Nursing Home Residents Silenced by Fear of Retaliation

People who live in nursing homes endure abuse because they fear they will be punished further if they speak up, according to a new report.

an older person's face in the shadows
(Image credit: Getty Images)

Patients in nursing homes are suffering because they too often fear if they complain about problems, they will be punished by staff, according to a horrifying report by the Long Term Care Community Coalition.

“Fear of retaliation is a pervasive phenomenon that inflicts significant emotional harm on nursing home residents,” says Eilon Caspi, the principal author of the report, “They Make You Pay.” 

The report’s threatening title was inspired by a story about fear of retaliation deterring residents at a Florida nursing home from reporting poor care. One resident said staff would “make you pay” by delaying care or sabotaging meals of complaining residents.

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Fear causes harm

The report found that patients anticipating retaliation can be even more damaging than actual punishment: “Too often, fear of staff retaliation – the fear itself – prevents residents from voicing concerns and from receiving the care and services to which they are entitled. Ultimately, this inaction leads to unnecessary emotional, psychological, and physical harm to vulnerable residents.”

For example, a study at University of Connecticut Center on Aging on residents’ fear of retaliation in Connecticut long-term care homes included a survey that asked residents, “Do you worry about retaliation if you were to report a complaint or concern?”

According to the report, 23% of nursing home residents said they did worry about retaliation if they were to report a complaint or concern. In addition, 4% reported that they do not want to complain and 1% reported not wanting to get people in trouble.

Also, the Atlanta Long-Term Care Ombudsman reported that 44% of the residents who had seen abuse of other residents did not report it; half of the residents did not report it due to fear of retaliation.

You can share your own experience and find information about how to address long-term care issues, links to federal and state contacts and complaint forms and tools for resident-centered advocacy at

Nursing home staffing low 

The coalition also gathered federal data to reinforce prior reports that nursing homes in the U.S. remain understaffed, which President Biden has pledged to address. According to that report, “Nursing homes are turning over more than half of their staff over a 12-month period. The median total nursing staff turnover is 53%, including 50% RN turnover. Higher turnover is associated with worse quality of care.”

Staffing levels are different in different parts of the country, with the lowest staffing levels in the region that includes Arkansas, Louisiana, New Mexico, Oklahoma and Texas, The highest staffing levels are found in the region that includes Alaska, Idaho, Oregon and Washington. 

The coalition website also has information about finding a good nursing home. Data about specific nursing homes, including staffing levels, can be accessed at the Center for Medicare and Medicaid Services Care Compare site.

Note: This item first appeared in Kiplinger’s Retirement Report, our popular monthly periodical that covers key concerns of affluent older Americans who are retired or preparing for retirement. Subscribe for retirement advice  that’s right on the money. 

Senior Retirement Editor,

Elaine Silvestrini has had an extensive career as a newspaper and online journalist, primarily covering legal issues at the Tampa Tribune and the Asbury Park Press in New Jersey. In more recent years, she's written for several marketing, legal and financial websites, including and, and the newsletters Auto Insurance Report and Property Insurance Report.