Here are things families, advocates and volunteers should watch out for in a nursing home:

1-  Does the place smell like urine and feces.

2-  How long are the call lights or bells standing in before someone checks on the resident.

3-  How many of the patients have bandages on their arms or legs.  How many have bruises or skin tears.  NOT All are abuse, sometime the patients bump themselves.  Pay close attention to where the injuries are and if the patient could do it to themselves.  It's sort of like 42 stab wounds in the back and the coroner rules it a suicide. Bruising and skin tears are usually a sign of rough handling of the patients and this needs to be reported.

4-  How many air beds are in the facility.  Air beds are easy to recognize.
Many make a hissing sound, most have much thicker mattresses than normal, many of them have a 2 foot by 2 foot box attached at the foot of the bed.
Air beds are very expensive.  It costs Medicare an average of $5,000 a month to rent them.  Medicare will not pay for air bed rental unless the patient has a stage 3 +  (Bedsores are staged 1 through 4)  bedsore.  Don't let anyone fool you,  98 percent of all bedsores or decubitis ulcers as they are called are preventable.  Bedsores indicate the patient has been left laying in their own waste for long periods of time and or their nutrition is bad.
Once a bedsore is discovered, BY LAW,  that patient is to be turned or repositioned every 2 hours.  If there is more than 2 air beds in the facility,  that is a huge red flag the facility is not changing or feeding properly.

5-  How many IV's are hanging?  IV's indicate either dehydration or infection.  Either is bad news.  (Do not confuse an IV with a nasal gastric or gastric feeding tube)

6-  How many patients does each certified nursing assistance (CNA's) have to feed.  Should not be feeding more than 4 patients at a time.

7-  Look at the patient,  I mean really look at the patient.  Squat down in front of them and look them in the eye.  Do they squint.  If they do and they aren't wearing glasses,  ask them where are their glasses.  The same with hearing.  If they have hearing aids in their ears, cup your hand over that ear.  If the battery is OK you'll hear a squeal,  no squeal batteries are dead or hearing aid not turned on or up loud enough for the patient to hear.  Look in their mouths while your talking to them.  Do they have teeth, if not ask them where they are.  If they have teeth,  are they green or slimy.  While you are checking these things out,  smell-----do they stink, are they wet or messed, is their hair combed and are they in clean clothes.

8-  At dinner time,  each tray will state if the patient is diabetic.  Does the tray have concentrated sugar on it.  What does the food look like.  Is the food hot and the milk cold.  Check the dinner cart as they are returning it to the kitchen.  Are the meals eaten or still covered.

9-  Check in the patients room.  Is there a water pitcher and either a glass or straw.  Teach your people to do the dehydration and starvation tests. They are simple to do.  Take the skin on the back of your hand between your thumb and pointer finger and GENTLY  lift it up into a little peek.  If the skin stays up longer than your skin,  they are dehydrated.  Check out the color of urine in the catheter bags.  It should be straw yellow and not cloudy.  If it's dark and cloudy and there is an strong sour smell that is infection and the staff should be notified.  If one is not getting enough water usually more than one is affected.  Take your thumb and middle fingers and at the muscle area on your upper arm GENTLY squeeze.  If there is no resistance in the muscle area and your thumb goes directly to the bone, they are malnourished.

10-  Check out the activity calendar, located on the bulletin board.  Most of them are filled but are those activities really taking place.  How many of the residents are simply parked in their wheel chairs in the hallways.

11-  Look at their nails.  Are they long and jagged.  Are they clean.

12-  Talk to the patients.  Ask about baths, hair being washed and combed. About staff yelling or scolding them.  Look at the staff.  Are they rushed, do they talk to the residence or just do what they have to do and never say a word.

There are many other signs of neglect and abuse such as over-medication/under medication but the above are easy to detect.