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 nursing homes that participate in Medicare or Medicaid by inspecting them and investigating complaints to make sure health and safety standards are met. Alongside it, the Long-Term Care Ombudsman program works to resolve problems related to the health, safety, welfare, and rights of the people who live in these facilities. 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

You will usually notice something is wrong before anyone tells you. The federal government's list of elder-abuse red flags applies squarely inside a facility, and the ones worth watching for include:

  • Unexplained bruises, black eyes, welts, cuts, burns, pressure marks, or rope marks.
  • A sudden change in behavior, or a resident who becomes withdrawn, agitated, or fearful.
  • A staff member or caregiver who controls or isolates the resident, or who will not leave you alone together.
  • Sudden changes in bank accounts, unexplained withdrawals, or abrupt changes to a will or other financial documents.

Neglect shows up in the everyday details: a resident who is not being kept clean, who has lost weight, whose call light goes unanswered, or who is left in an unsafe or unsanitary room. No single sign proves abuse, and each can have an innocent explanation, but a cluster of them, or one that no one can explain, is reason to look harder and to call. 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 or needs emergency medical care, 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 runs a Long-Term Care Ombudsman program, and its representatives are advocates for residents whose job is to resolve residents' problems and complaints and to help families understand residents' rights and get quality care. The Ombudsman is free and works for the resident, not the facility. You can reach your local program through the Eldercare Locator at 1-800-677-1116.
  3. File a complaint with your State Survey Agency. This is the state agency, usually part of the state health department, that inspects facilities and investigates complaints, including abuse of a patient. Filing here triggers an official investigation of the facility. If you do not know how to reach your state's agency, call 1-800-MEDICARE (1-800-633-4227) and ask for the contact information for your State Survey Agency.
  4. Consider Adult Protective Services for the individual. Adult Protective Services is the state and local program that receives and responds to reports of abuse, neglect, and financial exploitation of older adults, and every state runs one. The Ombudsman and the State Survey Agency focus on the resident and the facility; Adult Protective Services can be another route for concern about the individual, and it is reachable through the same Eldercare Locator line, 1-800-677-1116.,
  5. For money taken or a scam, use the fraud hotline. If the abuse involved theft or financial exploitation, the U.S. Department of Justice runs a National Elder Fraud Hotline at 833-372-8311.

You do not need to prove that abuse happened before you report. A reasonable suspicion is enough, and confirming what occurred is the agency's job, not yours. 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 works to resolve the problem you raised, advocating for the resident and helping settle complaints between the family and the facility. The State Survey Agency investigates the complaint against the facility itself, because looking into quality-of-care concerns is exactly what it exists to do.

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 the limited reasons the rules allow. The facility must give the resident and their representative written notice of the transfer or discharge and its reasons, send a copy to the State Long-Term Care Ombudsman, and, except in specified urgent situations, give that notice at least 30 days before the move. 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 or needs emergency care, call 911. Otherwise, call your Long-Term Care Ombudsman, the free advocate for nursing home residents, reachable through the Eldercare Locator at 1-800-677-1116,, 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 advocate who works for the resident and tries to resolve their problems and complaints directly. The State Survey Agency is the state office, usually part of the health department, that inspects facilities and investigates complaints to enforce health and safety standards. Many families contact both: the Ombudsman to help their loved one now, and the State Survey Agency to trigger an official investigation of the facility.

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. A reasonable suspicion is enough. Investigating whether abuse or neglect actually happened is the agency's role, not the reporter's, so you do not need to gather evidence or be certain before you call.

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 limited reasons, must give written notice with the reasons and send a copy to the State Long-Term Care Ombudsman, and, except in urgent situations, must give that notice at least 30 days in advance. 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 DoElder financial exploitation is the misuse of an older adult's money, often by someone trusted. The warning signs, who does it, and the steps to take now. CaregiverArea Agencies on Aging: How to Find and Use YoursAn Area Agency on Aging is your state-designated local front door to help for an aging parent. What yours does, who it serves, and how to find it today.

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.

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Brevy Care Team

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