When someone we love moves into a nursing home or assisted living facility, we expect them to receive not just professional care—but dignity, safety, and compassion. Unfortunately, elder abuse remains a serious and often hidden issue in long-term care environments.
According to the World Health Organization, nearly 50% of long-term care facility staff in 2023 admitted to abusive or neglectful behavior. That number reflects only self-reported incidents—countless others go unnoticed, especially among residents who are unable to advocate for themselves.
At Axis Estate Planning, we’re committed to empowering families with the knowledge they need to protect the people who matter most. This guide will help you recognize the risk factors and warning signs of abuse and know what to do if you suspect something is wrong.
Understanding the Risk Factors
Certain systemic challenges in long-term care settings can make abuse more likely:
Understaffing and Poor Training
Overburdened or undertrained caregivers may struggle to meet residents’ needs—leading to neglect or even mistreatment.
Discrimination and Vulnerable Populations
Women, people of color, LGBTQ+ individuals, and those living with cognitive or mental health conditions often face a higher risk of abuse. Veterans and trauma survivors may be especially vulnerable to mistreatment due to misunderstandings or caregiver frustration.
Cognitive and Physical Impairments
Seniors with dementia, Alzheimer’s, or mobility limitations may be unable to report abuse—or not be believed if they do. That’s why loved ones must remain attentive to behavioral or physical changes.
Types of Elder Abuse & Warning Signs
Physical Abuse
Use of force resulting in pain or injury—pushing, slapping, pinching, or improper restraint.
Signs include:
- Bruises, cuts, or broken bones
- Flinching or fear around staff
- Refusing physical contact
Sexual Abuse
Any non-consensual sexual contact or behavior.
Watch for:
- Bruising around private areas
- STIs or unexplained infections
- Withdrawal or anxiety
- Avoidance of certain caregivers
Emotional or Psychological Abuse
Includes threats, humiliation, or forced isolation.
Possible signs:
- Depression or mood swings
- Sudden fear or silence around staff
- Social withdrawal
Neglect
Failure to meet basic needs like hygiene, food, or medical care.
Look for:
- Weight loss or dehydration
- Unclean clothing or surroundings
- Bedsores, untreated conditions
- Missed medications
What to Do If You Suspect Abuse
- Observe and Document
Keep a log of visits, concerns, and any physical or behavioral changes. Photos can be helpful if taken respectfully. - Speak with Facility Leadership
Bring up your concerns with the administrator or care coordinator. Request written responses and a plan for resolution. - Report It
If there’s no improvement—or immediate risk—contact your state’s Adult Protective Services or the Long-Term Care Ombudsman. - Seek Legal Guidance
An elder law attorney can help you understand your rights and options. Legal action may be necessary if harm occurred due to negligence or abuse.
Trusted Resources
- Eldercare Locator: 1-800-677-1116
- National Center on Elder Abuse: ncea.acl.gov
- The Consumer Voice: theconsumervoice.org
- Find Your Ombudsman: consumervoice.org/get_help
Final Thoughts
Every elder deserves to be treated with care and respect. If your instincts tell you something is wrong, don’t hesitate—speak up. You could be the voice that makes the difference.
At Axis Estate Planning, we’re here to help families navigate difficult decisions and advocate for the well-being of those they love.
Need legal guidance or concerned about a loved one’s care?
Let us help you take the next step.
Visit Us: 900 Wilshire Drive, Suite 105, Troy, MI 48084
Call Us: (248) 251-1001
Learn More: www.axisattorneys.com
Axis Estate Planning
Trusted. Thoughtful. Here for what matters most.
At Axis Estate Planning, we recognize the emotional and practical challenges families face when confronting a dementia or Alzheimer’s diagnosis. As of 2025, Alzheimer’s disease continues to be the most common form of dementia, accounting for approximately 60% to 80% of all dementia cases worldwide. In the United States alone, an estimated 7.2 million adults aged 65 and older are living with Alzheimer’s dementia. That number is expected to nearly double—reaching 13.8 million by 2060—unless a medical breakthrough changes the course of this disease.
This increase is far more than a statistic. It represents a rising public health challenge that affects entire families, communities, and the way we prepare for the future.
Dementia: The Broader Category
Dementia is not a single disease—it is a term used to describe a wide range of cognitive impairments that interfere with daily life. These conditions impact memory, language, judgment, and reasoning. Dementia includes several disorders, such as:
- Alzheimer’s disease
- Vascular dementia
- Lewy body dementia
- Frontotemporal dementia
Symptoms can include confusion, forgetfulness, communication difficulties, and impaired decision-making. At Axis Estate Planning, we often help families understand what these symptoms may mean in both medical and legal contexts.
Alzheimer’s: A Leading Cause of Cognitive Decline
Alzheimer’s disease, the most prevalent form of dementia, is a progressive neurodegenerative condition. It is caused by the accumulation of abnormal proteins in and around brain cells, resulting in a gradual decline in memory, behavior, and physical function.
