If someone in a nursing home is in immediate danger, call 911. For situations that aren’t life-threatening but involve suspected abuse or neglect, your primary contact is your state’s survey agency, which is the government body responsible for investigating complaints about nursing home conditions. You can also reach out to your local Long-Term Care Ombudsman program, which investigates reports of abuse and advocates for residents at no cost. Both options keep your complaint confidential.
Recognize the Signs First
Before you report, it helps to identify what you’re seeing. Elder abuse in nursing homes takes several forms, and some are easier to miss than others.
- Physical abuse: Unexplained bruises, scars, burns, or signs of restraint use
- Emotional abuse: New or worsening depression, anxiety, or sudden changes in behavior
- Neglect: Preventable health problems like bedsores, weight loss, dehydration, or unclean living conditions
- Sexual abuse: Withdrawal, mood changes, or unexplained physical signs
- Financial abuse: Unusual changes in banking activity or spending patterns
You don’t need proof to file a report. A reasonable suspicion is enough. Investigators are trained to determine whether abuse occurred; your job is simply to raise the concern.
File a Complaint With Your State Survey Agency
Every state has a survey agency that inspects nursing homes and investigates complaints about care quality, unsafe conditions, understaffing, and abuse. This is the channel Medicare.gov directs you to for nursing home complaints. To find the contact information for your state’s agency, visit the CMS contact page at cms.gov or call Medicare directly at 1-800-MEDICARE (1-800-633-4227).
When you file, you’ll want to provide as much detail as possible: the resident’s name and location, the name of the facility, what you observed or were told, when it happened, and the names of any staff or witnesses involved. Write down dates and times while they’re fresh. If you have photos of injuries or unsanitary conditions, keep those as well. The more specific your report, the faster the agency can act.
Contact the Long-Term Care Ombudsman
The Long-Term Care Ombudsman program exists specifically to advocate for people living in nursing homes and assisted living facilities. Ombudsman representatives investigate reports of abuse, neglect, and rights violations, and all their services are free and confidential. They handle a wide range of issues: physical, verbal, mental, or financial abuse, improper use of chemical or physical restraints, poor quality of care, inappropriate transfers or discharges, and dietary or medical care concerns.
One important distinction: ombudsman representatives follow the expressed wishes of the resident. If the resident can communicate their preferences, the ombudsman will defer to them. If the resident cannot, the ombudsman works with their designated representative. This makes the program especially valuable when a resident feels powerless or is afraid to speak up on their own. You can find your local ombudsman through the Eldercare Locator at eldercare.acl.gov or by calling 1-800-677-1116.
Understand Where Adult Protective Services Fits
Adult Protective Services (APS) is often the first agency people think of, but its role in nursing home cases is limited. In most states, APS investigates abuse of older adults living in the community, not in licensed long-term care facilities. When APS receives a report about abuse inside a nursing home, it typically refers the case to the Long-Term Care Ombudsman or the appropriate licensing agency rather than investigating directly.
There’s one exception worth knowing: if the facility is operating without a proper license, APS may get involved or refer the matter to the relevant licensing authority. If you’re unsure whether a facility is licensed, report to APS anyway. They’ll route your complaint to the right place.
When to Call Law Enforcement
Call 911 or your local police if someone is in immediate, life-threatening danger. This includes situations where a resident is being physically harmed right now, has injuries that need emergency medical attention, or has been sexually assaulted. Police can intervene on the spot in ways that regulatory agencies cannot.
Even when the situation isn’t an emergency, law enforcement is the appropriate contact if you suspect criminal activity, such as theft, assault, or fraud. Filing a police report creates a legal record that can support other investigations. You can file with law enforcement and a state agency at the same time; the two processes are separate and can run in parallel.
What to Document Before You Report
Strong documentation makes a real difference in how quickly and effectively an investigation moves forward. Here’s what to gather if you can:
- Timeline: Dates, times, and descriptions of each incident or observation, in as much detail as you can recall
- Physical evidence: Photos of injuries, living conditions, or anything that looks wrong. Note changes over time if you visit regularly.
- Witness information: Names and contact details for anyone else who saw what happened. This could be other family members, friends, neighbors, medical providers, or even delivery personnel and postal carriers who interact with the facility.
- Resident details: The resident’s full name, date of birth, room number, and the full name and address of the facility
- Staff involved: Names or physical descriptions of any staff members connected to the suspected abuse
If the resident is able to describe what happened, write down their words as closely as you can. Their own account carries significant weight in an investigation.
Protections Against Retaliation
Fear of retaliation is one of the biggest reasons abuse goes unreported. If you’re a family member, you may worry the facility will treat your loved one differently. If you’re a staff member, you may fear losing your job. Federal and state laws address both concerns.
Nursing home staff are protected by law from being punished for making a report. No supervisor or administrator can prevent a staff member from reporting abuse, and no facility policy can override mandated reporting laws. A person who files a report in good faith cannot face civil or criminal liability for doing so. The only exception is if someone knowingly files a false report. In fact, the legal risk runs in the other direction: there are significant penalties for failing to report when you’re required to.
Complaints filed with state survey agencies and the ombudsman program are kept confidential. Your identity as the reporter is not shared with the facility during the investigation.
Report to Multiple Agencies if Needed
There’s no rule that limits you to a single report. In serious cases, filing with more than one agency creates multiple layers of accountability. A practical approach for most situations: file with your state survey agency (the primary investigator for nursing home complaints), contact the Long-Term Care Ombudsman (for ongoing advocacy and resident support), and call law enforcement if any criminal behavior is involved. Each agency has a different role and different powers, so overlapping reports don’t create conflicts. They create a more complete response.