The Worst Nursing Home States In The U.S.

Senior citizens (people aged 65 and older) represent 14.9% of the U.S. population.

However, 10% of elderly adults are subjected to some form of abuse every year.

And 16% of senior nursing home residents report incidents of abuse, with data confirming that women are far more likely than men to suffer elder abuse.

This study considers the data regarding elder abuse in the U.S. It pinpoints the different types of abuse elderly people suffer, and where nursing home elder abuse is especially prevalent in the U.S. (and where it’s least prevalent across the country). 

But first: what are the different types of elder abuse, and what kind of treatment defines elder abuse?

Common Types of Elder Abuse

Elder abuse means when an older adult is harmed, mistreated, or neglected by someone they depend on, such as a caregiver, relative, or a member of staff in a care facility. It can involve physical violence, emotional manipulation, financial exploitation, sexual harassment, or failing to provide essential care like food, medication, or safe living conditions.

This type of abuse can occur in both private homes and institutional settings; it’s often unreported because many victims are afraid to (or are unable to) speak out. 

The effects of elder abuse can be seismic. Beyond immediate physical pain and distress, elder abuse can also induce serious health problems, loss of independence, financial hardship, and an increased risk of early death. For all these reasons and more, elder abuse is an urgent issue for both communities and families.

And the raw numbers tell their own story: across the U.S. in 2023, 94,449 health citations were issued to nursing home facilities.

Common Types Of Nursing Home Abuse

Beyond the study numbers, the details regarding elder abuse complaints within long-term care facilities reveal a shocking picture. 

Physical abuse leads the complaint list, making up 38% of all abuse-related complaints. This includes incidents where residents were hit, roughly handled, or unnecessarily restrained: violent acts that are also potentially fatal. 

Following closely behind physical abuse is gross neglect (24%). Such a high number emphasizes a significant failure to meet residents’ most basic needs: a good level of hygiene, appropriate nutrition, and timely medical care. 

Psychological abuse is the complaint in 16% of cases, a figure that indicates emotional harm caused by intimidation, humiliation, or deliberate isolation. This kind of abuse may not leave a physical trace but often causes permanent mental harm.

Financial exploitation (14% of complaints) suggests a high number of residents having their money taken, either by emotional manipulation, force, or theft. 

Sexual abuse cases represent 8% of total complaint numbers. While these numbers are comparatively low, they regard a particularly serious elder abuse issue. Such cases involve severe violations of personal dignity and often involve the targeting of elderly patients incapable of defending themselves.

Overall, this statistical summary shows that elder abuse in care facilities, far from being an isolated issue, is a systemic problem affecting thousands of vulnerable elderly patients.

The wide variety of abuse types (physical, emotional, financial, and sexual) highlights the urgent need for comprehensive oversight, better reporting and complaint handling systems, and stronger enforcement of care standards to protect elderly residents.

Specific Abuse Citations: The Main Issues

If we consider the nation’s ten most common nursing home deficiencies, it’s clear that there are widespread, recurring failures in all areas of resident care. 

Infection prevention and control was the most frequently cited issue (22,918 instances), followed closely by inadequate supervision and safety hazards (20,807) and improper food handling or sourcing (19,595). 

Other frequently cited violations include neglected medical care plans, unsafely stored medication, and failure to help carry out daily living tasks like eating or bathing. 

Combined, these ten categories cover 144,542 citations, a number significantly higher than the 94,449 total citations issued. This discrepancy is due to the fact that multiple citations are often issued to the same facility, with a single facility potentially cited for multiple simultaneous deficiencies.

For example, a single nursing home could be flagged for both poor infection control and lack of resident supervision during a single inspection. 

However, we consider the data, it clearly illustrates persistent care quality issues in long-term care facilities. It also underscores the importance of regular inspections, better accountability, and improved enforcement against elder abuse.

Here are the ten states in most apparent need of better elderly care practices.

10 States With The Most Nursing Home Abuse Citations

California leads the U.S. on reported abuse citations (3,251), followed closely by Illinois (2,875) and Texas (2,091). These three states alone account for a significant portion of all documented nursing home abuse cases. More, in fact, than the rest of the top ten states combined, which are: Ohio (1,780 citations), Missouri (1,351), Pennsylvania (1,310), New York (1,101), Michigan (1,058), Wisconsin (974), and Maryland (744).

These numbers highlight a distinct lack of adequate elder care oversight. They also emphasize critical, systemic nursing homes issues, and suggest an urgent need for far better staff training, and vastly more effective regulatory enforcement.

And the high number of abuse citations in the worst-performing nursing homes in the U.S. demands stronger protections and accountability measures to safeguard elderly residents.

