If you suspect abuse or neglect in a nursing home, your first call depends on the severity of the situation. For immediate danger or a crime in progress, call 911. For all other concerns, report to your state’s Adult Protective Services (APS) agency, the Long-Term Care Ombudsman program, or your state’s health department survey agency. You can report to more than one of these at the same time, and in many cases, you should.
Call 911 for Immediate Danger
If a resident is being physically harmed, sexually assaulted, or is in a medical emergency caused by neglect, call 911 first. Law enforcement should respond to suspected crimes against nursing home residents with the same urgency as crimes in any other setting. Federal law already requires nursing home staff, including owners, managers, and contractors, to report any reasonable suspicion of a crime against a resident to both law enforcement and the state regulatory agency. If the facility hasn’t done that, you can.
After the immediate threat is addressed, you should still file reports with the agencies below to create a formal record and trigger an investigation into the facility itself.
Adult Protective Services
Adult Protective Services is the primary agency responsible for investigating abuse, neglect, and financial exploitation of vulnerable adults. APS is run at the county or state level, so the exact phone number varies depending on where the nursing home is located. The national Eldercare Locator at 1-800-677-1116 can connect you to the correct local APS office.
APS serves adults 18 and older who, because of physical or mental impairments, cannot protect themselves from harm and have no one willing and able to help them. When you call, an intake worker will ask for details about the resident, the facility, what you observed or suspect, and when it happened. You do not need proof to file a report. A reasonable concern is enough to trigger an investigation. In most states, you can report anonymously, though providing your contact information helps investigators follow up if they need clarification.
The Long-Term Care Ombudsman Program
Every state has a Long-Term Care Ombudsman program, federally mandated under the Older Americans Act, that works specifically on behalf of people living in nursing homes, assisted living facilities, and other residential care settings. Ombudsman staff and trained volunteers investigate complaints, advocate for residents, and work to resolve problems related to health, safety, and residents’ rights.
These programs handle a significant volume of cases. Nationally, ombudsman programs work to resolve over 200,000 complaints each year, and they resolve or partially resolve about 71% of those to the satisfaction of the resident or the person who filed the complaint. The ombudsman is particularly useful when the issue involves care quality, dignity violations, or situations where you’re not sure whether what you’re seeing crosses the line into abuse. They can investigate and help you understand what steps to take next. To find your local ombudsman, visit the Eldercare Locator website or call 1-800-677-1116.
Your State’s Health Department or Survey Agency
Nursing homes are regulated by state health departments (sometimes called the state survey agency), which conduct inspections and can issue penalties, require corrective action plans, or even revoke a facility’s license. Filing a complaint with this agency triggers a different kind of investigation than APS. Rather than focusing on the individual victim, the state survey agency looks at whether the facility is meeting federal and state standards of care.
You can file a complaint online or by phone in most states. The Centers for Medicare and Medicaid Services (CMS) website lists contact information for each state’s survey agency. This is the right channel when you believe the problem is systemic: understaffing, unsanitary conditions, or a pattern of neglect affecting multiple residents.
Signs That Should Prompt a Report
You don’t need to be certain that abuse is happening to report it. The following signs, identified by the National Institute on Aging, are red flags worth acting on:
- Physical abuse: unexplained bruises, scars, burns, or signs of restraint
- Emotional abuse: new or worsening depression, anxiety, fearfulness, or sudden behavioral changes
- Neglect: preventable health problems like bedsores, dehydration, unclean living conditions, or soiled clothing
- Sexual abuse: withdrawal, mood changes, or unexplained physical signs
- Financial exploitation: unexplained changes in banking or spending patterns, missing belongings, or new people gaining access to the resident’s finances
- Abandonment: a resident left without necessary care or supervision
Some of these signs can also result from medical conditions or medications, which is exactly why reporting matters. Investigators are trained to determine the cause. Your job is to flag what you’ve noticed.
What to Document Before You Call
The more specific information you can provide, the faster an investigation can move. Before you make your report, write down everything you can remember or observe:
- The resident’s full name and location (facility name, room number if you know it)
- What you observed, including dates, times, and descriptions of injuries or conditions
- Who was involved, including names or descriptions of staff members if applicable
- Any witnesses who saw what you saw
- Photos, if you can safely take them without putting the resident at risk
If the resident is able to communicate, certain questions can help you understand the scope of the problem. Ask whether anyone has hurt them, called them names, or made them feel uncomfortable. Ask whether anything is missing from their room. Ask whether anyone new has started helping with their money or paperwork. These conversations can reveal patterns of isolation, financial exploitation, or intimidation that may not be visible on the surface.
If You Suspect Physical or Sexual Assault
When abuse involves physical or sexual assault, preserving medical evidence is critical. Request that the resident receive a medical forensic examination as soon as possible. For sexual assault specifically, hospitals with specially trained forensic examiners can conduct a comprehensive exam that includes documenting injuries, collecting biological samples, and coordinating treatment.
Older patients sometimes need modifications to the standard exam process. They may be more physically fragile, at higher risk for tissue or skeletal injury, and may need extra time and sensitivity during the assessment. A good examiner will adapt the process to the patient’s comfort level while still collecting the evidence needed for a potential criminal case. Do not bathe the resident or change their clothing before the exam, as this can destroy evidence.
You Can Report to Multiple Agencies at Once
There is no rule that limits you to a single report. In fact, filing with multiple agencies is often the most effective approach. APS investigates the harm to the individual. The ombudsman advocates for the resident’s rights within the facility. The state survey agency evaluates whether the facility is meeting its regulatory obligations. Law enforcement investigates potential crimes. Each agency has a different scope and different enforcement tools, and a report to one does not automatically trigger action by another.
Anyone can file a report: family members, friends, other residents, facility staff, volunteers, or concerned community members. In most states, certain professionals like doctors, nurses, and social workers are mandated reporters who are legally required to report suspected abuse. But you do not need to be a mandated reporter to file. If something feels wrong, report it and let investigators determine what happened.