The 10 Things Nursing Homes Don’t Want You to Know

Nursing homes are notorious for keeping damaging information from residents and the public. It’s essential for the nursing home industry to be transparent and accountable to ensure residents receive the care they deserve. However, this is not always the case. 

1. Infection Control Problems

Caregivers often transmit infections directly to residents or from resident to resident by failing to abide by appropriate infection control practices. Every nursing home is required to have an infection control committee that reviews and enforces its policies and procedures. In practice, these committees often do not exist or take little effort to combat the spread of infections. These failure can be categorized into three main areas: 

Drug Resistant Bacteria 

In nursing homes, drug-resistant bacteria, known as “superbugs,” are a serious concern for infection control. These bacteria, like MRSA and CRE, can cause severe infections that are hard to treat because they resist many antibiotics. They spread easily among residents, staff, and visitors through contact and contaminated surfaces. Older adults in nursing homes are especially vulnerable to these infections. 

The primary superbugs in nursing homes are:

Clostridioides Difficile: Commonly referred to as C. diff, this infection of the colon causes severe dehydration. Without treatment, it can lead to sepsis and death. Every year around 500,000 people are infected with C. diff and 15,000 of those people die. C. diff is caused by overuse of antibiotics that kill the good bacteria that is usually available to protect the body from C. diff. It is also highly contagious and can spread throughout nursing homes without appropriate infection control practices, including appropriate washing, sterilization, and infection control practices. 

Methicillin-Resistant Staphylococcus Aureus (MRSA): Staph is a bacteria that exists on the skin and objects around us. It is usually not harmful. However, when a person has an entry point on their skin, such as a recent surgery, a bedsore, or other wound, the bacteria can enter the bloodstream causing bacteremia, also sometimes referred to as “blood poisoning.”  MRSA is resistant to many antibiotics used to treat other conditions. More than 80,000 people are infected with MRSA each year. 11,000 people died from MRSA complications each year. 

Carbapenem-Resistant Enterobacteriaceae (CRE): CRE is sometimes referred to as the nightmare bacteria. It is a bacteria that is resistant to almost all antibiotics. Each year 9,000 people are infected with CRE and 600 of those people die. 

Drug Resistant Streptococcus Pneumonia: This superbug is also referred to as S. pneumonia. This superbug causes sinus, ear, pneumonia, and blood poisoning. Around 1.2 million people contract infections from this superbug, which kills about 7,000 people per year. 

Lack of Basic Care Supplies

A shortage of essential care items like masks, gowns, and gloves can make it hard to control infections in nursing homes. Without enough supplies, staff may struggle to protect themselves and residents from germs. Stories of staff members being forced to purchase supplies with their own money are all too common. 

Vaccination Gaps

In long-term care settings, like nursing homes, COVID-19 vaccination rates for workers are lower compared to hospitals. The same goes for flu vaccinations, according to a report by the Centers for Disease Control and Prevention. This makes residents more vulnerable to infectious diseases like pneumonia and RSV, which are also common in nursing homes. Nursing home residents are especially vulnerable to these conditions because of weakened immune systems and underlying medical conditions. 

2. Nursing Homes Can Have Hidden Costs

Nursing home care in the United States can be pricey. According to Genworth Financial’s 2021 Cost of Care Survey, the average yearly cost for a semi-private room in a nursing home is about $94,900. For a private room, it’s even higher, at around $108,405 per year. That is more than double the full cost of tuition, books, and room and board at the average private college in America and approximately 50% more than the full tuition and room and board at Harvard University, which comes in at $76,000, as of 2024. 

The catch is most of this money needs to come from your own pocket, or subsidized by taxpayer money through taxes for Medicaid. Medicare only covers a small part, and only if certain conditions are met.

Some unexpected nursing home costs that might show up on your bill later include:

  • Health Assessment: Many nursing homes conduct a health assessment upon a resident’s arrival. This is considered part of standard care. In certain facilities, this may appear as a separate, one-time fee on your bill.
  • Leave of Absence Fee: Some nursing homes impose an additional charge for a “leave of absence” or “bed-hold” service. This fee covers the cost of reserving a bed when a resident temporarily leaves for medical reasons. Without a bed-hold agreement, the nursing home may discharge the resident to accommodate others.
  • State Assessments: Certain states levy a nursing home assessment fee, typically passed on to residents paying privately. If long-term care insurance covers the expenses, this fee may not apply.
  • Additional Services: Extra services such as social services, therapies, or financial management may add on more charges. This varies by state and facility.
  • Cost Increases: Be aware of pre-bills accompanying monthly statements, projecting estimated costs for the following month. Many nursing homes adjust basic service fees, such as room and board, annually. 

It’s important to understand all these costs before you decide on a nursing home, so you’re not surprised later on.

3. Nursing Homes Are Often Understaffed

Nursing homes are chronically understaffed. In 2021, 94% of nursing home providers reported experiencing a shortage of staff members.

When nursing homes are short on staff, residents do not receive the help they need. This puts residents at risk of abuse or neglect. Tasks such as assistance with daily activities, medication administration, and responding to emergencies may be delayed or overlooked. Residents don’t get the supervision and assistance they need with things like eating and walking, leading to malnutrition and dehydration, choking, and falling. 

Staff may experience increased stress and fatigue from having to take on heavier workloads. This can negatively impact their job satisfaction and performance. They may lash out at residents and become perpetrators of abuse or become apathetic and accept that their residents will go without care. 

4. Lack of Staff Training

It is not enough to have bodies in the building. In order to provide the care that residents need, staff must be adequately trained. Unfortunately, however, many nursing home staff members go without any significant training from the nursing home. Training staff members costs money. A properly trained staff is expensive because it requires instructors, conferences, proficiency tests, and time being paid when not providing care. 

