The Brother James facility in Springfield, Illinois isn’t precisely a nursing home. It’s a residential care facility for men 18-years and up who suffer from mental and physical disabilities. The Brother James Court facility was fined $10,000 for a variety of violations. Living in Brother James Court is a 19-year-old man. He has Cerebral Palsy, Seizure Disorder and a history of sternum, arm, ankle, and hand fractures. He weighs 69 pounds and is under five feet tall. He can’t speak, but he can communicate by pointing. On August 21, 2011, in violation of the rules, a single person moved the patient from his wheelchair to his bed; this in turn may have been responsible for the boy’s broken leg. It’s hard to tell because he wasn’t treated for a leg break for another 9 days. In the meantime, the employees at the facility repeatedly and dutifully documented that the boy cried and screamed in pain all night. Day after day, they documented his screams, and yet no one alerted medical staff to this radical change in behavior. When asked if the boy was assessed for his nightly screams of pain, one employee responded “It is what it is.” We typically call this nursing home neglect. Neglect is hard to define, because it takes many forms. Sometimes, like in this case, the neglect is obvious. Other times, identifying neglect can be difficult.