If someone in a nursing home is in immediate danger, call 911. For situations that aren’t emergencies, your primary reporting contacts are your state’s survey agency and the Long-Term Care Ombudsman program, both of which investigate complaints and can intervene on a resident’s behalf. You don’t need to have proof or know every detail before making a report.
The reporting process can feel overwhelming, especially when you’re worried about a loved one. Here’s how to move through it step by step.
Recognizing Abuse and Neglect
Before you report, it helps to know what you’re looking at. Nursing home abuse isn’t always obvious, and it doesn’t always leave visible marks. Physical abuse can show up as bruises, fractures, burns, or injuries that don’t match the explanation staff give you. But neglect is far more common and easier to miss: unexplained weight loss, dehydration, poor hygiene, bedsores, frequent infections, or repeated falls.
Behavioral changes are just as telling. A resident who becomes withdrawn, fearful, unusually quiet, or anxious around certain staff members is signaling something. Depression, agitation, and sudden confusion can all point to improper care. Missed medications, untreated medical conditions, and unsanitary living conditions are forms of neglect even when no one is being physically harmed.
Bedsores deserve special attention. Pressure ulcers frequently indicate that staff aren’t repositioning a resident often enough or maintaining basic hygiene. When bedsores progress to advanced stages, that’s a strong sign of sustained neglect rather than an unavoidable medical issue.
Financial abuse is another category entirely. This can involve unauthorized use of a resident’s funds, missing personal belongings, or unexplained changes to financial documents. It sometimes comes from staff, sometimes from other residents, and sometimes from outside parties who have access to accounts.
When to Call 911
Call 911 or your local emergency number if a resident is in immediate physical danger, has injuries that need urgent medical attention, or if you suspect a crime is actively occurring. This includes sexual assault, severe physical violence, or any situation where waiting for an investigation could result in further harm. Emergency responders can secure the scene, document injuries, and connect the case to law enforcement.
For everything else, the reporting channels below are designed to handle complaints and trigger formal investigations.
File a Complaint With Your State Survey Agency
Every state has a survey agency that oversees nursing homes certified by Medicare and Medicaid. This is the agency that conducts inspections and can impose penalties on facilities that violate care standards. Filing a complaint here triggers a formal investigation process.
Most states offer three ways to file: through an online complaint portal, by phone, or by mail. When your complaint is received, intake staff review it and assign a priority level based on how serious the alleged violation is. The complaint then goes to a regional office, where investigators may contact you for additional details. You’ll receive written acknowledgment that your complaint was filed, and a follow-up letter once a decision is reached.
To find your state’s survey agency, visit Medicare’s Care Compare website and look for the complaint contact information listed for the specific facility, or search for your state’s health department complaint line. You can also call 1-800-MEDICARE (1-800-633-4227) and ask to be directed to the right agency.
Contact the Long-Term Care Ombudsman
The Long-Term Care Ombudsman program exists in every state specifically to advocate for nursing home residents. Ombudsmen are trained to investigate complaints, mediate disputes between residents and facilities, and help families navigate the system. They can also explain residents’ rights, advise on Medicaid and Medicare coverage, and guide you through legal issues like powers of attorney and guardianship.
Common complaints ombudsmen handle include inadequate medical or personal care, problems with medication and nutrition, financial concerns involving a resident’s funds, violations of residents’ rights (like being treated disrespectfully or having preferences ignored), and disputes over admission or discharge decisions.
An ombudsman will work with the facility to resolve the issue when possible. When that’s not enough, they refer cases to regulatory agencies with enforcement power. You can find your local ombudsman through the Eldercare Locator at 1-800-677-1116 or by searching online for your state’s ombudsman program.
Report to Adult Protective Services
Adult Protective Services handles abuse reports for adults living in any setting, including nursing homes, group homes, and hospitals. APS investigates allegations of abuse, neglect, and exploitation and can coordinate with law enforcement when needed. The exact name of this agency varies by state, but the Eldercare Locator can connect you to the right office.
APS is especially important for financial abuse cases. If you suspect someone is stealing from a resident or misusing their money, APS can investigate alongside law enforcement. You can also file a report with your local police department’s non-emergency line or contact the district attorney’s office to request prosecution.
What to Include in Your Report
The more detail you provide, the faster investigators can act. But don’t let incomplete information stop you from filing. Agencies expect that you won’t know everything, and they have their own investigative tools.
When possible, try to include:
- Dates and times of the incidents you observed or learned about
- Location within the facility where the incident happened
- Names of anyone involved, including staff members and witnesses
- A description of what you observed or what the resident told you
- The resident’s health conditions, including any memory loss or difficulty communicating
- Photos of injuries, living conditions, or anything else that documents your concern
- Whether there’s an ongoing risk of danger to the resident or others
Keep copies of everything you submit and notes on every conversation you have with facility staff, investigators, and agencies. A written record protects you and strengthens the case.
Report Directly to the Facility
If you suspect a specific staff member is responsible, you can also report your concerns to the facility’s administrator or the person designated to receive abuse reports. Every nursing home is required to have an internal process for handling these complaints. This step can sometimes resolve issues quickly, particularly for lower-level care problems.
However, if the facility doesn’t act on your complaint, or if you suspect the problem is systemic rather than limited to one employee, escalate immediately to the state survey agency and ombudsman. Internal reporting should supplement external reporting, not replace it.
Protections Against Retaliation
Federal law protects people who report fraud, abuse, and safety violations. The Whistleblower Protection Act and its 2012 enhancement prohibit retaliation against anyone who discloses violations of law, abuse of authority, or dangers to public health and safety. This covers federal employees, contractors, subcontractors, and grantees connected to the Department of Health and Human Services.
For nursing home staff who witness abuse, these protections mean your employer cannot demote you, give you a poor performance review, suspend you, or reassign you as punishment for reporting. If you’re a family member, nursing homes are also prohibited from retaliating against residents whose families file complaints. A facility that discharges or mistreats a resident in response to a complaint is committing a separate violation of federal residents’ rights protections.
If you believe retaliation has occurred, the HHS Office of Inspector General accepts reports and investigates these claims directly.
Filing Multiple Reports
You don’t have to pick just one agency. In fact, filing with multiple organizations increases the chances that the situation gets addressed quickly. For a serious case, a reasonable approach is to contact the state survey agency for a formal investigation, reach out to the ombudsman for advocacy and mediation, file with Adult Protective Services if exploitation or severe neglect is involved, and notify local law enforcement if a crime may have been committed. Each agency has a different role and different enforcement tools, and they regularly coordinate with each other on overlapping cases.