Certain populations are more affected than others:
- Older adults: Approximately 74% of people with Alzheimer’s are age 75 or older
- Women: Nearly two-thirds of Alzheimer’s patients are women
- Communities of color: Older Black Americans are about twice as likely, and older Hispanic Americans about 1.5 times as likely, to develop Alzheimer’s compared to older white Americans
These disparities make it even more critical to ensure early diagnosis, proper care access, and culturally aware legal support. At Axis Estate Planning, we are committed to helping all families navigate these sensitive challenges with care and respect.
The Impact on Caregivers
Dementia doesn’t just affect those diagnosed—it affects the caregivers who support them every day. Family members, often unpaid and untrained, carry the emotional and physical burden of care. While many individuals with dementia prefer to remain at home, caregiving can become increasingly demanding.
Thankfully, many senior living facilities now offer memory care units, which include:
- Secure environments tailored for dementia patients
- Structured, memory-enhancing activities
- Personalized care plans
- Support with daily living in a way that preserves dignity
Axis Estate Planning frequently advises clients on choosing facilities that align with a loved one’s care needs and long-term goals.
The Legal Side of Dementia and Alzheimer’s
Planning ahead is crucial when facing a progressive diagnosis like Alzheimer’s. As the condition worsens, individuals may lose the ability to make legal or financial decisions. Establishing foundational legal documents early—while your loved one is still capable of making decisions—ensures that their wishes are respected and their assets are protected.
Essential documents include:
- Powers of Attorney
- Healthcare Directives
- Living Wills
- Revocable and Irrevocable Trusts
These tools not only offer peace of mind but also reduce stress during future medical or legal emergencies. Axis Estate Planning works closely with families to craft plans that reflect each person’s values, care preferences, and financial realities.
Let Axis Estate Planning Help You Plan with Confidence
If you or someone you love is facing a dementia or Alzheimer’s diagnosis, you don’t have to navigate the legal and care-related complexities alone. At Axis Estate Planning, we provide thoughtful, compassionate guidance to help families secure the support their loved ones need—while protecting their legacy and future.
Visit Us: 900 Wilshire Drive, Suite 105, Troy, MI 48084
Call Us: (248) 251-1001
Learn More: www.axisattorneys.com
Axis Estate Planning
Trusted. Thoughtful. Here for what matters most.
At Axis Estate Planning, we understand that selecting a nursing home for a loved one is one of the most emotional and significant decisions a family can face. Many begin their search by turning to the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System. While this system, introduced in 2008, was designed to simplify comparisons between facilities, it has notable limitations—especially as of 2025—that families must consider before relying on it exclusively.
Understanding the Five-Star Rating System
The CMS system provides each nursing home with an overall rating based on three primary components:
- Health inspections
- Staffing levels
- Quality measures (including resident care outcomes)
Although helpful at a glance, these ratings often fail to reflect the full reality of a facility’s performance and care quality.
Why the Star Rating Isn’t Enough
Self-Reported Data Can Be Misleading
Much of the data used to determine star ratings is self-reported by the nursing homes themselves. This includes:
- Staffing levels
- Incident reports
- Resident care metrics
Investigations have found that some facilities:
- Inflate nurse staffing numbers
- Underreport safety issues
- Misrepresent resident conditions and treatments
Inspection Standards Vary Widely
State agencies conduct health inspections, but the quality and consistency of these reviews can differ significantly across state lines. Concerns include:
- Inconsistent inspection protocols
- Advance notice given to facilities before inspections
- Serious violations not being reflected in the overall rating
As a result, a nursing home that appears excellent online may fall short of expectations upon closer inspection.
A Smarter Way to Choose a Nursing Home
At Axis Estate Planning, we advise families to take a more hands-on, investigative approach when evaluating long-term care options:
Tour the Facility
In-person visits allow you to see staff-resident interactions, cleanliness, and the overall environment firsthand.
Ask Thoughtful Questions
Engage with administrators, nurses, and caregivers. Discuss:
- Staff-to-resident ratios
- Emergency procedures
- Dementia care experience
- Employee training and retention
Speak with Current Residents and Their Families
Firsthand accounts from those currently living in or visiting the facility can offer invaluable insights.
Explore Additional Resources
In addition to the CMS website, consult:
- The Michigan Department of Health and Human Services
- Long-term care ombudsman evaluations
- Trusted advisors like doctors and elder law attorneys
Use a Checklist
Bring along tools like the AARP Nursing Home Checklist to help structure your evaluation and avoid missing critical information.
Final Thoughts
The Five-Star Quality Rating System can serve as a helpful initial reference, but it should never be the sole basis for selecting a nursing home. With long-term care becoming a central part of aging in America, it’s essential to go beyond online scores and make decisions grounded in observation, research, and guidance.
If you’re facing long-term care decisions or need help protecting a loved one’s future, Axis Estate Planning is here to provide clarity, support, and trusted legal guidance every step of the way.
Visit Us: 900 Wilshire Drive, Suite 105, Troy, MI 48084
Call Us: (248) 251-1001
Learn More: www.axisattorneys.com
Axis Estate Planning
Trusted. Thoughtful. Here for what matters most.
