Legal Liability for Healthcare Negligence in Elderly Care Centers and Nursing Homes

What is health neglect in elderly care centers and nursing homes?

Health neglect in elderly care facilities and nursing homes is defined as physical, psychological, or economic harm suffered by an elderly individual due to inadequate provision of care, supervision, nutrition, hygiene, medication, health monitoring, safety, rehabilitation, or emergency intervention needs. This harm may manifest as falls, fractures, bedsores, infections, weight loss, dehydration, medication errors, psychological distress, mistreatment, delayed referral to hospital, need for intensive care, or death.

Nursing homes and elderly care centers offer more than just accommodation. The institution's responsibility is much broader, especially for elderly individuals requiring care due to conditions such as dementia, Alzheimer's, Parkinson's, stroke, bedriddenness, mobility difficulties, diabetes, heart disease, hypertension, nutritional problems, or medication monitoring. The elderly individual's daily living activities, health status, safety, and psychosocial needs must be regularly monitored.

According to the latest information from the Ministry of Family and Social Services, a nursing home/elderly care and rehabilitation center is defined as a residential social service institution that provides health, social services, rehabilitation, and psychological support services to individuals aged 70 and over, as well as those aged 60 and over who require rehabilitation and care, are under protection, and cannot live independently.

Therefore, when evaluating damages occurring in elderly care facilities, responsibility cannot be absolved simply by saying "the elderly person was already ill." It must be examined whether the institution developed a care plan appropriate to the elderly person's condition, conducted health monitoring, provided necessary staff, managed the risk of falls and bedsores, properly monitored medication, and ensured timely hospital referral in case of emergency.

The Difference Between a Nursing Home and a Senior Care and Rehabilitation Center

In a legal assessment, the first step is to determine which institution the elderly person receives services from. Not all nursing homes offer the same services. Some institutions provide accommodation and social support services for more independent elderly individuals, while others offer more intensive support for those requiring advanced care, rehabilitation, dementia, or who are bedridden.

The Ministry of Family and Social Services' Regulation on Nursing Homes and Nursing Home Elderly Care and Rehabilitation Centers, dated 2026, regulates the accommodation, care, and rehabilitation services that will be utilized by individuals aged 70 and over, as well as elderly individuals aged 60 and over who have a health board report indicating partial or complete dependence due to age-related illnesses and who require rehabilitation and care, at nursing homes and nursing home elderly care and rehabilitation centers affiliated with the Ministry.

The Ministry's statement regarding admission criteria indicates that for nursing homes, the elderly person must be able to independently perform daily living activities, such as eating, drinking, bathing, and using the toilet; and for elderly care and rehabilitation centers, the elderly person must require temporary or permanent special attention, care, and rehabilitation due to physical or age-related physical decline or mental decline similar to dementia.

This distinction is important in terms of accountability. The level of supervision expected for an elderly person who can independently perform daily living activities is not the same as the level of supervision expected for an elderly person who is bedridden, has dementia, or is at high risk of falls. The institution must establish a care, staffing, and safety system appropriate to the individual's level of needs.

Responsibility of Private Nursing Homes and Elderly Care Centers

When elderly care services are provided in a private nursing home or private elderly care center, a private law relationship arises. Often, the relationship between the private institution and the elderly person or their relatives is based on a contract for care, accommodation, supervision, and services. Therefore, the private center is obligated not only to provide rooms and meals but also to safely and diligently deliver the care services stipulated in the contract and legislation.

There are also specific regulations regarding private nursing homes. The Regulation on Private Nursing Homes and Nursing Home Elderly Care Centers, determines the procedures and principles regarding the opening of nursing homes and nursing home elderly care centers to be opened by individuals and private legal entities, service standards, personnel status, operating conditions, fees, supervision, transfer, and closure.

Therefore, in cases of negligence occurring in private centers, not only the individual fault of the care staff but also the institutional organization of the center is examined. Was there sufficient staff? Were the nurses, doctors, physiotherapists, dieticians, or care staff appropriate to the needs? Was there sufficient staff on night shifts? Were the elderly person's health records kept? Were their medications administered regularly? Were the risk of falls, bedsores, and nutritional deficiencies monitored? The answers to these questions determine the responsibility of the private center.

