When someone you love is being harmed or neglected in a nursing home, the people to call are not the ones you would use for a parent living at home. Inside a licensed facility, two authorities exist specifically to protect residents: the Long-Term Care Ombudsman, a free advocate for people who live in nursing homes, and the State Survey Agency, the state office that inspects facilities and investigates complaints. If someone is in immediate danger, though, the first call is still 911. Knowing how to report nursing home abuse or neglect is mostly a matter of which of these you reach, and in what order.

In This Guide

What Counts as Nursing Home Abuse or Neglect

Abuse in a nursing home is the same set of harms recognized everywhere else, physical, emotional, sexual, and financial, but here it happens to someone in the care of a licensed facility and its staff. Neglect is its quieter form: the failure to provide the care, supervision, food, hygiene, or medical attention a resident needs and is owed. Both are reportable, and you do not have to decide which label fits before you call.

What makes the facility setting distinct is that the people responsible for a resident's safety are also the people being paid to provide care, and an entire oversight system exists to hold them to a standard. The State Survey Agency, usually part of the state health department, oversees health care facilities, including nursing homes, that participate in Medicare and/or Medicaid, for example by inspecting facilities and investigating complaints to ensure that health and safety standards are met. Alongside it, the Long-Term Care Ombudsman program identifies, investigates and resolves complaints made by or on behalf of residents and represents their interests before governmental agencies. Those two roles are why reporting abuse inside a facility looks different from reporting it for an older adult living at home.

Signs of Nursing Home Abuse or Neglect

The U.S. Department of Justice and the National Institute on Aging list warning signs of elder abuse, neglect, and financial exploitation. The ones to watch for include:

  • Bruises, black eyes, welts, lacerations, or rope marks; bone fractures; unexplained pressure marks, burns, cuts, or scars; broken eyeglasses or other signs of being restrained.
  • A sudden change in behavior, or a resident who becomes withdrawn or acts agitated or violent.
  • A caregiver controlling or isolating the resident, or refusing to allow visitors to see or speak to the resident alone.
  • Sudden changes in bank accounts, including an unexplained withdrawal of large sums of money by a person accompanying the resident; unauthorized ATM withdrawals; abrupt changes in a will or other financial documents; or bills left unpaid despite adequate financial resources.
  • The resident's own report of being hit, slapped, kicked, or mistreated, verbally or emotionally mistreated, neglected or abandoned, financially exploited, or sexually assaulted. DOJ lists this as a warning sign in its own right.

Watch for a pattern that might suggest a problem, and seek help if you are concerned. You do not personally need to prove that abuse is occurring, because professionals will investigate. If you want a fuller walkthrough of the warning signs and the general reporting system, see our guide to recognizing and reporting elder abuse.

How to Report Nursing Home Abuse: Who to Call

For a resident of a nursing home or other long-term care facility, there is a short, specific order to work through.

  1. If there is immediate danger, call 911. If the resident is in immediate danger, that call comes before every other step. For anything less urgent, you have time to take the steps below.
  2. Call the Long-Term Care Ombudsman. Every state has a Long-Term Care Ombudsman program, the federally mandated advocate for nursing home residents. It identifies, investigates and resolves complaints made by or on behalf of residents and represents their interests before governmental agencies, which can include standing up for their residents' rights. Its services are free and confidential. Its mandate is to represent the resident and act on the resident's direction, so when a family member files a complaint, the program must find out, as far as possible, what the resident wants and follow that. NIH lists 202-332-2275 as a number for finding your state's ombudsman.
  3. File a complaint with your State Survey Agency. This is a state agency, usually part of the state health department, that inspects health care facilities and investigates complaints. Medicare sends complaints about nursing home care, such as abuse of a resident, not enough staff, or unsafe or unsanitary conditions, to this agency, and you can file with it directly. You can file anonymously. If you do not know how to reach your state's agency, call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) and ask for the contact information for your State Survey Agency.
  4. Consider Adult Protective Services for the individual. Adult Protective Services is a social services program run by state and local governments for older adults and adults with disabilities who need help because of abuse, neglect, self-neglect, or financial exploitation. In all states, it is charged with receiving and responding to reports of adult maltreatment. Because it is run at the state and local level, a report goes to the program in the resident's state; the National Adult Protective Services Association lists phone numbers for each state's program and can be reached at 202-370-6292.,
  5. For a scam or financial fraud, use the fraud hotline. For scams and financial fraud targeting older adults, the U.S. Department of Justice runs the National Elder Fraud Hotline at 833-372-8311, staffed 10 a.m. to 6 p.m. Eastern Time, Monday through Friday.

