Choosing a Facility
Nursing Home Abuse and Neglect: Warning Signs and How to Report
What Are the Warning Signs of Nursing Home Abuse, and How Do You Report It?
Nursing home abuse includes physical, sexual and emotional abuse, neglect and financial exploitation, and the warning signs range from unexplained bruises and bedsores to sudden changes in mood or money. If your parent is in immediate danger, call 911. Then report it to your state survey agency, Adult Protective Services or the Long-Term Care Ombudsman; your state page lists the numbers.
Nursing home abuse is any harm a resident suffers on purpose or through neglect: being hit or handled roughly, threatened or humiliated, sexually assaulted, left without food, water or care, or having money and belongings taken. If you think your parent is in danger right now, call 911. If not, report what you’ve seen to your state survey agency, Adult Protective Services or the Long-Term Care Ombudsman. You don’t need proof first. Investigating is their job.
This guide covers what counts as abuse under federal rules, the signs to watch for on each visit, exactly who to call, what the nursing home has to do once a report is made, and how to check a home’s abuse record before your parent moves in.
What Counts as Nursing Home Abuse
Every nursing home certified by Medicare or Medicaid must follow federal rules, and the rule on abuse is blunt. Under 42 CFR 483.12, each resident has the right to be free from abuse, neglect, misappropriation of property and exploitation. That includes freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint used for discipline or staff convenience rather than to treat a medical symptom.
Medicare defines abuse as the willful infliction of injury, unreasonable confinement, intimidation or punishment that causes physical harm, pain or mental anguish. It includes verbal, sexual, physical and mental abuse.
The CDC groups abuse of older adults into five types:
- Physical abuse: injury, pain or impairment from intentional force.
- Sexual abuse: any forced or unwanted sexual contact.
- Emotional or psychological abuse: words or actions that cause fear, anguish or distress.
- Neglect: failing to meet basic needs such as food, water, hygiene, clothing and medical care.
- Financial abuse: using an older adult’s money, benefits or property for someone else’s benefit.
Abuse can come from staff, visitors or other residents. The federal rule protects residents from abuse “by anybody,” and the home is responsible for protecting your parent whoever the source is.
Warning Signs of Nursing Home Abuse and Neglect
No single sign proves abuse. Older skin bruises easily, and some health conditions cause weight loss or confusion. What matters is a pattern, an explanation that doesn’t fit, or a change you can’t account for. The Justice Department’s Elder Justice Initiative lists these red flags.
| Type | Signs to watch for |
|---|---|
| Physical abuse | Bruises, black eyes, welts or cuts; broken bones; untreated injuries in different stages of healing; your parent saying they were hit, slapped or kicked |
| Emotional abuse | Agitation or fearfulness; becoming withdrawn or unresponsive; rocking or other unusual behavior; personality changes such as apologizing over and over |
| Neglect | Dehydration, malnutrition or weight loss; untreated bedsores; poor hygiene, soiled clothing or bedding; unsafe or dirty conditions |
| Sexual abuse | Bruises around the breasts or genitals; unexplained genital infections or bleeding; fear or withdrawal around certain people |
| Financial exploitation | Sudden changes in bank accounts; large unexplained withdrawals; changes to a will or other documents; forged signatures; missing belongings |
A few patterns are worth extra attention in a nursing home setting:
- Staff answers that change. If you get different stories about how an injury happened, write each one down.
- Your parent goes quiet around one person. Fear or silence that shows up only with a certain aide or resident deserves a question.
- Sudden drowsiness. A parent who becomes much sleepier or less alert after a medicine change may be getting a drug that affects behavior. Ask what was prescribed and why.
- Calls go unanswered. Call lights left on, meals left out of reach and repeated toileting accidents can point to neglect or short staffing. The nursing home staffing guide shows how to check a home’s nurse hours.
If your parent lives with dementia and can’t describe what happened, your observations carry more weight. Visit at different times of day, including evenings and weekends, and keep dated notes and photos of injuries.
What to Do if You Suspect Abuse: Call 911, Then Report
You can take these steps in this order. Skip straight to the first one if anyone is at risk right now.
- Call 911 if your parent is in immediate danger or a crime may have happened. Medicare says to call 911 or your local emergency number right away in an emergency, including a suspected crime.
- Make sure your parent is safe and seen. Ask for a nurse or doctor to examine any injury, and ask that it be documented.
- Write down what you saw. Note the date, time, who was involved, what was said and any photos you took.
- Report to the state survey agency. This is the state office that inspects nursing homes for Medicare and Medicaid. Medicare’s guidance is to contact it if you think someone has been abused. It investigates complaints and can cite the home. CMS publishes a contact list of every state survey agency.
- Call the Long-Term Care Ombudsman. The ombudsman is a free advocate for residents who can visit, help your parent speak up and push the home to fix the problem. The residents’ rights and ombudsman guide explains how they work.
