An assisted living complaint has two homes: the state agency that licensed the facility, and the free, confidential long-term care ombudsman who advocates for residents. If anyone is in danger right now, call 911 before anything else. Once everyone is safe, the way to file a complaint against the facility comes down to knowing which of those two offices does what, and what each one needs from you.,,,

In This Guide

Who Actually Oversees Assisted Living?

The state does. The U.S. Department of Health and Human Services' policy office ASPE puts it plainly: residential care settings "are licensed and regulated at the state level," and although states cover similar areas, "their requirements vary considerably." So the regulator who can inspect the facility and act on a violation is your state's licensing agency, and every state names that agency, and the facility type, a little differently.

The ombudsman, by contrast, is national in shape. The Older Americans Act defines the "long-term care facility" that the ombudsman program serves to include "any other adult care home, including an assisted living facility." The federal Administration for Community Living (ACL) describes state long-term care ombudsman programs as working to resolve problems related to the health, safety, welfare and rights of people living in nursing homes, board and care homes and assisted living facilities.

Why Assisted Living Complaints Work Differently From Nursing Homes

If you have dealt with a nursing home before, you may expect a single federal rulebook and a state inspector who enforces it. That is how nursing homes work. Under 42 CFR part 483, nursing facilities that take Medicare or Medicaid must meet federal participation requirements, and those requirements "serve as the basis for survey activities." The Medicaid and CHIP Payment and Access Commission (MACPAC) adds that certified nursing facilities "must be inspected regularly by state survey agencies."

Assisted living sits outside that system. Its licensure and its definition are set by each state, which is why one state calls it a residential care facility for the elderly, another a residential care facility, and another an assisted living residence.,, There is one federal overlay: since 2014, federal Medicaid rules have set standards for community-based residential care settings that receive Medicaid payment for residents' services. That is a condition of Medicaid payment, not a nationwide licensing standard like the federal nursing home requirements.

What this means for you is practical. The federal nursing home rights and complaint rules described in our guide to nursing home residents' rights are written for nursing homes. For assisted living, your parent's rights and your complaint route come from your state's rules, plus the ombudsman program that federal law requires in every state. If your parent actually lives in a nursing home, our guide on how to report nursing home abuse or neglect covers that route instead.

Which Channel Fits Your Problem

Most problems fit more than one box, and that is fine. You can contact the regulator and the ombudsman at the same time, because they do different things. This table is a starting point for the first call.

Problem First call What that office can do Whose say-so it acts on
Someone is in immediate danger 911 Emergency response Call right away
Suspected abuse, neglect or financial exploitation Adult Protective Services or the state licensing agency, plus the ombudsman APS receives and responds to reports of adult maltreatment; in most states, APS and/or the licensing agency make the official findings APS and the regulator respond to your report; the ombudsman acts on the resident's informed consent
Poor care, missed medications, staffing, rights violations The state licensing agency, with the ombudsman as advocate The regulator investigates the facility; the ombudsman works to resolve the problem the way the resident wants The regulator responds to your complaint; the ombudsman follows the resident's direction
A move-out or discharge notice The ombudsman, then the licensing agency The ombudsman can help the resident understand the notice and seek remedies, including a hearing where the notice gives that right The resident's direction
A problem with the resident's power of attorney or guardian The ombudsman The ombudsman can investigate a complaint about the representative's action and, with consent, refer the resident to legal services The resident's consent
A scam or fraud targeting the resident The U.S. Department of Justice's National Elder Fraud Hotline, plus APS Takes reports of scams and financial fraud against older adults Your report

The roles in that table come from federal sources. ACL says that in most states, "substantiation determinations are made by adult protective services and/or the state's licensing and regulatory agency, not by the Ombudsman program," and that with consent the ombudsman refers matters to the right regulatory, protective or law enforcement agency. Adult Protective Services is run by state and local governments and, in all states, is charged with receiving and responding to reports of adult maltreatment. The ombudsman's power to take complaints about a resident's own representative, and its role in discharge disputes, are set out in ACL's guidance.

How to File an Assisted Living Complaint, Step by Step

Here's how the process usually goes when the problem is serious but nobody is in immediate danger.

1
Step 1

Raise it with the administrator

Pennsylvania's Department of Human Services, for example, tells families worried about the quality of care to talk directly to the facility administrator, and says each personal care home and assisted living residence must listen to concerns and have a system for addressing them. A written complaint gives you a record.

