Why Is Resident-to-Resident Nursing Home Abuse Increasing?

Takeaways

• Incidents of physical, verbal, and sexual violence between nursing home residents are a growing, though understudied, problem.
• Low staffing ratios, inadequate staff training, and facility design may all contribute to this issue.

Many people may think of nursing homes as fairly tranquil places, and this is generally the case. However, this may be changing, as incidents of violence in long-term care settings have been increasing. Though staff members do commit violent acts against nursing home residents, a significant number of perpetrators are fellow residents.

Could there be a correlation between an increase in the ratio of residents to staff? The U.S. population of older adults is swiftly growing while nursing homes struggle to hire and retain staff. At the same time, seniors moving into long-term care settings tend to experience declines in cognition and function. Given these dynamics, incidents of resident-to-resident aggression in nursing homes may be more likely to continue rising.

In December 2025, a sobering investigation revealed that hundreds of nursing home residents nationwide have been physically harmed by fellow residents, sometimes with tragic consequences. The report found at least 481 documented victims of physical and sexual assault, including rape and deaths, perpetrated by other residents since 2019.

A Clear Pattern, But an Understudied Problem

Resident-to-resident aggression (RRA) is a term encompassing physical, verbal, sexual, and psychological violence between residents in long-term care settings. Experts say RRA is widespread but significantly underresearched.

Though precise numbers nationwide are difficult to nail down, a recent study of assisted living facility residents in New York state between 2018 and 2022 found that about 15 percent of them experienced RRA. Many instances of RRA may also go unreported.

A 2019 government report found that reported abuse incidents, including perpetration by residents, more than doubled between 2013 and 2017.

Anecdotal and inspection reports suggest that severe assaults leading to hospitalization or death are increasing. This rise appears to be happening even though reporting practices vary widely by state and facility. In short, even if drawing exact trend lines hard to do, available data suggest that the most serious resident-to-resident violence is rising.

Why Does This Violence Occur?

Multiple intersecting factors contribute to resident-to-resident violence, especially among the frail elderly.

Cognitive Impairment and Dementia

Many nursing home residents live with cognitive impairments. Conditions such as dementia may lead to frustration, impaired judgment, and behavioral disturbances like aggression. Research shows that cognitively impaired residents are at increased risk of involvement in aggressive incidents, either as victims or perpetrators.

Common dementia symptoms, such as wandering, communication difficulties, and perceived invasions of personal space, can also trigger conflict.

Systemic Shortcomings in Staffing and Design

Experts cite insufficient staffing levels, poor staff training, and difficult-to-supervise physical layouts as other key contributors to RRA. Facilities with low staffing ratios often cannot adequately monitor residents, particularly those with behavioral challenges, leaving altercations unnoticed until serious harm occurs.

Many nursing homes are built more like hospitals than supportive living spaces. Long corridors and segregated communal areas can make supervision difficult and increase chances for unsupervised interactions.

In 2024, the Biden administration established minimum staffing requirements for nursing homes. The goal was to help improve safety and quality of care in long-term care facilities. Industry groups argued against the regulations and in December 2025, the Trump administration repealed the requirements.

Aging, Longevity, and Cognitive Decline – A Dangerous Mix?

People in the U.S. are living longer than ever. With advanced age comes a higher prevalence of cognitive impairments and more intense health care needs. Dementia rates rise sharply with age, and by the time individuals require nursing home care, many have some level of cognitive decline. This creates a setting where multiple residents with impaired judgment and behavioral regulation coexist, often without the environmental supports or staff expertise needed to manage these challenges safely.

This demographic reality correlates with elevated risk. Cognitive impairment is one of the most consistent predictors of being involved in aggressive incidents as either victim or perpetrator.

Are Nursing Homes Becoming More Dangerous?

Labeling nursing homes as inherently more dangerous because of RRA oversimplifies a complex issue. However, the current reality does expose serious safety gaps. Facilities were not originally designed for high ratios of residents with behavioral issues related to dementia or other cognitive issues. Understaffing and limited staff training, exacerbated by industry resistance to standardized staffing minimums, undermine prevention and early intervention.

Rules for reporting incidents are often inconsistent. As a result, many problems may go unnoticed or unrecorded, potentially masking the real extent of the issue. Together, these factors suggest that today’s nursing homes are struggling to safely care for vulnerable residents, especially as people live longer and have more complex cognitive health needs.

What Can Be Done?

Ensuring safety and dignity for nursing home residents will require holistic reforms to staffing and facilities and regulatory oversight and research. Only by acknowledging the full scope of the problem can meaningful solutions begin to be developed.

Potential strategies for improvement may include the following:

• Stronger staffing standards and training in dementia care and conflict de-escalation
• Improved environmental design to facilitate observation and reduce unsupervised interactions
• Better data collection and mandatory reporting standards to understand trends and target prevention
• Specialized units for residents with significant behavioral challenges that go beyond typical physical care

If you have an older family member in long-term care who may be a victim of suspected abuse or neglect, file a report with your local Adult Protective Services (APS) agency.

Additional Reading

For related reading, check out the following articles:

• What Are Nursing Home Residents’ Rights?
• When Nursing Home Eviction Is Legal
• Your Front-Line Advocate: Nursing Home Ombudsman
• What Makes a ‘Good’ Nursing Home? 10 Points to Consider
• Looking for Long-Term Care? See the 2026 Best Nursing Homes
• Private Equity and Nursing Homes: What Families Need to Know
• Which States Have the Best Protections Against Elder Abuse?