Reporting Abuse and Neglect in Long-Term Care

Takeaways

Call 911 if a long-term care resident is in immediate danger or needs urgent medical attention.
The long-term care ombudsman, Adult Protective Services, state survey agencies, and law enforcement have different roles in responding to suspected abuse and neglect. You do not need conclusive proof before reporting a concern, but specific dates, observations, and records can help.
If a facility does not respond, families can escalate the concern and contact more than one appropriate agency.

Every family that places a loved one in a nursing home, assisted living community, or other long-term care setting does so trusting that their loved one will be safe and treated with dignity. Most of the time, that trust is well placed. But abuse and neglect in long-term care can be difficult to detect, especially when a resident has cognitive decline or communication difficulties, or fears retaliation.

You do not need to determine whether conduct legally qualifies as abuse before asking for help. If something seems wrong, describe what happened, when it happened, and why you believe the resident may be at risk.

What Should Be Reported?

Report concerns that may threaten a resident’s safety, health, dignity, or financial well-being. Common examples include:

Physical abuse. Hitting, rough handling, unnecessary physical restraint, unexplained injuries, or overmedication.
Neglect. Leaving a resident in soiled clothing or bedding, failing to reposition someone at risk of pressure sores, skipping meals or medications, or ignoring calls for help.
Emotional or verbal abuse. Yelling, humiliating, threatening, or deliberately isolating a resident from family, friends, or other residents as a form of control.
Sexual abuse. Any nonconsensual sexual contact or behavior, including with residents who have cognitive impairment and cannot legally consent.
Financial exploitation. Misuse of a resident’s money, bank card, benefits, identity, or legal authority by a caregiver, employee, representative, or other trusted person.
Unsafe conditions or care-related fraud. Repeated staffing failures, medication errors, untreated injuries, dangerous conditions, or billing Medicare or Medicaid for services or equipment that were never provided or were unnecessary.
Resident-to-resident violence. Physical, verbal, or sexual harm caused by another resident when the facility fails to respond appropriately or protect residents.

Who Should You Contact?

The right contact depends on the urgency and nature of the concern. In some situations, more than one report may be appropriate.

911 or Law Enforcement

Call 911 if a resident is in immediate danger, has a serious injury, or needs urgent medical attention. Law enforcement may also be appropriate when the concern involves assault, sexual abuse, theft, or another possible crime. Do not wait for the facility to complete an internal review when the resident may be in immediate danger.

Long-Term Care Ombudsman

Every state has a federally mandated long-term care ombudsman program for residents of nursing homes, assisted living communities, and similar facilities. Ombudsmen advocate for residents and help identify, investigate, and resolve complaints about care quality, resident rights, discharge disputes, and abuse, free of charge. Their role is to represent the resident’s interest and work toward a resolution.

Family members, friends, or facility staff can file a complaint whether or not the resident can do so themselves. A directory of links to each state’s program is available online.

Adult Protective Services (APS)

State and local APS agencies investigate reports of abuse, neglect, self-neglect, and financial exploitation of older adults and adults with disabilities. They can intervene to protect someone at risk in both facility and home settings. Consider contacting APS when:

a resident may be unable to protect themselves;
a caregiver or other trusted person may be exploiting the resident; or
the resident needs protective intervention beyond the facility’s internal process.

State Survey Agency

A state survey agency generally investigates complaints about nursing homes that participate in Medicare or Medicaid. Complaints may involve abuse, neglect, poor care, inadequate staffing, unsafe or unsanitary conditions, and other mistreatment. An online directory of State Survey Agencies provides state-by-state contact information.

These agencies may be appropriate when a facility repeatedly fails to follow a care plan, provide medication or treatments, or respond to complaints.

Eldercare Locator

This service connects callers with their local ombudsman program, Area Agency on Aging, and APS office. Contact the Eldercare Locator online or call or text 1-800-677-1116. This can be a useful starting point when you know something is wrong but do not know which agency should receive the report.

National Elder Fraud Hotline

For suspected financial exploitation and scams targeting an older adult, contact the National Elder Fraud Hotline online at 1-833-372-8311.

What Victims and Families Can Do

If you believe a resident is in immediate danger, call 911 first.

Beyond emergencies, advocates who work with families regularly offer the same practical advice:

keep a record of the resident’s name, facility, room, and primary contacts;
as soon as you have a concern, write down specific dates, times, details, and locations of incidents as well as what the resident said happened and the names and job titles of involved staff or witnesses;
list injuries, behavior changes, worsening personal conditions, or missed medications, meals, treatments, or care-plan services;
hold on to relevant photographs, messages, voicemails, bills, and financial records;
keep copies of care plans, discharge notices, and other paperwork;
talk with your loved one first, if possible, about what outcome they want; and
follow up any phone conversation with a brief written summary.

You do not need proof of wrongdoing to contact an ombudsman or adult protective service. Raising a concern early is itself part of how these systems catch problems.

Do not confront a suspected abuser or notify the facility first if doing so could increase the resident’s risk. In that situation, contact an outside agency or law enforcement for guidance.

Why This Infrastructure Matters

No single hotline or agency can eliminate abuse and neglect in long-term care. But the layered system now in place reflects decades of federal policy created specifically to make sure a resident’s voice does not go unheard simply because they cannot advocate for themselves. For families navigating a difficult situation, knowing these resources exist, and that they are free and available in every state, is often the first step toward getting help.