Nursing home abuse shows up as unexplained injuries, sudden emotional withdrawal, poor hygiene, or missing money and belongings. You report it by calling 911 for immediate danger, then contacting your state’s Adult Protective Services and the Long-Term Care Ombudsman for that facility. The Administration for Community Living (ACL), the federal agency that runs the national Elder Justice program, coordinates these resources and funds the Ombudsman network in every state.
This guide walks through what to watch for, who is required to report it, how to check a facility’s record before or after placement, and exactly who to call.
Call 911 First If There Is Immediate Danger
If a resident is in immediate physical danger, injured, or you believe a crime is happening right now, call 911 before doing anything else. The steps below are for recognizing patterns and reporting concerns that are serious but not an active emergency.
Warning Signs by Type of Abuse
The U.S. Department of Justice’s Elder Justice Initiative groups warning signs into the categories below. No single sign proves abuse, but a pattern, or a caregiver who won’t let you see the resident alone, is a reason to look closer.
Physical Abuse
- Bruises, welts, or lacerations, especially in clusters or in unusual places
- Broken bones, sprains, or untreated injuries in different stages of healing
- Signs of being restrained, such as marks on wrists or ankles
- A sudden, unexplained change in behavior
- A caregiver who refuses to let you see or speak with the resident alone
Emotional and Psychological Abuse
- Being unusually withdrawn, agitated, fearful, or depressed
- Flinching or cringing around a particular staff member or caregiver
- Rocking, sucking, or other unusual repetitive behavior in someone who didn’t do this before
Neglect
- Dehydration, sudden weight loss, or malnutrition
- Poor hygiene, dirty clothing or bedding, or untreated bedsores
- Unsafe or unsanitary living conditions
- Missed medications or untreated medical needs
Financial Exploitation
- Missing cash, jewelry, or personal property
- Sudden changes to a will, power of attorney, or bank accounts
- Unpaid bills despite adequate income, or unusual bank withdrawals
- A new “friend” or caregiver who becomes involved in the resident’s finances
If you’re reviewing a resident’s bills, benefit statements, or account activity for anything unfamiliar, our guide on checking bills, benefits records and health accounts for medical identity theft covers how to spot charges that don’t match the care actually provided. And if someone claiming to be from Social Security or another agency contacts the family about the resident’s benefits, verify it using our guide to confirming a real Social Security call before sharing any information.
Sexual Abuse
- Unexplained bruising around breasts or genitals
- Torn, stained, or bloody underclothing
- Sudden difficulty walking or sitting without another explanation
Who Is Required to Report It?
Federal nursing home regulations require facilities certified for Medicare and Medicaid to report suspected abuse, neglect, or exploitation to the appropriate state agency. Many states also have their own mandatory reporter laws that apply to categories of professionals, such as nursing home staff, doctors, and social workers. Because reporting requirements, timelines, and covered professions vary by state, check your state’s Adult Protective Services or Attorney General page for the specific rule that applies where the facility is located. You do not need to be a mandatory reporter, or have proof, to report a concern yourself.
How to Use Medicare’s Care Compare Tool
Care Compare, at medicare.gov/care-compare, is the federal government’s public tool for researching Medicare- and Medicaid-certified nursing homes. It’s useful both before you choose a facility and while a loved one is already living there.
- Search by location. Enter a city, county, state, or ZIP code to see certified nursing homes in the area.
- Check the Five-Star Quality Rating. This combines health inspection results, staffing levels, and quality measures into one overall score, plus separate scores for each category.
- Review health inspection history. You can see past inspection findings and any deficiencies cited.
- Look at staffing data. Nurse staffing hours per resident are one of the strongest predictors of care quality.
- Compare several facilities side by side. The tool lets you select multiple nursing homes to compare at once.
A low star rating or a recent serious deficiency doesn’t automatically mean abuse is occurring, but it’s a reason to ask the facility direct questions and to visit in person before making a decision.
The State Long-Term Care Ombudsman: What They Do
Every state has a federally funded Long-Term Care Ombudsman Program, overseen by ACL’s Office of Elder Justice and Adult Protective Services. Ombudsmen and their staff and volunteers work to resolve complaints made by or on behalf of residents of nursing homes and other long-term care facilities, including complaints about the quality of care, rights violations, and abuse or neglect. Unlike Adult Protective Services, the Ombudsman Program focuses specifically on residents of licensed long-term care facilities, and services are free and confidential.
