How to file a complaint about a nursing home

If you are worried about the care a resident is receiving in a nursing home, you are not limited to complaining to the front desk and hoping for the best. Every Medicare- or Medicaid-certified nursing home operates under federal rules, and there is an official system for reporting problems and getting them investigated.

There are three main routes, and they are not mutually exclusive — you can use more than one at the same time:

• File a complaint with your state survey agency, the government office that inspects nursing homes. This can trigger an official investigation.
• File a grievance with the facility itself, which the facility is legally required to accept and respond to.
• Contact the Long-Term Care Ombudsman, a free advocate whose job is to resolve problems on the resident's behalf.

This guide explains how each route works, what to include so your complaint gets acted on, and what happens after you file. If the situation involves immediate danger, skip ahead to the last section — some problems should go straight to 911 or Adult Protective Services.

Official complaints about nursing homes are investigated by state survey agencies — usually part of each state's health department — acting on behalf of the federal Centers for Medicare & Medicaid Services (CMS). These are the same agencies that conduct the routine annual inspections, and they follow procedures set out in CMS's State Operations Manual.

Anyone can file a complaint: a resident, a family member, a friend, a visitor, or a staff member. You do not need to be related to the resident, and you do not need permission from the facility. Most states accept complaints by phone, online form, mail, or fax. To find your state's complaint intake contact, search for your state health department's "nursing home complaint" line, or use the resources listed on Medicare Care Compare, which links each facility to its state agency.

When the agency receives your complaint, it assigns a priority level based on how serious the alleged harm is. Allegations of immediate jeopardy — situations that may put a resident's life or safety in immediate danger — trigger the fastest response, generally an on-site investigation within days. Less urgent concerns are scheduled further out or folded into the facility's next regular inspection.

You will see both terms, and they are not interchangeable.

A complaint goes to the state survey agency — an outside government body — and can lead to an official investigation, citations, and enforcement action against the facility.

A grievance goes to the nursing home itself. Under federal regulation 42 CFR 483.10, every certified nursing home must have a grievance process, name a grievance official responsible for handling it, and give you a written decision that includes what the facility found and what corrective action it took. Filing a grievance is a resident right, and the facility may not retaliate against a resident for using it.

Which should you use? A practical rule of thumb:

• Start with a grievance for everyday problems the facility can fix directly — cold meals, laundry going missing, call lights going unanswered too slowly, scheduling issues.
• Go to the state when the problem involves possible harm, neglect, abuse, medication errors, unsafe conditions, or a violation of the resident's rights — or when you raised the issue with the facility and nothing changed.

You never have to complete the facility's grievance process before contacting the state. For anything serious, you can and should go to the state directly, and it is reasonable to do both at once: the grievance creates a paper trail inside the facility, and the state complaint brings in outside eyes.

Every state also runs a Long-Term Care Ombudsman program, established under the federal Older Americans Act and overseen nationally by the Administration for Community Living. Ombudsmen are advocates for residents — not inspectors and not facility employees. Their services are free.

An ombudsman can:

• Listen to the concern and help you figure out which route makes sense
• Work directly with facility staff to resolve the problem, with the resident's consent
• Explain residents' rights to you and to the facility
• Help you write and file a formal complaint with the state if that is needed

Ombudsmen are resident-directed: they keep what residents tell them confidential and act only with the resident's permission (or, when the resident cannot consent, according to program rules). Every nursing home is required to post contact information for the local ombudsman program — look for it near the entrance or ask for it. The ombudsman route is especially useful when you want a problem fixed but are unsure whether it rises to the level of a state complaint, or when you want someone experienced at your side.

Investigators can only act on what they can verify. A complaint that says "the care there is terrible" is hard to investigate; a complaint that says "on August 12 my mother waited over an hour for help after a fall" gives investigators something concrete to check against records, schedules, and interviews. Before you file, gather what you can:

• Dates and times — even approximate ones ("the weekend of August 9") are far better than none.
• Names or descriptions of the residents and staff involved, including job titles or shifts if you do not know names.
• Specific events — what happened, where in the building, who saw it, and what the facility said or did afterward.
• Documents and photos, if you have them: photos of injuries or conditions, copies of grievance responses, notes from conversations.
• A pattern, if there is one — one missed medication is different from missed medications every weekend.

You can remain anonymous. State agencies accept anonymous complaints, and if you do give your name, the agency is required to keep your identity confidential from the facility. The trade-off is practical: investigators cannot call an anonymous complainant back for details or tell them the outcome, so a confidential-but-named complaint is usually more effective than a fully anonymous one. Federal rules also protect residents from retaliation for voicing grievances, and abuse-reporting protections under 42 CFR 483.12 apply regardless of who reports.

Once the state survey agency accepts your complaint, here is the usual sequence:

1. Triage. The agency reviews the allegation and assigns a priority based on the potential for harm. The most serious allegations get on-site visits within days; others are scheduled later or combined with the next standard inspection.
2. An unannounced complaint survey. Inspectors visit the facility without warning. They focus on the specific allegation — observing care, reviewing medical records, and interviewing residents and staff — rather than re-inspecting everything.
3. Findings. If inspectors verify that the facility violated a federal requirement, the complaint is substantiated and the facility is cited, exactly as it would be during a regular inspection. The facility must then submit a plan of correction, and serious findings can bring fines and other penalties. If inspectors cannot verify the allegation, the complaint is recorded as unsubstantiated — which means it could not be confirmed, not necessarily that it was false.
4. The results become public. Citations from complaint investigations go into the facility's public inspection record alongside its annual survey results. Most states also notify named complainants of the outcome in writing.

This is why complaints matter beyond your own situation: they create a public record. On this site, citations that came out of a complaint investigation are marked "from a complaint" in each facility's inspection history, so families can see which problems were found through routine inspection and which were reported by someone like you. Our guide to reading inspection reports explains how to interpret those citations and their severity letters.

The complaint system is built for investigation, not emergencies. Some situations call for a faster response:

• Call 911 if a resident is in immediate danger, seriously injured, or in medical crisis, or if you believe a crime — such as assault or sexual abuse — has just occurred. Police reports and complaint investigations can proceed in parallel.
• Contact Adult Protective Services (APS) if you suspect abuse, neglect, or financial exploitation of a vulnerable adult. APS operates in every state and can act quickly to protect an individual resident while the survey agency investigates the facility. Your state's APS intake number is usually listed on its health or human services website.
• File the state complaint too. Even when police or APS are involved, a complaint to the survey agency is what puts the facility's conduct into the federal inspection system and its public record. Our guide to the abuse icon explains how substantiated abuse citations are flagged on facility records.

Finally, a word about lawyers. This guide describes the public complaint system; it is not legal advice, and this site does not provide legal advice or recommend facilities. If a resident suffered serious harm, if you are considering a lawsuit, or if you face decisions about guardianship or contracts, consult a licensed attorney — many offer free initial consultations, and state bar associations run referral services. Filing a complaint does not prevent you from taking legal action later, and taking legal action does not replace the value of getting the problem on the public record.