Administrative Responsibility in Public Nursing Homes

If an elderly individual resides in a nursing home or elderly care and rehabilitation center affiliated with the Ministry, the service is considered a public service. In such cases, administrative negligence may arise if an elderly person in a public institution falls, is neglected, is referred to a hospital too late, develops bedsores despite being bedridden, is denied medication, is subjected to ill-treatment, or their health condition is not monitored.

If damage has occurred due to an administrative action, the administrative judicial process must be conducted carefully. According to Article 13 of the Administrative Procedure Law No. 2577, those whose rights have been violated by administrative actions must apply to the relevant administration for the fulfillment of their rights within one year from the date they learned of the action, and in any case within five years from the date of the action, before filing a lawsuit; if the application is rejected or no response is given within thirty days, a lawsuit may be filed.

Therefore, if there is an allegation of negligence in a public nursing home, instead of directly filing a lawsuit in the judicial system, it is preferable to apply to the relevant administration based on the specific circumstances of the case, and then pursue a full judicial review in the administrative court. The application should clearly state the date of the incident, the nature of the negligence, how the damage occurred, the items of material and moral damages requested, and the records required.

Individual Care Plan and Institutional Supervision Obligation

In elderly care centers, an individualized care plan should be at the heart of the care service. Not all elderly individuals are the same in terms of physical, mental, social, and health status. One elderly person may be able to walk independently, while another may use a wheelchair; one may experience disorientation due to dementia, while another may require special care due to swallowing difficulties or being bedridden.

The Regulation dated 2026 stipulates that care and rehabilitation services will be planned and implemented in a way that supports the physical, social, and health status of the elderly, in accordance with their individual needs; and that services in nursing homes and elderly care and rehabilitation centers will be carried out within the framework of an individual care plan prepared specifically for each individual.

This provision is crucial in negligence cases. If an elderly person has a high risk of falls but this risk has not been assessed in the care plan, if they have dementia but controlled access and safety measures have not been taken, if they have difficulty swallowing but a feeding plan has not been prepared, or if they are bedridden but a positioning plan has not been implemented, the institution may be accused of violating its care plan obligations.

Falls, Fractures, and Safety Negligence in Nursing Homes

One of the most common types of injuries in elderly care facilities is falls. Elderly individuals may be prone to falls due to decreased muscle strength, balance disorders, low blood pressure, vision problems, medication side effects, dementia, Parkinson's disease, stroke, or osteoporosis. However, the existence of this risk does not absolve the institution of its responsibility; on the contrary, it makes risk management mandatory.

The institution must provide appropriate bed height, bed rails, a call bell, non-slip flooring, adequate lighting, toileting assistance, companionship/supervision, use of walkers or wheelchairs, nighttime monitoring, and physical environmental safety for elderly people at risk of falls. Unsupervised access to stairs, elevators, balconies, doors, garden exits, or hazardous areas should be prevented for patients with dementia.

The institution's responsibility after a fall is not limited solely to preventing falls. After a fall occurs, the elderly person must be examined, the possibility of fractures or head trauma assessed, an ambulance called if necessary, transportation to the hospital arranged, and family members informed. If the fall is concealed, reported late, or not followed up with the assumption that "there's nothing wrong," the harm may be more severe.

In fall cases, important evidence includes the incident report, camera footage, care staff duty roster, fall risk assessment of the elderly person, medication list, doctor's examination records, ambulance call records, emergency room documents, and fracture reports.

Bedsores, Neglect, and Lack of Hygiene

In bedridden or mobility-impaired elderly individuals, bedsores can be a serious indicator of neglect. Bedsores can develop due to prolonged periods in the same position, lack of skin care, nutritional deficiencies, dehydration, failure to prevent urine-feces contact, and improper positioning.

Not every bedsore automatically indicates institutional negligence. However, if a positioning schedule is not maintained, skin checks are not performed, nutritional support is not provided, the wound is not detected in the early stages, healthcare is sought late, or the wound progresses to infection and sepsis despite the elderly person being known to be bedridden, then severe care neglect becomes an issue.