2
Step 2

Write everything down

Note dates, times, what you saw, who you spoke with and what they said. Keep copies of the admission agreement, any notices, and any bills you are disputing. Detail matters: the Ohio Department of Health prefers written complaints because complaints are typically complex and the details are better provided in writing.

3
Step 3

Talk with your parent about what they want

The ombudsman will ask the resident what outcome they want, and will follow that, so it helps to know before you call.

4
Step 4

File with the state licensing agency

Use whichever channel it offers. The state examples below show what this looks like in practice.

5
Step 5

Call the long-term care ombudsman

Anyone can contact the program with a concern, and its services are free and confidential.

6
Step 6

Follow up

Ask each office for a tracking or reference number and how it will contact you. If anything changes for the worse after you complain, report that too.

How to Find Your State's Assisted Living Agency

Because each state licenses assisted living under its own name, the fastest way to the right regulator is often through someone local who already knows it. Three routes work everywhere:

  • Your state's ombudsman program. ACL points families to the state directory run by Consumer Voice, headed "Find the Long-Term Care Ombudsman Program in Your State." The National Institute on Aging also lists 202-332-2275 as a number for finding your state's ombudsman. With the resident's consent, the ombudsman refers complaints on to the regulatory agency.
  • The Eldercare Locator. This free ACL service connects older adults and families to services in their community, including the local Area Agency on Aging. You can reach the Eldercare Locator by calling or texting 1-800-677-1116, Monday through Friday, 8 a.m. to 9 p.m. Eastern Time, or by searching at eldercare.acl.gov.
  • The facility itself. Ask the administrator which state agency issued the facility's license.

Here is what the regulator route looks like in five states, as worked examples. Other states differ, so use your own state's agency.

State Who licenses assisted living How to file a complaint
Texas Texas Health and Human Services Commission (HHSC) HHSC Complaint and Incident Intake: 800-458-9858, Monday to Friday 7 a.m. to 7 p.m., or online or by email
California California Department of Social Services, Community Care Licensing Division (licenses them as Residential Care Facilities for the Elderly) Complaint hotline 1-844-538-8766 (1-844-LET-US-NO)
Georgia Georgia Department of Community Health, Healthcare Facility Regulation Division Complaint forms through GaMap2Care
Ohio Ohio Department of Health, for homes meeting Ohio's residential care facility definition Online complaint form (preferred), or 1-800-342-0553 if you have no internet or email
Pennsylvania Pennsylvania Department of Human Services, Bureau of Human Services Licensing Online complaint form, 1-877-401-8835, or email

The details behind each row:

What the Ombudsman Will and Won't Do

The ombudsman is the resident's advocate, and that shapes everything it does. Under the Older Americans Act, ombudsman programs identify, investigate and resolve complaints made by or on behalf of residents, and represent residents' interests before government agencies. Every state, plus the District of Columbia, Puerto Rico and Guam, has a State Long-Term Care Ombudsman office.

The ombudsman works for your parent, not for you. Consumer Voice explains that when someone other than the resident files a complaint, the program "must determine, to the extent possible, what the resident wants and follow resident direction." If your mother doesn't want the issue pursued, the ombudsman will generally respect that.

The ombudsman keeps identities confidential. Under 42 U.S.C. 3058g(d), the program may not reveal the identity of a complainant or resident unless that person (or their legal representative) consents in writing, gives oral consent that the ombudsman documents in writing, or a court orders it.

The ombudsman will not report suspected abuse without consent. The federal rule at 45 CFR 1324.19 says the ombudsman "shall not report suspected abuse, neglect or exploitation of a resident when a resident or resident representative has not communicated informed consent to such report," apart from narrow exceptions. Under 45 CFR 1324.19, the ombudsman may report suspected abuse without consent only when the resident cannot communicate informed consent and either has no representative or the representative's own actions may be harming them, with further conditions on top. When the resident does want regulatory or law enforcement action and consents, the ombudsman must help them reach the right agency.

The ombudsman is not the official finder of fact. ACL says an ombudsman investigates to resolve the complaint to the resident's satisfaction, not to officially decide whether a law or regulation was broken or to take enforcement action. In most states, that is the licensing agency's job, or APS's.

