If you suspect nursing home abuse, you have several places to report it, and you should use more than one. The most important first steps are calling your state’s Adult Protective Services (APS) line and contacting your local Long-Term Care Ombudsman program. For situations involving physical or sexual harm, call 911 or local police immediately. Each agency plays a different role, and filing with multiple organizations increases the chances of a swift investigation.
Adult Protective Services
Every state operates an Adult Protective Services program that investigates reports of abuse, neglect, and exploitation of vulnerable adults. APS is typically run through your county or state department of social services, and it’s the frontline agency for elder abuse complaints. You can find your local APS office by calling the Eldercare Locator at 1-800-677-1116, a free federal service run by the Administration for Community Living. Staff are available by phone, email, and online chat to connect you with the right local agency.
Some states also maintain statewide intake lines. New York, for example, operates a helpline at 1-844-697-3505 that can take your referral or direct you to your county’s APS office. Most states have a similar setup. When you call, be ready to describe what you witnessed or suspect, who was involved, and where and when it happened.
The Long-Term Care Ombudsman Program
Every state has a Long-Term Care Ombudsman program, federally required under the Older Americans Act, that specifically handles complaints about nursing homes, assisted living facilities, and other residential care settings. Ombudsmen investigate complaints, advocate for residents, and work to resolve problems related to health, safety, and residents’ rights. They can also represent a resident’s interests before government agencies and push for legal or administrative remedies.
The key difference between APS and an ombudsman is focus. APS investigates abuse broadly. Ombudsmen specialize in the facility setting and understand nursing home regulations inside and out. They can spot patterns of neglect, push back against a facility that’s stonewalling, and escalate issues to state regulators. You can locate your local ombudsman through the Eldercare Locator (1-800-677-1116) or at eldercare.acl.gov.
Your State Survey Agency
State Survey Agencies are the regulatory bodies that inspect and license nursing homes. They work with the Centers for Medicare and Medicaid Services (CMS) to ensure facilities meet federal quality and safety standards. When you file a complaint with a State Survey Agency, it can trigger an investigation and, if violations are confirmed, result in fines, required corrective action, or even loss of the facility’s certification to accept Medicare and Medicaid patients.
The State Survey Agency is usually housed within your state’s Department of Health. CMS maintains a directory of contact information for every state’s agency on its website. When a complaint is substantiated, the agency provides the person who reported it with a written summary of the investigation findings. If the investigation confirms abuse, the state is required to report the findings to local law enforcement and, when appropriate, the state’s Medicaid Fraud Control Unit.
When To Call Law Enforcement
If the abuse involves a crime, such as physical assault, sexual contact, theft, or any act causing bodily harm, call local police. You do not need to wait for a state agency to act first. Federal law also requires the nursing home itself to report suspected crimes to law enforcement. If the suspected crime resulted in serious bodily injury, the facility must report it within two hours. For other suspected crimes, the deadline is 24 hours.
“Serious bodily injury” under these rules means an injury involving extreme physical pain, substantial risk of death, protracted loss of function of a body part or organ, the need for surgery, hospitalization, or physical rehabilitation, or any injury resulting from sexual abuse. If you see signs that meet any of those descriptions, do not wait for the facility to act on its own. Call 911.
What To Document Before You Report
Strong documentation makes every report more effective. Before or immediately after you call, gather as much of the following as you can:
- Photos and video: Photograph any visible injuries, the resident’s living area, clothing, bedding, and any signs of neglect like unsanitary conditions or missing assistive devices like walkers or hearing aids.
- Dates and times: Write down when you observed the problem, when it may have started, and any changes you’ve noticed over time. Photographing injuries on multiple dates can show a pattern.
- Names: Note the names of staff members involved, potential witnesses (other residents, visitors, delivery personnel, hairstylists, clergy, neighbors), and any medical providers who have treated the resident.
- Medical records: Request copies of emergency room records, treating physician notes, pharmacy records, nurses’ notes, and lab reports if possible.
- Written materials: Save any journals, letters, calendars, or correspondence that may be relevant. If financial exploitation is a concern, gather checkbooks, bank statements, and receipts.
If the resident is able to speak about what happened, write down their account as close to their exact words as possible. Note their orientation to time and place, whether they can identify the person who harmed them, and how the experience has affected them. This kind of early documentation can be crucial if the case later moves to a legal proceeding.
Filing Multiple Reports
These agencies don’t duplicate each other’s work. APS focuses on the individual victim. The ombudsman advocates within the facility system. The State Survey Agency enforces regulatory compliance. Law enforcement investigates crimes. Filing with all relevant agencies creates overlapping accountability, so a complaint can’t quietly disappear inside one bureaucracy.
You also don’t need to be certain that abuse occurred to file a report. A reasonable suspicion is the legal threshold. If something looks wrong, report it and let investigators determine what happened.
Protections for People Who Report
Federal regulations prohibit nursing homes from retaliating against anyone who files a complaint, whether that person is a family member, a resident, or a staff member. Nursing homes are explicitly required to protect residents from intimidation or punishment, and that protection extends to the act of reporting concerns. Many states have additional whistleblower protections written into their own elder abuse laws.
If you’re a nursing home employee worried about your job, know that federal law is on your side. Facilities that retaliate against reporters face regulatory consequences. If you’re a family member worried about your loved one facing retaliation inside the facility after a report, say so when you file. Ombudsmen and APS workers can monitor the situation and intervene if the facility responds inappropriately.
How To Check a Facility’s Track Record
CMS operates a public tool called Medicare Care Compare that rates nursing homes and flags those with abuse histories. Since October 2019, facilities cited for abuse where residents were harmed receive a warning icon on their profile. This icon appears when a facility was cited for abuse causing harm on its most recent inspection or on a complaint survey within the past year. It also appears when a facility has been cited for abuse with potential harm on two consecutive inspection cycles. You can search any Medicare-certified nursing home at medicare.gov/care-compare to see its inspection results, staffing levels, and whether it carries an abuse flag.