To find your state’s Ombudsman program, contact the Eldercare Locator, a national service of the Administration for Community Living, at 1-800-677-1116, or visit eldercare.acl.gov.
Who to Contact, and When
- 911 or local police: Immediate danger, injury, or a crime in progress.
- Adult Protective Services (APS): Suspected abuse, neglect, or financial exploitation of an older or vulnerable adult, whether the person lives in a facility or at home. Find your state’s APS agency through the Eldercare Locator at 1-800-677-1116.
- Your state Long-Term Care Ombudsman: Complaints specific to a nursing home or assisted living facility, including care quality, rights violations, or suspected abuse. Find yours through eldercare.acl.gov.
- The facility’s state licensing or survey agency: Formal complaints that could trigger an inspection or licensing action against the facility.
- The National Center on Elder Abuse (ncea.acl.gov): General information and additional reporting resources if you’re not sure where to start.
You can report to more than one of these at the same time. Reporting even without proof is appropriate; investigators are trained to gather evidence and assess the situation.
Decision Path: What Should I Do Right Now?
- Is the resident in immediate danger or injured right now? Call 911.
- Do you suspect ongoing abuse, neglect, or financial exploitation but there’s no immediate danger? Contact Adult Protective Services and the state Long-Term Care Ombudsman.
- Is your concern about the facility’s overall quality of care, staffing, or a specific incident involving staff? Contact the state Ombudsman and consider a formal complaint with the state survey agency.
- Are you researching a facility before placement? Use Care Compare to review star ratings, inspection history, and staffing, and visit in person.
- Not sure which agency applies? Start with the Eldercare Locator at 1-800-677-1116; they can direct your call.
Documenting What You See
If you notice warning signs during a visit, write down the date, what you observed, and who was present, as soon as you can. Photograph visible injuries or unsafe conditions if it’s safe and appropriate to do so, and keep copies of any bills, care plans, or written communication with the facility. If the family also needs to review the resident’s account activity for a data exposure or unfamiliar login, our guide on responding to a data breach involving your personal information covers the credit-monitoring and reporting steps that apply if a facility or provider notifies you that records were compromised.
Who Should Be Extra Careful
Some residents face higher risk and deserve closer attention from family and friends: people with dementia or other cognitive impairment who may not be able to report abuse themselves, residents with few or no regular visitors, residents who are non-verbal or have limited mobility, and residents who recently changed facilities or caregivers. Family members managing a resident’s finances or acting as power of attorney should also watch for financial exploitation, since perpetrators are often someone the resident already trusts.
Evidence Limits
This article summarizes general guidance from the Administration for Community Living’s Elder Justice program, the Department of Justice’s Elder Justice Initiative, and the Centers for Medicare & Medicaid Services’ Care Compare tool. It does not evaluate any specific facility, cannot diagnose abuse, and is not a substitute for contacting Adult Protective Services, a Long-Term Care Ombudsman, or law enforcement. Mandatory reporting laws and timelines vary by state; confirm the specific rules that apply in your state directly with your state’s Adult Protective Services agency or Attorney General’s office.
Frequently Asked Questions
What is the difference between Adult Protective Services and the Long-Term Care Ombudsman?
Adult Protective Services investigates suspected abuse, neglect, or exploitation of older or vulnerable adults wherever they live. The Long-Term Care Ombudsman Program focuses specifically on residents of nursing homes and other licensed long-term care facilities and works to resolve complaints on their behalf. You can contact both.
Do I need proof before I report suspected nursing home abuse?
No. Report what you observed even if you don’t have documentation. Investigators are trained to gather evidence and assess the situation. Reporting in good faith, even if the concern turns out to be something else, is appropriate.
How do I find a nursing home’s inspection history and staffing levels?
Use Care Compare at medicare.gov/care-compare. Search for the facility by name or location to see its Five-Star Quality Rating, health inspection history, and staffing data.
Can I report suspected abuse anonymously?
Many state Adult Protective Services agencies and Ombudsman programs accept anonymous reports, though policies vary by state. Contact your state’s APS agency or Long-Term Care Ombudsman directly, or start with the Eldercare Locator at 1-800-677-1116, to confirm the options available where the facility is located.
Educational Disclaimer
This article is for general educational purposes only and is not legal, medical, or investigative advice. It does not diagnose abuse or evaluate any specific facility, caregiver, or individual situation. If you believe a resident is in immediate danger, call 911. For suspected abuse, neglect, or exploitation, contact your state’s Adult Protective Services agency or Long-Term Care Ombudsman, or consult a qualified attorney for guidance specific to your situation.
