Across the United States, nearly 15% of the population is now 65 or older — a demographic milestone that should have inspired stronger protections for aging Americans. Instead, elder abuse remains one of the most persistent and least visible crises in the country. An estimated 10% of older adults experience abuse each year, and within nursing homes specifically, 16% of residents report mistreatment. The numbers suggest a system already strained, and in many regions, failing outright.
A new analysis by High Rise Financial examining national citation records and abuse complaints paints a clearer picture of where — and how — older Americans are being harmed. The findings reveal not only the forms of abuse most frequently suffered, but also the states where nursing homes face the greatest scrutiny for dangerous conditions.
Understanding the Many Forms of Elder Abuse
Elder abuse covers a spectrum of harmful behaviors, ranging from physical violence to emotional manipulation, financial exploitation, or neglect. It occurs both in private homes and institutional settings, often at the hands of someone the victim relies upon — a relative, caregiver, or facility staff member.
The consequences can be devastating. Beyond immediate harm, abused seniors often face serious health complications, rapid decline in independence, financial vulnerability, and even a heightened risk of premature death. Fear, cognitive decline, and dependence frequently prevent victims from reporting what is happening to them, allowing abuse to continue undetected for long periods.
In 2023 alone, nursing home facilities across the U.S. received 94,449 health citations, underscoring systemic weaknesses in oversight and care standards.
What the Complaint Data Shows: A System Under Strain
A closer look at the types of abuse reported in nursing homes exposes troubling patterns. Physical abuse remains the most commonly reported category, accounting for 38% of all formal abuse complaints. These incidents involve hitting, rough handling, or improper restraints — all of which carry significant, sometimes life-threatening risk for elderly residents.
Gross neglect, which makes up 24% of complaints, reflects failures to meet basic human needs: adequate food, safe hygiene standards, or timely access to medical care. Such neglect often leads to infections, falls, or serious medical complications.
Behind these figures is another type of harm that rarely leaves physical marks yet has deep psychological impact. Sixteen percent of complaints involve emotional or psychological abuse, including intimidation, isolation, or verbal degradation.
Financial exploitation — reported in 14% of complaints — shows how vulnerable residents can be pressured, manipulated, or stolen from by people entrusted with their care.
The remaining 8% of complaints involve sexual abuse, a deeply disturbing category where elderly people, often unable to protect themselves, are subjected to profound violations of dignity and safety.
Taken together, these numbers reveal a multifaceted crisis: one in which violence, neglect, and manipulation can coexist within the same facility or even the same resident’s experience.
Behind the Scenes: The Most Common Facility Failures
Abuse does not occur in isolation — it occurs in environments where foundational systems already fail. The nation’s ten most commonly cited deficiencies in nursing homes reflect this broader breakdown.
The most frequent problem, with 22,918 citations, involves poor infection prevention and control — an especially alarming statistic given older adults’ vulnerability to illness. Close behind are issues involving lack of supervision and unsafe environments, documented 20,807 times, and improper food handling, with 19,595 citations.
Other recurring violations include improperly stored medication, inadequate care planning, and failure to assist residents with essential daily tasks such as eating or bathing. In total, these ten categories account for 144,542 citations — a higher count than the total number of cited facilities because many homes are cited multiple times across different categories.
This pattern indicates not just isolated oversight failures, but widespread operational weaknesses that endanger residents long before abuse is formally reported.
Where the Problems Are Worst: States With the Highest Abuse Citations
Some states stand out as particular hotspots for elder abuse in nursing homes.
California leads the nation with 3,251 citations, followed by Illinois with 2,875 and Texas with 2,091. These three states alone account for more elder abuse citations than the rest of the top ten combined — a reflection of both their large populations and serious systemic shortcomings.
Other states with elevated levels of abuse-related citations include:
- Ohio – 1,780 citations
- Missouri – 1,351
- Pennsylvania – 1,310
- New York – 1,101
- Michigan – 1,058
- Wisconsin – 974
- Maryland – 744
For families navigating care decisions, these numbers highlight the need for vigilance in areas where lapses are frequent and the stakes are high.
States With the Lowest Reported Abuse — and Why That May Be Misleading
On the opposite end, several states report far fewer citations.
Alaska has the lowest total in the nation with just 12 citations, followed by New Hampshire (58), North Dakota (59), Vermont (61), and Hawaii (64). These figures might suggest stronger protections or more effective oversight — but low totals are not always a sign of safer environments.
Smaller states often have:
- Fewer nursing home facilities
- Smaller resident populations
- Less frequent inspections
- Lower public awareness of reporting channels
- Potential underreporting due to lack of access or resources
Differences in how states define, track, and enforce abuse also influence citation numbers. As a result, even the lowest-ranking states may have unreported or undetected issues that never enter official data.
A National Challenge Still Searching for Solutions
Elder abuse in the United States is pervasive, preventable, and deeply tied to inadequate oversight across long-term care systems. The data shows that vulnerable seniors face harm across a wide spectrum: physical violence, neglect, psychological trauma, financial exploitation, and sexual assault.
Facilities struggle with basic compliance, evidenced by tens of thousands of citations involving infection control, food handling, supervision, and medical care. And while certain states clearly face more severe challenges, no part of the country is immune.
Improving outcomes will require:
- Stronger regulations and consistent enforcement
- Better reporting systems for residents and families
- Higher staffing standards and improved training
- Greater transparency in inspection findings
- Policy changes that reflect the realities of an aging population
Most importantly, these findings demand a cultural shift toward treating older adults with the dignity, protection, and priority they deserve.
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