The Regulation clearly states that care and rehabilitation services should be carried out to include daily care, nutrition, hygiene, personal care, and health monitoring. Therefore, leaving the elderly person dirty, not bathing them, neglecting diaper changes, not providing wound care, and consistently failing to provide personal care services such as nail/oral care may be grounds for compensation and administrative complaints.

Neglect of Medication Tracking and Health Monitoring

Older individuals often take multiple medications. Medications for blood pressure, diabetes, heart disease, anticoagulants, psychiatric disorders, Alzheimer's disease, pain relievers, diuretics, and sleep medications all require regular monitoring. For individuals residing in nursing homes or elderly care facilities, it is crucial that their medications are administered at the correct time, in the correct dosage, and according to their doctor's instructions.

Failure to monitor medication can lead to consequences such as blood pressure crises, hypoglycemia (low or high blood sugar), bleeding, confusion, falls, kidney failure, arrhythmias, or poisoning. The responsibility of the institution for medication management is even greater, especially for dementia patients who cannot monitor their own medication.

In allegations of medication neglect, medication administration schedules, nurse records, doctor's orders, prescriptions, pharmacy bills, medication packaging, blood glucose and blood pressure measurement records, and hospital admission documents should be examined. If records are missing or it is unclear who administered the medications and when, the institution's responsibility for record keeping and tracking is questionable.

Nutrition, Fluid Loss, and Weight Loss

In elderly care centers, nutrition doesn't simply mean providing food. If an elderly person has swallowing difficulties, dental or prosthetic problems, diabetes, kidney disease, heart disease, dementia, loss of appetite, depression, or special dietary needs, an appropriate nutritional plan should be developed.

Rapid weight loss, dehydration, low albumin, muscle wasting, weakness, frequent infections, pressure sores, or confusion may indicate nutritional and fluid intake problems. The institution should monitor how much the elderly person eats, their fluid intake, weight, and dietary needs. This support should be provided when an assessment by a dietitian or healthcare professional is required.

The regulation states that care and rehabilitation services include establishing a nutritional plan and conducting health monitoring. Therefore, if an institution fails to inform the family, arrange a doctor's evaluation, or make dietary adjustments despite a significant weight loss in an elderly individual, this can be considered neglect of care.

Delayed referral to hospital and lack of emergency intervention

Elderly care centers are not obligated to treat every medical condition. However, they are responsible for recognizing deteriorating health conditions in elderly individuals, providing necessary first aid, calling an ambulance, arranging hospital transfer, and informing family members.

Symptoms such as fever, shortness of breath, confusion, falls, head trauma, chest pain, signs of stroke, low/high blood sugar, serious infection, vomiting, inability to eat, inability to urinate, bleeding, or intense pain should not be ignored. Ignoring these symptoms on the grounds that an elderly individual is "already old" or "already ill" can have serious consequences.

In an allegation of delayed referral, the chronology of events is crucial. When was the first symptom observed? Who was notified? Were fever, blood pressure, pulse, and oxygen saturation measured? Was a doctor called? When was the ambulance called? When was the family informed? When did they arrive at the hospital? The answers to these questions reveal the existence of negligence.

Ill-treatment, violence, and psychological neglect

In elderly care centers, legal liability is not limited solely to physical health neglect. Humiliation, shouting at, threats, punishment, isolation, unnecessary restrictions, prevention of visits, confiscation of personal belongings, interference with finances, psychological pressure, or physical violence against an elderly individual also have serious legal consequences.

Such incidents are subject to compensation, penalties, and administrative oversight. Elderly individuals, especially those with dementia, Alzheimer's, or communication difficulties, may struggle to describe mistreatment. Therefore, bruises, weight loss, fear, sudden behavioral changes, restlessness during visits, shyness towards staff, neglect, and repeated unexplained injuries should be carefully investigated.

From a criminal law perspective, depending on the nature of the incident, crimes such as intentional injury, negligent injury, torture, threat, insult, deprivation of liberty, committing a crime through negligent conduct, or negligent homicide may arise. Article 89 of the Turkish Penal Code regulates negligent injury; Article 85 regulates causing the death of a person through negligence.