Other states lead by example: here are the ten states that feature nursing homes with the lowest number of elder abuse citations in the country.

10 States With The Fewest Nursing Home Abuse Citations

Rhode Island makes the tail end of the list of top ten states with the lowest nursing home citations (84). 

Maine is next up (82 citations), followed by South Dakota (79), Idaho (75), Wyoming (68), Hawaii (64), Vermont (61), North Dakota (59), and New Hampshire (58). 

Alaska was subject to by far the fewest U.S. nursing home abuse citations, recording just 12 citations in total.

These figures highlight fluctuating levels of reported abuse across the country. While the low numbers may suggest better conditions or oversight in these states, they may also be due to factors like fewer nursing home facilities, lower resident populations, or potential underreporting.

Rural states with comparatively small populations may have fewer inspections or file fewer complaints due to limited access to resources, less oversight, or scant awareness among residents and families. Additionally, variations in how states define and track abuse, as well as differences in inspection diligence, can greatly determine reported citation counts.

As a result, while these states appear to have fewer reported issues, it’s essential to consider demographic, systemic, and procedural differences in reporting practices.

One case of abuse is one too many: continuous improvement in transparency, oversight, and care standards remains critical across all 50 states.

Elder Abuse: A Recap, And Looking Forward

Elder abuse is a growing, deeply troubling, and often underreported crisis in the United States, affecting some of the most vulnerable people in the country. Adults aged 65 and older now represent nearly 15% of the total U.S. population, and 1 in 10 will suffer abuse every year. 

This can take many forms, including physical, emotional, financial, and sexual abuse. It’s most often inflicted by people the elderly person relies on for care or support, including relatives, caregivers, and staff in nursing homes.

The problem is most alarming in the latter setting, with 16% of residents reporting abuse. A high number of resident home abuse cases remain unreported due to fear, shame, or an inability to report the mistreatment.

Women, in particular, disproportionately suffer elder abuse: data clearly shows they’re more likely than men to become victims.

Data also underscores the extent to which elder abuse is widespread. In 2023, over 94,000 health citations were issued to U.S. nursing homes, numbers that emphasize a troubling pattern of substandard care and neglect. 

The main types of abuse reported within long-term care environments include physical abuse (38% of complaints), gross neglect (24%), psychological abuse (16%), financial exploitation (14%), and sexual abuse (8%).

Physical abuse reports often involve direct harm such as hitting, slapping, or unnecessary restraint: actions that can cause life-threatening injuries or indefinite trauma. Gross neglect cases highlight a failure to meet even the most rudimentary human needs, including adequate hygiene care, basic nutrition, and sufficient medical care.

The effects of psychological abuse can be devastating and may range from fear and anxiety to long-term emotional trauma. Financial abuse, meanwhile, robs seniors of their life savings and independence. Sexual abuse of elderly patients remains one of the most disturbing and underreported forms of mistreatment.

Such cases involve severe violations of personal dignity, and often involve the targeting of elderly patients incapable of defending themselves

Beyond direct examples of abuse, the general quality of nursing home care draws justifiable criticism. The list of the top ten most commonly cited care deficiencies reveals a pattern of repeated failures: from infection prevention and unsafe food handling, to a lack of resident supervision and improper medication storage.

Infection control alone accounts for more than 22,000 citations, while supervision failures and food safety issues trail closely behind. Combined, these categories amount to more than 144,000 citations, a number far in excess of the overall citation count due to multiple deficiencies often found within a single facility.

Some states stand out as nursing home abuse hotspots: California features the highest number of citations (3,251), followed by Illinois (2,875) and Texas (2,091). These three states alone account for a sizable share of the nation’s reported elder abuse.

Conversely, the likes of Alaska, New Hampshire, and North Dakota report relatively few citations (though such figures may in part be due to smaller populations, limited facilities, and underreporting). Disparities in how states inspect facilities, define abuse, and report citations can also affect data interpretation. As such, states with low citation totals may suffer unrecorded problems.

Ultimately, the data does confirm that elder abuse in America is both pervasive and preventable. The variety of abuse types and the sheer volume of care facility violations reveal a broken system that puts thousands of elderly residents at risk every day.

Improving elder care demands policy changes; it also demands stronger accountability measures, increased transparency during inspections, and better staff training. Perhaps most importantly, elder abuse should be a rare and shameful phenomenon.

The results of this study sadly prove that the elderly population of the United States is not currently afforded an appropriate level of deference and respect.

At High Rise Financial, we expect nursing home staff members to provide adequate medical care to our elderly loved ones. But that isn’t always the case, and staff members can inflict harm on patients.

If nursing home negligence has harmed someone you love, legal action is often an effective way to hold the guilty party accountable and seek compensation for the damage done.