching facilities through Medicare’s Care Compare website and the Indiana State Department of Health’s inspection reports. In Indiana, you can also access facility inspection reports and complaint histories through the Indiana Family and Social Services Administration. These databases reveal citation histories, staffing ratios, and quality ratings that marketing materials won’t show you. Look for patterns of violations, particularly those related to resident safety, medication management, or abuse allegations.
Don’t rely solely on scheduled tours. Unannounced visits at different times—during meals, evening shifts, or weekends—give you a realistic picture of daily operations. Observe staff-resident interactions during unguarded moments when staff aren’t performing for visitors. Are residents engaged and cared for, or do they appear neglected or fearful? Strike up conversations with current residents and their families if possible. Their experiences often reveal truths that glossy brochures can’t hide.
If you suspect abuse or neglect in Indiana, contact the Indiana Long-Term Care Ombudsman at 1-800-622-4484 or report online through the Indiana Family and Social Services Administration. The ombudsman serves as an advocate for residents and can investigate complaints confidentially. You can also contact Indiana Adult Protective Services at 1-800-992-6978. Keep records of incidents, take photos when appropriate, and don’t hesitate to involve local law enforcement if you witness criminal behavior.
How The Restoracy improves quality of care.
Quality care starts with having enough skilled, compassionate caregivers—which is why The Restoracy maintains the highest caregiver-to-resident ratios in Indiana. Our small home model means our team members genuinely know each resident’s preferences, routines, and needs. There’s no rushing through care because our residents live in homes, not institutions, where relationships matter more than efficiency quotas.
Our physical environment eliminates the red flags that plague larger facilities. Instead of long, intimidating hallways, our residents enjoy a home with easy access to outdoor areas, comfortable common rooms, and private bedrooms that ensure dignity and personal space. No shared bedrooms means every resident has their own sanctuary for rest and personal belongings. Supplies and equipment are readily accessible to our team, ensuring that care isn’t delayed by logistical barriers that compromise resident well-being.
Transparency defines our approach to family communication. We welcome questions, provide regular updates, and encourage family involvement in the care decisions. Our open-door policy welcomes both scheduled and surprise visits because we’re proud of the care we provide every single day. To see the difference that proper staffing, thoughtful design, and genuine care make in your loved one’s daily life, we invite you to schedule a tour and experience what quality skilled care truly looks like.