Failure to Inform Relatives and Concealment of Records

In elderly care centers, relatives should be informed of significant changes in the elderly person's health status. Families should be informed in cases such as falls, fractures, hospitalizations, bedsores, infections, weight loss, changes in medication, psychological deterioration, or risk of death.

The institution's concealment of the incident, failure to keep records, or delayed notification to the family also creates liability. Especially in cases of falls or injuries, a report should be prepared, camera recordings should be preserved, a health professional should conduct an assessment, and relatives should be informed.

In such cases, it is important for families to request all records by submitting a written application. The institution should be asked to provide care plans, health records, medication schedules, fall/injury/incident reports, camera footage, duty rosters, hospital referral documents, ambulance records, and staff reports.

What types of compensation can be claimed?

If harm occurs due to negligence in an elderly care center or nursing home, the injured elderly person, or their relatives in case of death, can claim compensation for both material and moral damages.

Compensation claims may include medical expenses, private hospital costs, surgery costs, intensive care costs, medication costs, physical therapy and rehabilitation costs, caregiver costs, medical device costs, travel and accommodation expenses, reimbursement of care center fees, or additional care costs.

For example, if a hip fracture occurs due to a fall, expenses for surgery, replacement, hospital stay, physical therapy, and caregiver may be claimed. If an infection develops due to bedsores, expenses for wound care, antibiotics, intensive care, and additional treatments may be requested. If serious harm occurs due to neglected medication, related treatment costs and the need for ongoing care will arise.

Moral compensation is claimed due to the suffering, fear, humiliation, neglect, physical harm, decreased quality of life, loss of trust, and violation of personal rights experienced by the elderly person. If the elderly person has passed away, their relatives may claim compensation for loss of support and moral damages.

Consumer Law and Contract Liability in Private Centers

The contract with a private elderly care center is important in terms of the services the center promises. The contract may include provisions for services such as a room, meals, personal care, medication monitoring, doctor's appointments, nursing services, physiotherapy, psychological support, companionship, special care, dementia care, or health monitoring.

If the private center has not provided these services properly, a claim of breach of contract and defective service may arise. The fact that the elderly individual or their relatives pay a fee to the private center increases the center's obligation to provide care services safely and in accordance with the contract. Defenses such as "there was a shortage of staff," "it was crowded," or "the elderly person could have fallen" may not be sufficient if the necessary care and supervision measures were not taken.

In private clinic files, contracts, payment receipts, service commitments, brochures, WhatsApp messages, care plans, invoices, medication lists, doctor evaluations, and security camera footage are important evidence.

Full Judicial Review Cases in Public Institutions

If negligence occurs in a public nursing home or elderly care and rehabilitation center, a full judicial lawsuit may be filed against the administration for service misconduct. The administration is obligated to provide appropriate care and supervision services to the elderly, organize personnel, conduct health monitoring, maintain records, and create a safe living environment.

The specific damages must be clearly stated in the application to the administration. For example, claims such as "surgical expenses, care expenses, physical therapy costs, and compensation for moral damages due to the client's hip fracture" should be clearly written. In case of death, loss of support and moral damages should be specified separately.

In administrative law, expert examination is often decisive. The court investigates whether the care service was carried out in accordance with the legislation, whether the individual care plan was implemented, whether the health monitoring was adequate, and whether the harm is related to negligence in providing the service.

How should evidence be collected?

In cases of neglect at elderly care centers or nursing homes, evidence must be collected quickly. This is because camera recordings can be deleted, staff may change, evidence of injury may disappear, or recordings may be altered.

The evidence to be collected includes: care contracts, payment receipts, individual care plans, health monitoring forms, medication schedules, blood pressure/blood sugar measurement records, nutrition and weight tracking records, bathing and hygiene records, position change charts, wound care forms, fall/incident reports, camera recordings, staff duty rosters, doctor and nurse notes, ambulance records, hospital emergency room records, medical summaries, forensic reports, photographs, text messages, and witness statements.

Photographs and hospital reports are particularly important in cases involving allegations of bedsores, falls, mistreatment, or malnutrition. When an elderly person is brought to the hospital, the incident should be clearly explained to the doctors, and any existing wounds, bruises, fractures, weight loss, or signs of neglect should be included in the report.

