If someone in a nursing home is in immediate danger, call 911. For situations that aren’t emergencies, the primary place to file a report is your State Survey Agency, which you can reach by calling 1-800-MEDICARE (1-800-633-4227). Beyond that single phone call, there are several other agencies that can help depending on the type of abuse involved, and knowing which ones to contact will make your report more effective.
Recognize What Counts as Abuse
Nursing home abuse isn’t limited to someone being hit. It falls into several categories, and some are easier to miss than others. Physical abuse includes pushing, hitting, slapping, or restraining a resident against their will. Sexual abuse means any forced sexual contact. Neglect is a caregiver intentionally failing to provide basic needs like food, shelter, healthcare, or medication. Emotional abuse covers yelling, verbal threats, humiliation, intimidation, or deliberately ignoring a resident. Abandonment occurs when a caregiver leaves a vulnerable person alone without any care. Financial abuse includes stealing money, forging checks, using credit cards without permission, or taking someone’s Social Security benefits.
Watch for unexplained bruises, scratches, or fractures. Behavioral changes are just as telling: crying, expressions of fear, cowering, withdrawal, difficulty sleeping, or any shift from the person’s normal baseline. Sudden changes to a resident’s financial situation, like missing money or unfamiliar charges, point to financial exploitation. You don’t need to be certain abuse is happening to file a report. Investigators don’t expect you to have all the details.
Call 911 for Emergencies
If a resident is in immediate physical danger, has been seriously injured, or you suspect a crime is in progress, call 911 first. Everything else, including formal complaints and agency notifications, can follow once the person is safe. For situations that aren’t urgent but still involve possible criminal behavior like theft, you can call the non-emergency number for your local police or sheriff’s office to file a report.
File a Complaint With Your State Survey Agency
The State Survey Agency is the main regulatory body that inspects nursing homes participating in Medicare and Medicaid. It investigates complaints about abuse, inadequate staffing, unsafe conditions, and other forms of mistreatment. This is the agency Medicare.gov directs you to for nursing home complaints.
To find your state’s agency, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Some states also have online complaint portals, though requirements vary. In Florida, for example, complaints must be signed and cannot be filed over the phone. After you file, expect to receive periodic written updates on the status of your complaint. If investigators find a violation, the case moves through a review process that can result in disciplinary action against the facility or individual staff members.
Contact the Long-Term Care Ombudsman
Every state has a Long-Term Care Ombudsman program, established under the Older Americans Act, specifically designed to protect residents of nursing homes, assisted living facilities, and other residential care communities. Ombudsmen investigate and resolve complaints on behalf of residents, represent residents’ interests before government agencies, and can pursue legal and administrative remedies when needed. They also help residents and families understand their rights.
The Ombudsman is a particularly good resource when the problem involves the resident’s rights being violated, disputes with facility management, or situations where you’re not sure which agency to contact. You can find your state’s program through the Administration for Community Living’s online directory or by calling the Eldercare Locator at 1-800-677-1226.
Report to Adult Protective Services
Adult Protective Services (APS) investigates abuse, neglect, and exploitation of vulnerable adults. In Texas alone, APS completes roughly 85,000 investigations per year. When a caseworker confirms that abuse occurred and the resident accepts help, APS develops a service plan in coordination with the resident, their family, and partner agencies to prevent further harm.
In severe cases, APS has legal tools at its disposal. If a resident’s life or physical safety is in immediate danger and the person lacks the capacity to consent to services, a caseworker can ask a court for an Emergency Order for Protective Services to remove the resident and transport them to a medical facility. APS can also pursue guardianship referrals when a resident appears unable to make decisions that would keep them safe, connecting them with someone who can make those decisions on their behalf.
Reporting Financial Exploitation
Financial abuse requires notifying different agencies depending on who is doing the exploiting. If a staff member or volunteer at the facility is involved, report it to the facility administrator as well as to APS, your State Survey Agency, and local law enforcement. If the person is a licensed professional, you can also report them to the relevant state licensing board.
Some financial abuse involves specific benefit programs. If a Social Security representative payee is misusing a resident’s benefits, contact your local Social Security office or call 800-772-1213. If a VA-appointed fiduciary is misusing veterans’ benefits, contact the Department of Veterans Affairs. If a court-appointed guardian or conservator is stealing money or property, report it to the court that appointed them. You can also contact your local District Attorney’s office and ask them to pursue prosecution.
What to Document Before You Report
Strong documentation makes investigations more effective. Gather as much of the following as you can before filing your report:
- Dates and times of each incident you observed or were told about
- Location where the incident occurred
- Names and positions of anyone involved, including the person you believe is responsible
- Witnesses and their contact information
- Description of injuries such as bruises, scratches, lacerations, fractures, or redness on the skin
- Behavioral changes that differ from the resident’s normal baseline, like new fearfulness, withdrawal, or difficulty sleeping
- The resident’s health conditions, including any information about memory loss or decision-making ability
- Whether you believe there is an urgent risk of danger to the resident or someone else
Photograph visible injuries if you can do so safely. Even if your documentation is incomplete, file your report anyway. Investigators are trained to build cases from partial information, and a delay in reporting can put the resident at further risk.
Protections Against Retaliation
Federal law protects certain reporters from retaliation. Under the Whistleblower Protection Act of 1989 and the National Defense Authorization Act for Fiscal Year 2013, employees of federal contractors, subcontractors, grantees, and subgrantees are protected when they disclose violations of law, gross mismanagement, waste of funds, abuse of authority, or dangers to public health and safety related to a federal contract or grant. Retaliation includes any adverse employment action taken by a supervisor or administrator in response to a protected disclosure.
For family members and non-employees, protections vary by state. Many states have their own whistleblower and retaliation laws that cover anyone who reports suspected abuse in good faith. Your State Survey Agency or Long-Term Care Ombudsman can tell you what protections apply in your situation. If you’re a facility employee worried about your job, consider filing your complaint with the Ombudsman or APS rather than going through internal channels alone, as this creates an external record of your report.