Legal help is a separate question. ACL notes that neither the Older Americans Act nor the federal rule requires the program to provide legal services, but the federal rule does require ombudsmen to help residents seek administrative, legal and other remedies.

If You Suspect Abuse, Neglect or Exploitation

If your parent is in immediate danger, call 911. The National Institute on Aging gives that same advice first.

When the danger is not immediate, report it. Adult Protective Services takes reports in every state, and because it is run by state and local governments, your report goes to the program serving the state where your parent lives. The National Adult Protective Services Association lists phone numbers for each state's program and can be reached at 202-370-6292. You can also report to the state licensing agency, as the Texas and Ohio examples above show, and call the ombudsman, who will act on your parent's wishes.,

For scams and financial fraud aimed at an older adult, the National Elder Fraud Hotline run by the U.S. Department of Justice is 833-372-8311, staffed 10 a.m. to 6 p.m. Eastern Time, Monday through Friday.

Our guide on how to recognize and report elder abuse covers the warning signs and the full reporting process in more depth.

What Happens After You Complain

Each office follows its own process, and timelines are set by states, not by one national clock.

At the ombudsman. Federal law requires that residents and complainants "receive timely responses" to complaints, and leaves the actual response standards to each state's ombudsman policies. Those state standards must give priority to complaints about abuse, neglect and exploitation and to time-sensitive complaints, weighing how severe and how imminent the risk to the resident is.

At the licensing agency. Each state sets its own process. A few examples:

  • Pennsylvania's Department of Human Services assesses each complaint for its health and safety risk to residents, and sets investigation time frames from the allegations together with the facility's licensing history, past complaints and compliance record.
  • In Ohio, complaint investigations are unannounced, and a complainant who leaves contact details gets an acknowledgement with a tracking number, then a letter with the outcome.,
  • Texas law requires HHSC to inspect each assisted living facility at least every two years, and HHSC's consumer guidance says it inspects licensed facilities once a year and also looks into complaints made about them.

At the facility. Some states put deadlines on the facility itself. Pennsylvania's assisted living rules require a residence to give the complainant a status report within 2 business days of a written complaint, and a written decision explaining its findings and planned action within 7 days. Those are the residence's own response duties, not the state agency's investigation deadline.

When you file, ask each office what its timeline is and how it will keep you informed.

Retaliation and Eviction Threats

If you're worried about retaliation, it helps to know exactly what the law covers.

Federal law protects complaints made to the ombudsman. The Older Americans Act requires each state to "prohibit retaliation and reprisals by a long-term care facility or other entity with respect to any resident, employee, or other person for filing a complaint with, providing information to, or otherwise cooperating with" the ombudsman's office, and to provide for appropriate sanctions. The federal rule at 45 CFR 1324.15(i) requires states to have ways to investigate those allegations. The sanctions themselves are set by the state.

That federal duty is tied to the ombudsman. It is not a general federal ban covering every complaint to every agency. Whether a complaint made only to the licensing agency is protected depends on your state's rules; Pennsylvania's, below, and the three states in the next section are examples. Ask the agency when you file.

Pennsylvania shows what a strong state rule looks like. Its assisted living regulations require residences to tell residents, on admission, of their right to lodge complaints "without intimidation, retaliation or threats of retaliation," and they spell out that "retaliation includes transfer or discharge from the residence." Residences must also post the phone numbers of the licensing office, the local ombudsman and other agencies in large print in a public place.

If a move-out notice appears after a complaint, don't wait. Contact the ombudsman, since cooperating with the ombudsman is itself protected. ACL's example is a resident who receives an involuntary discharge notice with a right to an administrative hearing: the ombudsman can make sure the resident understands the notice and how to request a hearing, refer them to a non-profit legal services program, and speak for the resident at the hearing. Also check your state's notice rules. Georgia's personal care home rules, for example, require 30 days' written notice of a discharge or transfer unless an immediate transfer is required, given to both the resident and their representative.

Complaints in Board-and-Care and Adult Family Homes

Your parent may live in a smaller residential home that the state licenses under its own name, such as a board and care home, a residential care facility for the elderly or an adult family home. The ombudsman program covers board and care homes as well as assisted living, so the federal duty on each state to prohibit retaliation against anyone who complains to, or cooperates with, the ombudsman reaches these homes too.,

Everything else is state law. These three states' rules are their own, so don't assume your parent's state matches.