The Importance of Expert Reports

In such cases, expert reports often determine the outcome of the trial. Depending on the nature of the case, the expert panel should include a geriatrics specialist, a physical therapy and rehabilitation specialist, an internal medicine specialist, an infectious diseases specialist, a nursing/care services specialist, a social work specialist, a forensic medicine specialist, or an orthopedics specialist.

The expert must answer the following questions: What were the elderly person's care needs? Did the institution prepare a care plan appropriate to these needs? Could falls, bedsores, infections, medication errors, or nutritional deficiencies have been prevented? Was regular health monitoring conducted? Was referral to a hospital delayed in case of an emergency? Were records kept properly? Was there a causal link between the harm and the institution's negligence or service defect?

Objections should be raised to incomplete expert reports. General statements such as "falls can occur in the elderly" or "bedsores can occur in the elderly" are insufficient. The report should detail the specific elderly individual's health status, care needs, institutional records, and preventative measures.

Can a criminal investigation be opened?

If healthcare neglect in an elderly care facility results in serious injury or death, a criminal investigation may be initiated. Depending on the nature of the incident, crimes such as negligent injury, negligent homicide, intentional injury, torture, ill-treatment, abuse of office, or negligent conduct may be considered.

For example, if an elderly individual has been left uncared for for days, developed infected bedsores, and died from sepsis; if a hip fracture occurred due to a known risk of falls and no precautions were taken; or if serious harm occurred because medication was not administered, a criminal complaint can be filed with the prosecutor's office.

Criminal investigations and civil lawsuits are different. A criminal case aims to punish those responsible, while a civil lawsuit aims to compensate for the damage. However, forensic reports, expert reports, and witness statements obtained in a criminal case can be important evidence in a civil lawsuit.

What should families do?

If neglect is suspected in an elderly care facility or nursing home, the first thing to do is document the elderly person's health condition. If there are signs of wounds, bruises, fractures, weight loss, neglect, infection, or mistreatment, the individual should be immediately taken to the hospital and a report should be obtained.

The second step is to submit a written request to the institution, demanding all records. Verbal interviews should not suffice. Care plans, medication schedules, incident reports, camera footage, health monitoring forms, and staff records should be requested.

The third step is to correctly distinguish between the private and public sectors. In private institutions, private law, contractual liability, and consumer law should be considered; in public institutions, appeals to the administration and full judicial review cases should be evaluated.

The fourth step is to apply to the Provincial Directorate of Family and Social Services, CİMER (Presidential Communication Center), the prosecutor's office, and the relevant supervisory authorities, depending on the severity of the incident. The legal process should not be delayed, especially if there are allegations of ill-treatment, violence, concealment of records, death, or serious injury.

Conclusion: Neglect in elder care results in serious legal liability

Elderly care centers and nursing homes provide more than just accommodation and meals. For elderly individuals requiring care or supervision, health monitoring, personal care, nutrition, hygiene, safety, rehabilitation, psychological support, and emergency response processes must be carried out together. Disruptions to these services can have serious consequences for the lives and physical well-being of elderly individuals.

Not every fall, infection, or health deterioration is automatically due to institutional fault. However, the institution may incur legal liability if it has failed to assess the elderly person's risks, develop or implement an individualized care plan, provide adequate staffing, monitor medication, manage the risk of bedsores and falls, monitor nutrition and fluid intake, prevent maltreatment, or delay referral to a hospital in an emergency.

The injured elderly person or their relatives may claim compensation for treatment costs, care expenses, rehabilitation costs, private hospital expenses, material damages, and moral damages. In case of death, the relatives' rights to compensation for loss of support and moral damages arise. In private centers, breach of contract, defective service, and private law liability should be considered; in public centers, administrative negligence and full judicial review should be evaluated.

Therefore, in cases where there is suspicion of healthcare neglect in nursing homes or elderly care facilities, medical reports should be obtained without delay, institutional records should be requested in writing, photographic and message evidence should be preserved, the distinction between private and public institutions should be clearly made, and the file should be prepared in a way that allows for expert examination. A strong legal process succeeds not only on the basis of an allegation of "neglect," but also through the presentation of concrete evidence demonstrating a lack of care plans, health monitoring, medication administration, staff organization, record deficiencies, harm, and causal link.