From time to time, shortcomings in elder care come into sharp focus. It could be a shocking news story. It could be an observation made during a holiday visit.

Recently, according to state investigators, employees of an assisted-living facility in Winston-Salem subjected residents to a “fight club” seemingly for their own amusement. Tragically, these employees encouraged their dementia patients to fight with one another while cellphone cameras recorded not only the disturbing scene but also the abusers’ reactions.

Shockingly, this didn’t involve a small, independent facility but rather one of the largest Alzheimer’s and memory care facility providers in the country with more than 7,400 residents, according to the company’s website.

While this is a particularly egregious and sensational example of elder abuse that captured our attention, there are many other ways that our parents, grandparents and other senior loved ones face a heightened risk of neglect and abuse in these types of facilities.

In my work as an attorney representing seniors and families dealing with the aftermath of abuse, I’ve seen many situations where meal trays were left out of reach of restricted-mobility residents, improper medical “restraints” were used, open wounds become infected because of improper first aid, residents went weeks without bathing, and beds were covered in excrement.

The enormity of this problem is evident when one considers there are 1.7 million licensed nursing homes and nearly 1 million assisted-living facility beds in the U.S. According to the Centers for Disease Control and Prevention, more than 69% of nursing home beds and more than 81% of assisted-living facility beds are run by for-profit companies. In North Carolina, 16 facilities either meet or are candidates for the Centers for Medicare and Medicaid Services’ Special Focus Facility Program, an index of facilities with a history of consistently poor care.

Enough is enough

While it is up to your legislators and law enforcement to hold these facilities accountable, there are steps we can each take to protect people we care about. And the holidays, for all their merriment, can be a time to take stock.

First, do your research

Medicare has a website, Nursing Home Compare (, where you can search nursing homes’ regulatory history and statistics like health inspection ratings and staffing ratings. You can also view recent inspections for specific facilities.

The North Carolina Division of Health Service Regulation is the agency responsible for enforcing standards in long-term care. It keeps a database ( that includes facility inspections, ratings and penalties. It also administers the N.C. Star Rating System for assisted living facilities. In addition, it offers a complaints hot line in the event you have a loved one who is receiving poor care (800-624-3004).

Contact your regional long term care ombudsman at your local Area Agency on Aging or through the Division of Health Service Regulation ( They can help with deciding what type of facility your loved one needs, whether it be a nursing home, assisted-living facility or family care home. They also can provide guidance on specific facilities and information on residents’ rights.

Make each visit count

Visits to loved ones in nursing homes are not only opportunities to share love and affection; they are opportunities to check on their health and well-being. This is true year round, including during the holidays.

Take time out from festive doings to talk quietly and earnestly about their treatment. Nursing home patients may inclined not to “spoil the mood”; tell them to put any such concern aside and level with you. Also, see beyond holiday decorations to really study their surroundings. Notice how staff treat patients who are not being visited or experience moments of need. Try to visit residents at different times of day and not just the popular visiting hours to get a real sense of the conditions.

Know your loved ones’ rights

North Carolina has a Bill of Rights for nursing home residents. Residents have the right to a dignified existence and to raise grievances, among other enumerated rights. The Nursing Home Patients’ Bill of Rights can be found in Chapter 131E of the North Carolina General Statutes. If you haven’t looked through this, take an hour or so of your holiday vacation time to do so.


There are quality national and state organizations, The National Consumer Voice for Quality Long-Term Care and Friends of Residents in Long-Term Care among them, advocating for the interests of those in long-term care. Lending your efforts to groups like these can amplify your voice in a way you could not do on your own.

The situation is bad but not hopeless. We, as individuals and as a group of people committed to the dignity of our elders, have more resources than ever at our disposal. Nothing will change, however, without a major push to protect this vulnerable population.

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J. Brett Davis, an attorney at The Law Offices of James Scott Farrin, has taken on nursing homes around the state in cases of neglect.

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