If you suspect neglect at a nursing home, you can report it immediately to your state’s Long-Term Care Ombudsman, your State Survey Agency, or Adult Protective Services. In an emergency, call 911 first. You do not need proof to file a report, and federal law protects residents and families from retaliation for making complaints.
What Counts as Neglect
Federal regulations define nursing home neglect as the failure of a facility, its employees, or its service providers to provide goods and services necessary to avoid physical harm, pain, mental anguish, or emotional distress. That definition is broad on purpose. It covers situations that might not look dramatic but cause real suffering over time.
In practice, neglect can look like:
- Unmet basic needs: a resident left in soiled clothing for hours, dehydration, missed meals, or inadequate hygiene
- Medical neglect: skipped medications, untreated bedsores, infections that go unaddressed, or failure to follow a care plan
- Emotional or social neglect: isolating a resident, ignoring call lights repeatedly, or leaving someone without mobility assistance so they’re effectively confined to bed
You don’t need to classify the neglect into a formal category to report it. If your loved one’s needs are going unmet and the facility is responsible for meeting them, that qualifies.
Where to Report
There are several channels for reporting, and you can (and often should) use more than one at the same time. Each serves a different function.
Long-Term Care Ombudsman
Every state has a Long-Term Care Ombudsman program, funded through the federal Older Americans Act. Ombudsmen are advocates for nursing home residents. They investigate complaints, work to resolve problems directly with facilities, and can represent residents’ interests before government agencies. If you’re unsure whether what you’ve observed rises to the level of neglect, an ombudsman can help you sort that out. You can find your state’s ombudsman through the Administration for Community Living’s online directory at acl.gov or by calling the Eldercare Locator at 1-800-677-1116.
State Survey Agency
State Survey Agencies are the regulatory bodies that inspect nursing homes and enforce federal health and safety standards. When you file a complaint, they can launch a formal investigation, conduct an unannounced inspection, and cite the facility for violations. Every state has one, and you can find contact information through the CMS website at cms.gov. Complaints can typically be filed by phone, online, or in writing, depending on the state.
Adult Protective Services
If the resident is a vulnerable adult, your state’s Adult Protective Services (APS) office is another reporting option. APS investigates allegations of abuse, neglect, and exploitation of older adults and people with disabilities. In many states, certain professionals such as doctors and social workers are legally required to report suspected neglect to APS, but anyone can file a report.
The Facility Itself
You can also report concerns directly to the nursing home’s administrator or director of nursing. Federal regulations require facilities to investigate all allegations of neglect and report confirmed or suspected violations to the State Survey Agency and other authorities within specific timeframes: within 2 hours if the situation involves abuse or serious bodily injury, and within 24 hours for other allegations. Filing an internal complaint creates a paper trail, but it should not be your only step if you believe the neglect is serious or ongoing.
Law Enforcement
If your loved one is in immediate danger, call 911. Severe neglect, such as a resident found severely dehydrated, malnourished, or with untreated injuries, can constitute a crime. You do not need to wait for a regulatory investigation before involving law enforcement.
How to Document What You’ve Observed
You don’t need a documented case to file a report. But collecting evidence strengthens your complaint and helps investigators act faster. Start as soon as you notice something wrong.
Keep a written log with dates, times, and specific observations. Note what you saw, who was present, and what staff members said when you raised concerns. Details that seem minor in the moment, like how long a call light went unanswered or the condition of bedding during a visit, can establish a pattern over time. Write entries as close to real-time as possible, since specifics fade quickly from memory.
Photographs are powerful evidence. If your loved one has bedsores, unexplained weight loss, bruises, or is consistently found in unsanitary conditions, take dated photos. Most smartphones automatically embed a timestamp, which adds credibility.
Request copies of your loved one’s medical records. You’re looking for medication administration logs, incident reports, nurses’ progress notes, and any emergency room visit records. Gaps in medication logs or missing incident reports can be just as telling as what’s documented. Under federal law, residents and their legal representatives have the right to access these records.
If other visitors, family members of other residents, or staff members have noticed similar problems, ask them to share what they’ve seen. A written account from a witness, even informal, adds weight to a complaint. Staff members may be reluctant to speak up, but their observations often carry significant credibility with investigators.
Protections Against Retaliation
Federal law gives every nursing home resident the right to make a complaint to staff or any other person without fear of punishment. This protection extends to family members and other advocates who file reports on a resident’s behalf. A facility cannot discharge, transfer, reduce services, or otherwise retaliate against a resident because someone filed a complaint.
If you believe retaliation has occurred after making a report, document it and contact your Long-Term Care Ombudsman or State Survey Agency immediately. Retaliation itself is a violation that regulators take seriously.
Checking a Facility’s Track Record
Medicare’s Care Compare website (medicare.gov/care-compare) lets you look up any Medicare-certified nursing home and review its inspection history. Facilities recently cited for resident harm or potential harm related to abuse or neglect are flagged with a specific icon. You can also read the full inspection reports to see what types of violations were found and how the facility responded.
This information is useful both before and after filing a report. If the facility has a history of neglect citations, that context strengthens your complaint and may prompt investigators to prioritize it. It can also help you make decisions about whether to seek a transfer to a different facility while your complaint is being investigated.
What Happens After You Report
Once a complaint reaches the State Survey Agency, investigators typically conduct an unannounced visit to the facility. They review records, interview staff and residents, and observe conditions firsthand. The timeline varies by state and severity. Complaints involving immediate danger are prioritized and may trigger an inspection within days. Less urgent complaints can take several weeks.
You may or may not be contacted during the investigation. Many states keep the identity of the complainant confidential to protect against retaliation. After the investigation concludes, the agency determines whether a violation occurred and what corrective action the facility must take. Penalties can range from a required plan of correction to fines, and in severe cases, loss of Medicare and Medicaid certification.
If you filed through the Ombudsman program, your ombudsman will typically follow up with you about the outcome and can continue advocating on the resident’s behalf if conditions don’t improve. You can also file additional complaints if new problems arise or if the original issues aren’t resolved.