If you suspect neglect in a nursing home, your first call should go to your state’s Long-Term Care Ombudsman program. You can reach one through the Eldercare Locator at 1-800-677-1116. For situations involving immediate harm or serious injury, call 911 first, then file formal reports. The reporting process involves multiple agencies, and understanding which ones to contact (and in what order) makes your complaint far more likely to result in action.
Recognizing Neglect Before You Report
Before filing a report, it helps to know what qualifies as neglect under federal rules. The legal definition is specific: neglect is the failure of a facility, its employees, or service providers to provide goods and services necessary to avoid physical harm, pain, mental anguish, or emotional distress. That covers a wide range of failures, from skipped medications to ignored hygiene needs.
Some signs are hard to miss. Severe bedsores (pressure ulcers) are one of the clearest indicators of neglect because they develop over time and are almost always preventable with routine repositioning. If a resident is left sitting in a wheelchair or lying in bed without being moved, these wounds can progress to dangerous stages. Other physical signs include unexplained weight loss, dehydration, frequent infections, and untreated falls.
Subtler signs matter too. Look for residents left in soiled clothing or bedding, strong odors of urine or feces in their room, unbrushed teeth, or unwashed hair. Dehydration can show up as unusual tiredness, irritability, complaints of feeling cold, hair loss, or skin that looks thin and papery. Behavioral changes like new fearfulness, withdrawal, or sudden silence around staff can also signal a problem. Any of these patterns is worth reporting.
Where to File Your Report
Long-Term Care Ombudsman
The Long-Term Care Ombudsman program exists specifically to handle complaints about nursing homes, assisted living facilities, and other residential care settings. Ombudsman staff investigate complaints, advocate for residents, and work to resolve problems directly with the facility. In federal fiscal year 2023, over 1,500 staff members and more than 3,400 trained volunteers provided these services nationwide, resolving or partially resolving 71% of all complaints to the satisfaction of the resident or complainant.
You don’t need proof to file a complaint. A reasonable concern is enough. The ombudsman will investigate on your behalf, and your identity can be kept confidential. To find your local program, call the Eldercare Locator (1-800-677-1116) or search online for your state’s ombudsman office.
State Survey Agency
Every state has a Survey Agency that works with the Centers for Medicare and Medicaid Services (CMS) to ensure nursing homes follow federal health and safety regulations. These agencies conduct inspections and investigate complaints about care quality. Filing a complaint here can trigger a formal state inspection of the facility.
Contact information for your State Survey Agency is listed on the CMS website. You can file by phone or in writing. When a complaint is filed, the agency decides whether to conduct an unannounced survey of the facility, review records, or interview staff and residents. This is one of the most powerful tools available to families because facilities that fail inspections face real consequences, including fines and loss of Medicare funding.
Adult Protective Services
Adult Protective Services (APS) handles abuse and neglect of vulnerable adults, but its role in nursing home cases varies by state. Some states give APS jurisdiction over facility-based neglect, while others route those complaints exclusively through the ombudsman or State Survey Agency. In South Carolina, for example, APS only handles cases involving adults living at home or in the community, while nursing home complaints go to the ombudsman. Check your state’s rules, but when in doubt, file with both. No one will fault you for over-reporting.
Law Enforcement
If you believe a crime has been committed, including severe neglect that caused serious injury, contact local police. Under the Elder Justice Act, nursing facilities that receive Medicare or Medicaid funding are actually required to report suspected crimes against residents to law enforcement themselves, within 2 hours if serious bodily injury is involved, or within 24 hours for all other incidents. If you suspect the facility has not made that report, calling police yourself ensures the situation gets attention.
What the Facility Is Required to Do
Federal regulations place strict reporting obligations on nursing homes. When any allegation of abuse, neglect, or exploitation is made, the facility must report it to its administrator and to the State Survey Agency immediately. The specific deadlines: no later than 2 hours if the events involve abuse or serious bodily injury, and no later than 24 hours if they don’t. The facility then has 5 working days to complete an internal investigation and report the results.
This matters for you because it means the facility has a legal duty to act the moment you raise a concern. If you tell a nurse, administrator, or any staff member about suspected neglect, the clock starts. If the facility fails to investigate or report, that itself is a violation you can report to the State Survey Agency.
How to Document What You’ve Seen
Strong documentation makes your report more effective and harder to dismiss. Start keeping a written log with dates, times, and descriptions of what you observed. Be specific: “Mom had a quarter-sized red sore on her left heel on March 12” is far more useful than “she had bedsores.”
Photographs are powerful evidence. Take pictures of bedsores, soiled bedding, dirty living conditions, or injuries, with timestamps. If your loved one is willing and able to describe what’s happening, write down their words as close to verbatim as possible, noting the date.
Request copies of your loved one’s medical records. Under federal law, residents (or their legal representatives) have the right to access these records. Look for gaps in care documentation, missing medication logs, or notes that don’t match what you’ve observed. The facility is also required to keep its most recent state and federal inspection reports available for anyone to review, so ask to see those as well. Previous violations can establish a pattern.
Keep copies of everything you submit. Save emails, note the names of people you spoke with, and record confirmation numbers for any complaints you file. If the situation escalates to a legal matter, this documentation becomes essential.
Filing With Multiple Agencies at Once
You don’t have to choose just one place to report. In fact, filing with multiple agencies is often the most effective approach. A complaint to the ombudsman gets an advocate working on your loved one’s behalf quickly. A simultaneous complaint to the State Survey Agency puts the facility on notice for a potential inspection. And if the situation involves criminal conduct, a police report creates a separate legal record.
Each agency serves a different function. The ombudsman mediates and advocates. The State Survey Agency enforces federal regulations. Law enforcement investigates crimes. APS (where it has jurisdiction) can provide protective intervention. These systems overlap by design, so using more than one increases the chances that something changes for your loved one.
You can file complaints anonymously with most agencies, though providing your contact information allows investigators to follow up with questions. Retaliation against residents or families who file complaints is illegal under federal law, and facilities found retaliating face additional penalties.