Maryland caregiver's alleged monthlong plot to target 87-year-old raises major concerns about assisted living facilities. What you need to know

However, it’s believed that James had been plotting the attack for a month. A police investigation found that a seldom-used door to the facility had been propped open and the security sensor had been tampered with 36 days prior to the shooting (1).

While this may be an extreme case, incidents of abuse, neglect and mistreatment in LTC facilities and nursing homes are more common than people may realize. Here’s what you need to know before signing a contract.

The rise of elder abuse

Nearly 70% of Americans aged 65-plus will require some form of long-term care during their lifetime, and 1 in 5 will require care for more than five years (2). Long-term care provides help with activities of daily living (ADL), which can include bathing, dressing and eating.

But it comes at a cost. According to CareScout (3), the annual national median cost of care is $74,400 for care in an assisted living community, $114,975 for a semi-private room in a nursing home and $129,575 for a private room in a nursing home. However, those costs could be higher or lower, depending on your location.

When families are paying thousands of dollars every month for long-term care, they expect their loved ones will be protected — and not put at risk by the very people hired to care for them.

But rates of abuse are high in nursing homes and long-term care facilities. Globally, 1 in 6 adults aged 60 and older experienced some form of abuse in community settings in 2023, according to the World Health Organization (4), with 2 in 3 staff reporting they had committed abuse in the previous year.

Not only can abuse have devastating emotional effects, but residents could also “suffer serious physical injuries that turn into long-term disabilities,” (5) such as bedsores that lead to severe infections, according to the Nursing Home Abuse Center (NHAC).

While any senior could be a target, “residents with Alzheimer’s disease or other forms of dementia are especially vulnerable,” according to NHAC. Socioeconomic status could also play a role: “People who rely on Medicaid to pay for nursing home care may stay at lower-quality facilities with higher rates of neglect and abuse.”

There are different types of abuse, ranging from physical, emotional and sexual abuse to financial exploitation, passive neglect and deprivation. Abuse can take place between residents and family members, caregivers or even other residents.

In some cases, abuse is the result of staffing shortages, poor supervision or lack of staff training or experience. For example, staff shortages could lead to neglect, such as failing to administer medications on time.

However, there are cases where caregivers are abusive, which is why it’s important for facilities to conduct rigorous hiring practices that include criminal background checks, verification of qualifications and behavioral interviews. New hires should be closely supervised during probationary periods. Some facilities might also conduct random drug testing and offer continuous staff training.

Keeping your loved ones safe

Asking the right questions about staffing protocols — and reviewing state inspection reports — can help reduce the risk of placing a loved one in a potentially dangerous environment.

Medicare’s Care Compare (6) ranks the overall quality of nursing homes (from 1 to 5 stars). You can also find a public record of violations and sanctions on Care Compare or through state-level departments of health. ProPublica’s Nursing Home Inspect (7) allows you to search more than 90,000 nursing home inspection records.

You can also contact your state ombudsperson to find out if a facility has any outstanding violations.