Does the Death Certificate Show Nursing Home Abuse and Neglect?

person signing death certificate for law firm

Death certificates often show tell-tale signs of abuse and neglect at nursing homes and assisted living facilities. But, to the untrained eye, death certificates can be confusing and provide more questions than answers.  

When a loved one passes away in a long-term care facility under unknown circumstances, you may be left wondering “how did this happen?” “Were the nursing home staff negligent or careless?” “Did the nursing home abuse or neglect my loved one?” “What caused my loved one’s death?” 

The answers to these questions may be difficult to obtain. The nursing home staff and management may not provide you with any information about what happened to your loved one. Other care providers may not have any information either. You might think about asking for your loved one’s records from the nursing home, but these records can be difficult to get ahold of without a formal legal process. Nursing homes will hide behind patient privacy laws to keep the records out of the family’s hands when a resident dies or is injured under their care.

Even if you can get the records, often they are difficult for someone without medical training to read. Or they may be incomplete or missing key information. Sometimes the staff and administrators will falsify the documentation to make it seem like they didn’t do anything wrong. 

However, there is a document that family members can obtain free of charge that can help determine if the nursing home caused a loved one’s death – the official death certificate.

What is a Death Certificate? 

Whenever a person dies, a physician must complete a death certificate documenting the cause and manner of death. The death certificate lists details about the person who died, including their age, their residence, the location of their death, but most importantly – the official cause of death. The death certificate may be signed by a certifying physician, a coroner, or a medical examiner. 

When a person dies from natural causes, any physician may complete the death certificate. However, if a person dies from unnatural causes (such as an accident, homicide, or suicide), the death certificate must be completed by a medical examiner or coroner. 

What is the Cause of Death on a Death Certificate? 

The cause of death on the death certificate is the legal and official determination of what caused the person’s death. By signing a death certificate, the physician is giving a medical opinion as to the cause of death.

Where Do I Find the Cause of Death? 

The cause of death is clearly labeled on the death certificate, and will appear near the signature of the doctor, medical examiner, or coroner who prepared the death certificate. The exact location of the cause of death may vary from state to state (see examples below), but it will always be clearly marked on the death certificate. 

(above is an example of a death certificate in the state of Ohio)

(above is an example of a death certificate in the state of Colorado)

(above is an example of a death certificate in the state of Montana)

(above is an example of death certificate in the state of Texas)

This section is broken into several boxes. The immediate cause of death is the most recent event or condition that led to death. The remaining boxes should be read as a chain of events.

For instance, a death certificate for someone who died from heart failure following pneumonia may say in Box A “Cardiopulmonary arrest” with Box B as “respiratory distress” and Box C as “Pneumonia.” This means that the heart stopped beating (cardiopulmonary arrest) because the person could not breathe (respiratory distress) because they had a lung infection (pneumonia). 

Many death certificates provide an interval or time between when the condition started and the time of death. If the person died very suddenly, the box may say “hours” or even “minutes.” If the person had a condition for a long period of time, the box on the far right may say “weeks,” “months,” or even “years.” Sometimes the timeframe in this box is very specific, giving an exact number of days or weeks someone had the condition that caused their death. Sometimes it is very general, and doesn’t give an exact timeframe at all. 

Death certificates often also list chronic conditions that contributed to their death, but didn’t directly cause it. You’ll sometimes see diseases like diabetes, COPD, congestive heart failure, high blood pressure, or other chronic illnesses here. These are simply conditions the person had that made them more susceptible to the condition that caused their death. But, it does not mean that the condition caused their death.  

What is the Manner of Death on a Death Certificate? 

Death certificates also usually include something called a manner of death. The manner of death is different from the cause of death. The manner of death is also sometimes called the method of death. 

There are 5 potential manners of death: 

  1. Natural
  2. Accident
  3. Homicide
  4. Suicide
  5. Undetermined

A natural manner of death means that the person died from the consequences of an ongoing disease. For example, if a person died as a result of pneumonia, then the death will be most likely considered natural. 

An accidental manner of death means that the person would not have died unless there was some unexpected  event that occurred. Common accidental manners of death involving nursing homes and assisted living facilities include choking, asphyxiation, falls, or medication overdoses.  Accidental deaths at nursing homes and assisted living facilities are almost always the result of abuse, neglect, and negligence and need to be investigated. 

A homicide manner of death means that the death occurred because of the actions of another human. This could include intentional or unintentional involvement. For example, if a nursing home resident dies as a result of being intentionally given improper medication, such as insulin, the death may be considered a homicide. Homicides at nursing homes and assisted living facilities are unusual, but when they do occur, they need to be investigated quickly before evidence is lost. 

A suicide manner of death means the person took their own life. This is unlikely to occur at a nursing home. However, if it does, then there is most likely abuse, neglect, and negligence because few people take their own life without first showing signs of depression, erratic behavior, or other emotional changes. 

An undetermined cause of death means that despite the best efforts of the medical examiner and coroner, the manner of death could not be determined. 

What is the Location and Event Information on the Death Certificate? 

The date, time, and location of the injury will also be listed on the death certificate. Commonly, there is also a short description of how the injury happened. This may also provide clues about whether there was abuse and neglect. For example, if the death certificate states that the injury that caused the death was a fall at a nursing home or assisted living facility, there likely was some degree of abuse, neglect, or negligence that caused the death and should be investigated. 

Who Can Sign A Death Certificate? 

Any physician can sign a death certificate. It does not need to be a physician who recently saw the patient. It could be a doctor who simply reviews the medical records. 

