Rights and problems

Signs of nursing home abuse or neglect, and how to report it

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By Nursing Home Checker · Updated Oct 7, 2026 · How guides are checked

If someone is in immediate danger, call 911.

If you suspect abuse or neglect in a nursing home, you can report it today, and you do not have to prove anything first. The National Institute on Aging puts it this way: "You do not personally need to prove that abuse is occurring; professionals will investigate."

Who do you call?

You can use more than one of these at the same time, and you can also tell the home's administrator. See how to file a complaint about a nursing home for what to write down first.

What signs do federal agencies list?

The National Institute on Aging says you may see signs of abuse or neglect when you visit an older adult at home or in a residential facility. Its list says an older person might be a victim of abuse if they:

• Become withdrawn or act agitated or violent
• Display signs of trauma such as rocking back and forth
• Have unexplained pressure marks, bruises, burns, cuts or scars
• Develop preventable conditions such as bedsores
• Have hazardous, unsafe or unclean living conditions
• Look messy, with unwashed hair, dirty clothes or poor dental hygiene
• Lack personal health care items such as glasses, a walker, dentures or a hearing aid
• Have sudden and unexpected financial losses or unpaid bills despite having adequate financial resources

The U.S. Department of Justice adds to its own list a caregiver's refusal to let visitors see or speak to an older adult alone, an older adult's own report of being mistreated, and showing fear or becoming withdrawn when a specific person is around.

One sign is not proof. The Administration for Community Living notes that "one sign does not necessarily indicate abuse," and the National Institute on Aging says to watch for a pattern and seek help if you are concerned. Deciding what happened is the investigators' job.

What counts as abuse or neglect under federal rules?

• Abuse is the willful infliction of injury, unreasonable confinement, intimidation or punishment that results in physical harm, pain or mental anguish. It includes verbal, sexual, physical and mental abuse. "Willful" means the person acted deliberately, not that the person meant to cause harm.
• Neglect is the failure of the home, its employees or service providers to provide goods and services a resident needs to avoid physical harm, pain, mental anguish or emotional distress.
• Exploitation is taking advantage of a resident for personal gain through manipulation, intimidation, threats or coercion.
• Misappropriation of property is the deliberate misplacement or wrongful use of a resident's belongings or money without the resident's consent.

Residents also have the right to be free from physical or chemical restraints that are used for discipline or convenience and are not required to treat medical symptoms.

What must the nursing home do?

• Report quickly. A home must report an alleged violation to its administrator and to the State Survey Agency immediately, and no later than 2 hours after the allegation is made if it involves abuse or results in serious bodily injury. Otherwise the limit is 24 hours.
• Investigate and protect. It must thoroughly investigate, prevent further potential abuse while the investigation is under way, and report the results within 5 working days.
• Screen staff. It may not employ anyone found guilty by a court of abuse, neglect, exploitation, misappropriation of property or mistreatment, or anyone with such a finding in the state nurse aide registry.
• Report suspected crimes. Federal law and the rules that apply it require the owners, operators, employees, managers, agents and contractors of a home that receives at least $10,000 a year in federal funds to report a reasonable suspicion of a crime to the State Survey Agency and to law enforcement, within 2 hours if there is serious bodily injury and within 24 hours otherwise.

What happens after you report to the state?

The state agency sorts each complaint by how serious it is. The current CMS manual sets these maximum times for starting an on-site visit:

Visits are unannounced. If a state's own time frames are stricter, the state's apply. These are times for starting the visit, not for finishing the investigation.

Can you report anonymously, and will you hear back?

Medicare.gov says you can file a complaint anonymously. Federal rules require the state agency to take appropriate precautions to protect a complainant's anonymity and privacy, if possible. If you give your name and contact details, the CMS manual says the agency gives you a written report of the investigation findings, including whether it found the home out of compliance. Without contact details, the agency has no way to ask you follow-up questions or send you its report.

Can the home retaliate?

Federal rules prohibit it. A resident has the right to voice grievances without discrimination or reprisal, and a home may not prohibit or discourage a resident from communicating with federal, state or local officials. CMS guidance to inspectors says a home "must not establish policies or practices that hamper, compel, treat differently, or retaliate against a resident for exercising his or her rights." Federal law also bars a home from retaliating against an employee who reports.

What does the public record show?

Each home's page on this site shows whether CMS has given it the abuse citation icon. CMS assigns the icon in two cases: the home was cited for abuse where residents were found to be harmed, on its most recent standard inspection or on a complaint or infection-control inspection in the past 12 months; or it was cited for abuse with potential harm in that period and again in the period before. A home with the icon has its health inspection rating capped at two stars.

The icon reflects past citations, and CMS removes it when a home no longer meets the criteria. The home's page also lists its health citations, and the severity letters show how serious each one was.

Who else takes reports?

• Medicaid Fraud Control Units. The HHS Office of Inspector General says these state units investigate and prosecute abuse or neglect of residents in health care facilities. They are usually part of the state attorney general's office.
• HHS Office of Inspector General hotline. 1-800-447-8477. Abuse or neglect in nursing homes is on the list of complaints it investigates. It does not report back on the status of a complaint.
• National Elder Fraud Hotline. 833-372-8311, Monday to Friday, 10 a.m. to 6 p.m. Eastern. This Department of Justice line is for fraud against people 60 or older, not for physical abuse or neglect.

Can you put a camera in the room?

We found no federal nursing home rule about cameras that a resident or family places in a resident's room. Where it is addressed, it is addressed by state law and by the home's policies.