  • California (residential care facilities for the elderly). Anyone can complain about an RCFE to the Department of Social Services, orally or in writing. Unless the complainant asks otherwise, nothing given to the facility may name anyone mentioned in the complaint, other than department staff. For most complaints, it must inspect within 10 days unless it finds the complaint meant to harass or without any reasonable basis, or a visit would hurt its own or another agency's investigation, such as law enforcement's. It must tell the complainant in writing what it found within 10 business days of finishing. State law bars the licensee and its staff from retaliating in any way, including eviction or threat of eviction, against a resident or employee because anyone complained to the department or to the local or state ombudsman.
  • Washington (adult family homes). Residents have the right to voice grievances and get prompt efforts to resolve them, free of interference, coercion, discrimination and reprisal for exercising their rights. The Department of Social and Health Services must make unannounced inspections and complaint investigations, and may fine a home up to three thousand dollars for retaliating against a resident, employee or anyone else who complains to, gives information to or cooperates with the ombuds, the department, the attorney general's office or law enforcement.
  • Oregon (adult foster homes). Anyone, resident or not, may complain to the licensing agency, which must investigate, and every home must post the agency's phone number and how to complain. The owner or operator may not discourage or intimidate anyone to stop a complaint. Once a resident, or someone acting for them, complains, the home may not retaliate by raising charges, cutting services, rights or privileges, threatening either, taking or threatening action to force the resident out, or abusing or threatening to harass or abuse them. It also may not retaliate against the person who complained or a witness or employee interviewed. A person who complains in good faith is immune from civil or criminal liability for it.

Elsewhere, ask the licensing agency and the ombudsman which rules cover that type of home.

Frequently Asked Questions

Can I complain anonymously, or will the facility find out it was me?

Some agencies let you stay anonymous, but it can limit what they can do for you. Ohio's Department of Health lets complainants stay anonymous, and warns that it then cannot contact you for more information or tell you the result of its investigation. The facility won't learn your name from the ombudsman, which federal law bars from revealing your identity or your parent's without consent or a court order. How a licensing agency handles your name depends on your state, so ask when you file.

What if the problem is my parent's power of attorney or guardian?

The ombudsman can still help. ACL says the program's authority "is not limited to residents without guardians or other representatives," and that it can investigate a complaint about a representative's action that harms the resident. With the resident's consent, for example, it could refer a resident who wants a power of attorney revoked to a non-profit legal services program.

How do I check whether the facility is licensed?

Check before you rely on the regulator route. The National Consumer Voice for Quality Long-Term Care advises families choosing assisted living that "when a facility is licensed, you have more protections and a place to turn if you wish to file a complaint." Ask the administrator which state agency issued the license, then confirm it with that agency. Some states put the lookup online. In Texas, the HHSC Long-Term Care Provider Search lists licensed facilities. In Georgia, GaMap2Care includes license verification. Our guide on how to choose an assisted living facility covers checking the license and inspection reports before move-in.

Learn More

Care TypesThe Long-Term Care Ombudsman: A Free Advocate for Nursing Home and Assisted Living ResidentsEvery state has a free, confidential long-term care ombudsman for nursing home and assisted living residents. What they do, whose side they're on, how to call. CaregiverHow to Recognize and Report Elder AbuseWorried an older adult is being hurt or exploited? How to recognize elder abuse and who to call for each situation, from 911 to Adult Protective Services. CaregiverHow to Report Nursing Home Abuse or NeglectHow to report nursing home abuse or neglect: call 911 for immediate danger, then the Long-Term Care Ombudsman and your State Survey Agency. Signs and steps. Care TypesHow to Choose an Assisted Living Facility: A Step-by-Step GuideHow to choose an assisted living facility: check the state license and inspection record, tour twice, and read the contract and fees before you sign. Care TypesAssisted Living by State: Costs, Rules and Medicaid CoverageWhat assisted living costs, how licensing and Medicaid coverage differ from state to state, plus a guide to all 50 states so you can jump straight to yours. Care TypesNursing Home Residents' Rights: What Federal Law GuaranteesMedicare and Medicaid nursing homes owe residents federal rights: dignity, visitors, records in 24 hours, no abuse or convenience restraints. How to use them.

Find personalized help sorting out a complaint about your parent's assisted living facility at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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