However, there is an important exception to this. In most states, only a coroner or medical examiner can sign a death certificate with anything other than a natural manner of death. 

What is the Difference Between a Certifying Physician, Coroner, and Medical Examiner? 

A certifying physician is any doctor who signs the death certificate and certifies the cause of death. A certifying physician could be a primary care physician, an emergency medicine physician, a specialist, or any physician at all. 

A medical examiner and a coroner are different from a certifying physician. A coroner and a medical examiner are public officials who hold a legal position to determine any cause and manner of death. Coroners and medical examiners are public officeholders who oversee a county or multiple counties and have the highest authority in the jurisdiction to determine a cause of death. Typically, a coroner is an elected position while a medical examiner is appointed by some government body, such as the mayor or governor’s office. 

What Causes of Death are from Abuse and Neglect? 

There are many causes of death that can indicate that the nursing home neglected or even abused a resident and caused their death. If you see any of these causes of death for a loved one who died in the nursing home, there may be concern for negligence, neglect, or abuse:

  • Blunt Force Injuries or Blunt Force Trauma (injury to the body by a forceful impact with a dull object, such as falling and striking an object)
  • Subdural or Epidural Hematoma (these are forms of brain bleeds commonly caused in falls)
  • Brain herniation (this is permanent brain injury that usually results in death because of severe pressure inside the skull) 
  • Asphyxiation or Choking (when the brain is deprived of oxygen because the airway is blocked)
  • Hyperthermia (freezing) or Cold Exposure (when the core body temperature drops resulting in organ failure and death because of exposure to inhumanely cold temperatures)
  • Hypothermia (overheating) or Heat Exposure (when the core body temperature rises resulting in organ failure and death because of exposure to inhumanely hot temperatures) 
  • Burning (caused by exposure to dry heat, such as an iron or fire)
  • Scalding (caused by exposure to extremely hot and wet conditions, such as a hot water or steam)
  • Fractures of Broken Bones (any fracture including femur, pelvic, tibial, spinal, humeral, etc)
  • Sepsis or Septic Shock (organ failure caused by an untreated infection) 
  • Urinary Tract Infection (when bacteria enters the tube through which urine leaves the body–called the urethra)
  • Aspiration Pneumonia (a form of pneumonia caused when food or liquid is breathed into the airway instead of swallowed)
  • Pressure Injuries, Pressure Ulcers, Decubitis Ulcers (these are also called bedsores and usually occur when a person is left in one position for long periods of time)
  • Necrotizing Fasciitis (a flesh eating disease caused by a rare bacteria that spreads quickly and needs immediate surgical treatment) 
  • Malnutrition (a consistent lack of nutrition caused by not eating or not eating the correct foods) 
  • Dehydration (when the body does not have enough water in the body to carry out normal function) 
  • Hypernatremia (the amount of sodium in the bloodstream is too high because of severe dehydration causing kidney failure) 
  • Prerenal Azotemia (kidney failure commonly caused by dehydration) 
  • Medication Overdose or Medication Toxicity (when a medication–whether a needed or not–is given in such high doses that it is toxic) 

Can A Death be Natural and Still be Caused by Abuse and Neglect? 

Many deaths that are caused by abuse and neglect are classified as natural deaths. For example, nearly all infections, bedsores, malnutrition, dehydration, and deaths caused by a lack of medical care for a condition the resident had will be classified as a natural death. For example, if a resident at a nursing home requires daily medications because of a heart condition and the nursing home fails to provide that medication causing their death, that will most likely be considered a natural death. However, the death was also caused by poor care–meaning that it meets the definition of abuse and neglect. 

What if I Disagree with the Cause of Death on the Death Certificate? 

Although we would like to believe that death certificates are always accurate, in reality they are not. Frequently, doctors treat death certificates as little more than paperwork that needs to be completed. Too often, doctors quickly review a patient’s medical records and list out a number of conditions that the patient had when they died rather than putting in the work that was necessary to clearly identify the cause of death. We frequently see death certificates that include causes of death like “Alzheimer’s dementia” when the person died from injuries suffered in a fall weeks earlier. Sometimes these are innocent mistakes caused by untrained or overworked doctors. At other times, these errors are more nefarious. We have seen many circumstances where nursing homes and assisted living facilities have intentionally provided doctors with incomplete or inaccurate information so that the death certificate does not provide evidence of neglect and abuse. 

What Should I Do If I Suspect the Death was from Nursing Home Abuse and Neglect? 

If a loved one passes away in the nursing home or assisted living facility and you cannot get answers about what happened, the death certificate can give vital clues about whether they were neglected or abused. 

If you see any of the causes of death that may indicate neglect or abuse, or if the manner of death is anything other than “natural,” you should contact a lawyer with a record of success in long-term care neglect and abuse cases to investigate the true cause of death.  

There are strict time limits to pursuing claims for the injury or death of a loved one in the nursing home, so it is important to contact a lawyer as soon as you see one of these indications of neglect or abuse on the death certificate.

Our trial lawyers focus their practice on nursing home and assisted living neglect and abuse cases, and are ready to help investigate whether your loved one’s death was the result of wrongdoing by the long-term care facility and its staff. 

Disclaimer: This information is provided for informational purposes only. Nothing in this article should be construed as providing legal advice or the creation of an attorney client relationship. Laws are updated frequently and change from state to state. If you desire legal advice, you can contact Michael Hill Trial Law at, send an email to, call (800) 659-2712 to begin an investigation or contact another attorney.