- Contact Adult Protective Services if it applies. APS is run by state and local governments and serves older adults and adults with disabilities who need help because of abuse, neglect, self-neglect or financial exploitation. In some states APS also handles reports from nursing homes. The Eldercare Locator, 1-800-677-1116, can connect you to APS where you live.
- Tell the home in writing. File a grievance with the administrator. Each nursing home must have a Grievance Official and must answer in writing with what it investigated, what it concluded and what it changed.
You can report to more than one agency. Reporting to the home alone isn’t enough when you suspect abuse, because the state agency investigates independently.
Who to Call in Your State
Each state runs its own complaint line and ombudsman program. Here are six of the largest; your state page lists the numbers for every state.
| State | Nursing home complaint line | Long-Term Care Ombudsman |
|---|---|---|
| Texas | 800-458-9858 (HHS complaint and incident intake) | 800-252-2412 |
| Florida | 1-888-419-3456 (AHCA) | 1-888-831-0404 |
| New York | 1-888-201-4563 (Department of Health) | 1-855-582-6769 |
| Ohio | 1-800-342-0553 (Department of Health) | 1-800-282-1206 |
| Illinois | 800-252-4343 (Department of Public Health) | 1-800-252-8966 (Senior HelpLine) |
| Pennsylvania | 1-800-254-5164 (Department of Health) | 717-783-8975 |
California takes nursing home complaints online through the Department of Public Health’s complaint page, and its ombudsman line is 1-800-231-4024. In every state, the complaint line goes to the agency that inspects nursing homes, and the ombudsman line goes to the resident advocate.
Abuse Citation Flag: Nursing Homes by State
CMS Care Compare lists 1,426 nursing homes in this group (abuse citation flag) across 49 states and territories, data from August 2026. Pick a state for its nursing homes, cities and senior care rules.
What the Nursing Home Must Do After a Report
Federal rules set firm deadlines once anyone raises an allegation of abuse, neglect, exploitation or mistreatment, including an injury nobody can explain.
- Report within 2 hours to the administrator and to state officials, including the state survey agency and APS where state law gives APS a role in nursing homes, when the allegation involves abuse or serious bodily injury. Other allegations must be reported within 24 hours.
- Protect residents during the investigation. The home must prevent further potential abuse while it investigates.
- Investigate thoroughly and keep evidence that it did.
- Report the results to the state survey agency within 5 working days, and take corrective action if the allegation is verified.
- Report crimes. Staff must report any reasonable suspicion of a crime against a resident to the state agency and local law enforcement, within 2 hours when there is serious bodily injury.
The home also may not hire anyone found guilty of abuse, neglect or exploitation by a court, anyone with such a finding on the state nurse aide registry, or anyone whose professional license is disciplined for it.
Medicare also says residents have the right to complain without fear of discrimination or punishment. If you see retaliation after a report, tell the ombudsman and the state survey agency.
If the state survey agency doesn’t address your complaint, Medicare says to contact your Medicare Regional Office.
How to Spot Homes With Abuse Citations on Care Compare
Medicare’s Care Compare marks nursing homes with an abuse icon so families can see recent abuse findings before choosing. CMS gives the icon to a home that meets either test:
- Harm-level abuse: inspectors cited abuse that harmed a resident (scope and severity level G or higher) on the most recent standard inspection, or on a complaint or infection control inspection in the past 12 months.
- Repeat abuse: inspectors cited abuse with potential for harm (level D or higher) in the most recent period and again in the period before it, which reaches back to between 13 and 24 months ago.
CMS counts a citation as abuse when it falls under the federal tags for protecting residents from abuse and neglect, from wrongful use of their belongings or money, and from involuntary separation or confinement.
A home with the icon has its health inspection rating capped at two stars, so its best possible overall rating is four stars. CMS removes the icon at the first monthly website refresh after the home no longer meets the criteria.
The national picture: CMS data from August 2026 shows 1,426 of 14,690 nursing homes with the abuse icon, and 525 in the Special Focus program for homes with a history of serious quality problems. That leaves 12,971 homes with neither flag. The table below this guide breaks the abuse icon down by state.
The icon tells you a citation happened, not what it was. Open the home’s inspection report to read what inspectors found, how many residents were affected and what the home promised to fix. The inspection reports guide walks through how to read one, and the star ratings guide explains how the abuse cap affects a home’s stars.
To check homes near you, search the nursing home finder or put up to three homes side by side in the nursing home comparison tool. City pages such as Houston and Chicago list every home with its flags.
Financial Exploitation in Nursing Homes
Money abuse is easy to miss because it happens out of sight. Watch for large or unexplained withdrawals, new names on accounts, changed beneficiaries or a new power of attorney you didn’t know about, missing jewelry or cash, and bills that suddenly go unpaid.
A nursing home also can’t make you, as a family member, personally pay your parent’s bill. Medicare’s guide says the home may only ask family with legal access to use your parent’s own money to pay.