Nursing homes frequently skip the critical steps involved in adequately training staff. Rather than intensive training, nursing home staff are often forced to complete online training modules while on the clock. Because of shortages in the industry, nursing home staff often lack the time to provide adequate care. Asking them to complete training while on the clock is not fair to the staff or the residents. Staff are then forced to choose between providing resident care and completing online training modules. The result is an under-trained workforce unable to meet the basic needs of its residents. 

5. Nursing Homes Use Agency and Temporary Staff

Nursing homes may rely on temporary or agency staff to fill in for shortcomings. Agency staff are often used for both nurses and aides. While agency staff are supposed to have adequate training, they are unfamiliar with the residents and their needs, the facility’s policies, and the overall operation of the building. This can lead to deadly lapses in care, like providing residents with food they can choke on because they are unfamiliar with the resident’s dietary needs. According to a study released in Health Affairs Nursing Homes Increasingly Rely on Staffing Agencies for Direct Care, it was revealed that in 2022 50% of nursing homes were relying on agency staff for direct care. 

6. Mishandling Resident’s Medication

Medication management is a crucial service offered by nursing homes to support residents’ health yet medication errors happen often. Certain nursing homes struggle with multiple medication-related challenges, including:

  • Overmedicating residents
  • Inadequate monitoring of medication distribution
  • Errors in medication administration and management
  • Inappropriate use of antipsychotic drugs for patients with dementia
  • Deficiencies in communication regarding residents’ health needs among staff members

Approximately 800,000 avoidable medication mistakes happen annually in long-term care facilities across the United States.

7. Nursing Homes Often Hide Recurring Complaints

​​Nursing homes often keep quiet about their problems, not wanting people to know how bad things can be. They might hide instances of neglect, abuse, or serious incidents to make their facilities seem safer and more reliable than they actually are. By hiding these problems, nursing homes can make it harder for families to make informed decisions about where to send their loved ones for care. 

In Arizona, a resident of a nursing home experienced a sexual assault in the dining room. Similarly, in Minnesota, a woman contracted Covid-19 after staff relocated a coughing resident into her room. Meanwhile, in Texas, a woman with dementia was discovered in the nursing home’s parking lot, injured and lying in a pool of blood. State inspectors claimed three nursing homes put their residents in danger and broke rules, but did not disclose it to the public.

A study by The New York Times found about 2,700 similar dangerous incidents that weren’t in the ratings system, even though state inspectors confirmed them.

This study raises worries about how accurate and honest Medicare’s ratings are for nursing homes. It often makes nursing homes look better and safer than they really are. 

Other studies have shown similar results. The journal Medical Care reported the findings of a comprehensive study performed by the University of Chicago. The study investigated the accuracy of data reported by nursing homes. The study found that nursing homes only self-reported 59% bedsores that required hospitalizations. This is consistent with previous studies conducted by the University of Chicago. In the journal Health Services Research, the researchers reported that nursing homes only reported 57% of falls that occur in nursing homes. 

What this tells us is that far more injuries and accidents are occuring than the public knows about. 

8. Nursing Home Inspections

State survey agencies regularly inspect nursing homes to make sure they follow all the rules concerning care and services set by the government. These inspections happen once a year. During these visits, the inspection team looks at a few things: 

  • How well residents are taken care of
  • The methods the facility uses to provide care
  • How patients and staff interact
  • Environment of the nursing home

The team also checks medical records and talks to residents, families, caregivers, and staff to understand how the nursing home is doing. Then, they write a report that mentions any problems and rates the facility. If a nursing home isn’t doing well or meeting standards, the government might give them fines to push them to do better. They might also issue warnings to let other families know about problems at that nursing home.

When researching to find the best facility for a loved one, it’s essential to contact the relevant state agency in your area. This will help you determine if a particular facility has received any citations or if there have been any issues mentioned in recent inspection reports.

9. Residents Often Battle With Loneliness In Nursing Homes

Transitioning to a nursing home later in life can be a lonely experience for many seniors. They may feel a sense of loss or separation from their familiar surroundings, friends, and community networks. It can also be challenging to adapt to a new environment. 

A study published in 2019 in the journal Open Medicine revealed that 40% of residents in nursing homes experience feelings of loneliness. The study noted that seniors who reported higher levels of loneliness tended to report lower quality of life.

Loneliness and isolation in nursing home residents can increase the risk of:

  • Dementia
  • Heart disease
  • Stroke
  • Slower recovery of previous illnesses
  • Weakened immune systems
  • Depression
  • Anxiety
  • Premature death

By law, nursing homes are required to provide a homelike environment that maximizes the psychosocial wellbeing of each resident. Although this is the rule, it is not enforced by state inspectors because it simply doesn’t happen. Overworked staff rarely have time to devote to providing meaningful activities and interactions with residents. 

10. Poor Nutrition for Nursing Home Residents

Enjoying a good meal is important for health and happiness for all people including nursing home residents. However, not all meals are the same in terms of quality and meeting individual needs.

Nursing homes often set a budget for meals before the fiscal year begins. However, the cost of food may fluctuate and increase throughout the year–as we have seen happen many times in recent years. To stay within budget, nursing homes often resort to providing lower cost, poor quality food. This is even more of a problem when nursing homes outsource their dietary department to third party companies. These companies promise low costs in order to outbid competitors but still need to turn a profit. 

Anywhere from 35 percent to 85 percent of nursing home residents are malnourished. Sixty to 70 percent of nursing home residents are cognitively impaired; many of them require assistance with eating.

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.