You do not personally need to prove that abuse is occurring before you report; professionals will investigate., Reporting a worry that turns out to be nothing is far better than staying silent about one that turns out to be real.

What Happens After You Report Nursing Home Abuse

The two facility-specific offices do different things with your report. The Long-Term Care Ombudsman investigates and works to resolve the complaint on the resident's behalf. Because it acts on the resident's direction, when a family member raises the complaint, it must find out, as far as possible, what the resident wants and follow that. The State Survey Agency investigates the complaint against the facility itself, as part of its job of making sure facilities that take Medicare and Medicaid meet health and safety standards.

Keep your own record while this unfolds. Note dates, what you saw, who you spoke to, and what they said, and hold on to any photos or documents. It is what every one of these offices will ask about, and it keeps a timeline straight when more than one is involved.

Your Loved One's Rights as a Resident

Families sometimes hold back a complaint out of fear the facility will retaliate by discharging their loved one. Federal rules make that hard to do. A facility must let a resident stay and may transfer or discharge them only for six reasons: the move is necessary for the resident's welfare and their needs cannot be met there; their health has improved enough that they no longer need the facility's services; the safety of others in the facility is endangered by the resident's clinical or behavioral status; the health of others in the facility would otherwise be endangered; the resident has failed, after reasonable and appropriate notice, to pay (which the rules limit to cases such as not submitting the paperwork for third-party payment, or refusing to pay after Medicare or Medicaid denies the claim); or the facility stops operating. The facility must give the resident and their representative written notice of the transfer or discharge and its reasons, in a language and manner they understand, and send a copy to the State Long-Term Care Ombudsman. Except when the facility closes or in specified urgent situations, that notice must come at least 30 days before the move. The notice must also explain the resident's appeal rights and give the Ombudsman's contact information. If the resident appeals, the facility may not transfer or discharge them while the appeal is pending, unless failing to would endanger the health or safety of the resident or others in the facility, and the facility must document that danger. The requirement that a copy go to the Ombudsman is itself a safeguard: it puts the resident's own advocate on notice that a discharge is being attempted. If a facility threatens or moves to discharge a resident after a complaint, that is a reason to call the Ombudsman right away.

Frequently Asked Questions

Who do I call to report abuse in a nursing home?

Start with immediate danger: if the resident is in immediate danger, call 911. Otherwise, call your Long-Term Care Ombudsman, the free advocate for nursing home residents (NIH lists 202-332-2275 for finding your state's ombudsman),, and file a complaint with your State Survey Agency, which investigates facilities and can be reached by calling 1-800-MEDICARE (1-800-633-4227) for its contact information.

What is the difference between the Ombudsman and the State Survey Agency?

The Long-Term Care Ombudsman is a free, confidential advocate whose mandate is to represent the resident; it identifies, investigates and resolves complaints made by or on behalf of residents. The State Survey Agency is a state agency, usually part of the health department, that inspects facilities and investigates complaints to ensure health and safety standards are met. Many families contact both: the Ombudsman to help their loved one now, and the State Survey Agency to have the facility investigated.

Is reporting nursing home abuse the same as reporting elder abuse at home?

Not quite. For an older adult living in the community, Adult Protective Services is usually the front door. Inside a licensed facility, two authorities exist specifically for residents, the Long-Term Care Ombudsman and the State Survey Agency, and they are the more direct route., Our guide to recognizing and reporting elder abuse covers the community pathway in full.

Do I need proof before I report?

No. You do not personally need to prove that abuse is occurring; professionals will investigate. If you are concerned, seek help and report what you see.,

Can the nursing home discharge my parent for complaining?

Federal rules make retaliatory discharge difficult. A facility must let a resident stay and may transfer or discharge them only for six listed reasons. It must give written notice with the reasons and a statement of appeal rights, send a copy to the State Long-Term Care Ombudsman, and, except when the facility closes or in specified urgent situations, give that notice at least 30 days in advance. While an appeal is pending, the facility may not transfer or discharge the resident unless failing to would endanger the health or safety of the resident or others. If a discharge is threatened after you complain, call the Ombudsman immediately.

Learn More

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. CaregiverElder Financial Exploitation: How to Spot It and What to DoWorried someone is taking a parent's money? The warning signs of elder financial exploitation, who to call first, and why you don't need proof to report. CaregiverArea Agencies on Aging: How to Find and Use YoursYour parent's Area Agency on Aging may not go by that name. How to find it by address, what it can do, and why there's no income test to get help.

Find personalized help protecting a loved one in a nursing home 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.

Still have questions?

Brevy answers from this guide and every other guide here, and can check what you qualify for.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.