If you suspect staff have taken money or property, report it to the state survey agency and the ombudsman, who helps with financial problems involving the nursing home. For scams and fraud, call the Justice Department’s National Elder Fraud Hotline at 1-833-372-8311, 10 a.m. to 6 p.m. Eastern, Monday to Friday.
Setting up a durable power of attorney while your parent can still choose who to trust is one of the best protections. The legal and financial planning guide covers how.
Protecting Your Parent Day to Day
Families who visit often and ask questions are the strongest safeguard a resident has.
- Visit at different times. Residents have the right to visitors at any time, within reasonable clinical and safety limits.
- Go to care plan meetings. You and your parent can take part in care planning and ask for specific care. Ask about any new medicine, especially one that affects mood or behavior.
- Get to know the staff by name. Learn who the charge nurse, social worker and director of nursing are.
- Join or start a family council. Only 1,811 nursing homes reported a family council in the August 2026 CMS data, but councils give families a direct line to the administrator.
- Look after yourself too. Watching for problems at a distance is exhausting. The caregiver support programs guide lists free help, and 988 (call or text) offers 24/7 emotional support.
Who Pays if Your Parent Needs to Move
Sometimes the right answer is a different nursing home. Moving doesn’t change who pays:
- Medicare covers short skilled nursing stays after a qualifying hospital stay, not long-term custodial care. See does Medicare cover nursing homes.
- Medicaid pays for long-term nursing home care for people who meet their state’s income and asset rules, at any Medicaid-certified home. See Medicaid nursing home eligibility or check the rules with the Medicaid long-term care checker.
- VA benefits, long-term care insurance and private savings cover the rest. The paying for nursing home care guide compares each.
Before your parent moves, use the how to choose a nursing home checklist and read the new home’s last three years of inspections.
Frequently Asked Questions
Can My Parent Get in Trouble for Complaining About Staff?
No. Medicare's guide to living in a nursing home says residents have the right to complain without fear of discrimination or punishment, about the care they got or didn't get, about staff or other residents, or anything else about their stay. They can contact the Long-Term Care Ombudsman at any time.
Is It Abuse to Sedate a Resident to Keep Them Quiet?
Federal rules give every resident the right to be free from any physical or chemical restraint imposed for discipline or convenience and not required to treat medical symptoms. If you think a medicine is being used to manage behavior rather than treat a condition, raise it at the care plan meeting and with the ombudsman. The antipsychotics guide explains what CMS tracks.
Can a Nursing Home Hire Someone With an Abuse Record?
Not under federal rules. A certified nursing home may not employ anyone found guilty of abuse, neglect, exploitation or mistreatment by a court, anyone with such a finding on the state nurse aide registry, or anyone whose license is under a disciplinary action for those reasons.
Does the Abuse Icon Mean the Home Is Unsafe Right Now?
It means CMS found an abuse citation that meets its criteria in the recent inspection window: harm to a resident, or repeat citations for potential harm. CMS removes the icon at the first monthly refresh after a home no longer meets the criteria. Read the inspection report to see what happened and what the home changed.
What if the State Doesn't Resolve My Complaint?
Medicare says to contact your Medicare Regional Office if a complaint isn't addressed after working with the State Survey Agency. The regional offices work with state survey agencies, residents and providers to address concerns.
Who Do I Call if Money Is Missing From My Parent's Account?
Report theft by staff to the state survey agency and the ombudsman, who helps with financial problems involving the nursing home. For fraud or scams, the Justice Department's National Elder Fraud Hotline is 1-833-372-8311, 10 a.m. to 6 p.m. Eastern, Monday to Friday. Call 911 if a crime is happening now.
More on Choosing a Facility
- Choosing a Nursing HomeRatings, inspections, staffing and the questions to ask on a visit
- Star Ratings ExplainedWhat each Care Compare star rating measures and its limits
- Inspection ReportsDeficiencies, scope and severity, fines and where to find reports
- Staffing and TurnoverNurse staffing hours, turnover and the federal staffing data
- Antipsychotic UseThe FDA warning for dementia, CMS's measure and what to ask
- Residents' RightsFederal residents' rights and the free ombudsman program
This guide explains long-term care in plain language from official sources. It isn't medical, legal or financial advice; a doctor, your state Medicaid agency or an elder law attorney can advise on your situation.
Sources
- Medicare.gov: Preventing abuse in nursing homes
- eCFR: 42 CFR 483.12, Freedom from abuse, neglect, and exploitation
- CMS: Design for Care Compare Nursing Home Five-Star Quality Rating System, Technical Users' Guide (July 2026)
- Medicare.gov: Your guide to living in a nursing home (CMS Product No. 12217)
- Medicare.gov: Your guide to choosing a nursing home (CMS Product No. 02174)
- CDC: About abuse of older persons
- ACL: Supporting Adult Protective Services
- U.S. Department of Justice: Red flags of elder abuse
- U.S. Department of Justice: Find help or report abuse
- CMS: Contact information for filing a complaint with a state survey agency
- CMS Provider Data Catalog: Nursing Home Provider Information (August 2026)