What Should You Do If You Suspect Neglect or Abuse in a Nursing Home?

The short answer: make the resident safe first, write down what you saw, tell the facility in writing, and then report to the state agency that licenses the facility and to the Long-Term Care Ombudsman, on the same day. Do not wait for the facility to investigate itself before reporting, and do not let anyone tell you that a complaint will jeopardize the resident’s place. Federal law defines abuse and neglect precisely, requires the facility to report allegations to the state within two hours when abuse or serious injury is involved, gives the resident and family the right to voice grievances “without discrimination or reprisal,” and gives every visitor the right to see the facility’s most recent inspection results. Each state adds its own reporting duties, hotlines, and criminal statutes, and this article sets them out for New Jersey, New York, and Connecticut.

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What Counts as Abuse or Neglect?

Families often hesitate because they are not sure what they are seeing rises to the level of a reportable event. The federal definitions that govern every Medicare- and Medicaid-certified nursing home, at 42 C.F.R. 483.5, are broader than most people assume.

“Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being.” Yelling at a resident, leaving a resident in a wheelchair as a punishment, and withholding a call bell are abuse under that definition, not merely poor care.

“Neglect is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress.” Neglect is about the facility as a whole, and understaffing that leaves residents unturned, unfed, or unwashed is neglect whether or not any single aide meant harm.

The regulation also defines “exploitation,” meaning “taking advantage of a resident for personal gain through the use of manipulation, intimidation, threats, or coercion”; “misappropriation of resident property,” meaning “the deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a resident’s belongings or money without the resident’s consent”; and “sexual abuse,” meaning “non-consensual sexual contact of any type with a resident.” Under 42 C.F.R. 483.12, “the resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart.”

The signs are the ones families already know: unexplained bruises or fractures, pressure sores, weight loss, dehydration, poor hygiene, missing belongings or money, a resident who is withdrawn, fearful of particular staff, or sedated beyond what the care plan explains, call bells that go unanswered, and rooms and residents that smell of urine. One sign is a question. A pattern is a report.

What Does the Facility Have to Do?

More than most families are told. Under 42 C.F.R. 483.12(c), a nursing home must ensure that all alleged violations “are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities).” The facility must “have evidence that all alleged violations are thoroughly investigated,” must prevent further abuse while the investigation is pending, and must “report the results of all investigations” to the state survey agency “within 5 working days of the incident.”

Federal law also puts a duty on individuals. Under 42 U.S.C. 1320b-25, every “owner, operator, employee, manager, agent, or contractor” of a nursing home that receives federal funds “shall report to the Secretary and 1 or more law enforcement entities for the political subdivision in which the facility is located any reasonable suspicion of a crime” against a resident, within two hours if there is serious bodily injury and otherwise within 24 hours, on pain of a civil penalty of up to 200,000 dollars. A director of nursing who tells a family that an incident “was handled internally” is describing a violation of that section if the incident was a crime.

Two other federal rights matter at this stage. Under 42 C.F.R. 483.10(j), “the resident has the right to voice grievances to the facility or other agency or entity that hears grievances without discrimination or reprisal,” the facility must have “a Grievance Official who is responsible for overseeing the grievance process,” and the resident is entitled to “a written decision regarding his or her grievance.” And under 42 C.F.R. 483.10(g)(10) and (11), the resident may “examine the results of the most recent survey of the facility conducted by Federal or State surveyors and any plan of correction,” and the facility must keep survey and complaint investigation reports for “the 3 preceding years” available “for any individual to review upon request.” Ask for them.

What Should You Do, in Order?

1. Make the resident safe. If there is an injury, insist on medical evaluation, at a hospital if necessary. If a particular staff member is the problem, ask in writing that the person be kept away from the resident pending investigation, which the federal rule requires the facility to do anyway.
2. Document everything, that day. Photograph injuries, conditions, and the room with a timestamp. Write a dated log of what you saw, who was present, what staff said, and what you were told would happen. Keep copies of every message to and from the facility. In the New Jersey appellate cases we describe in a companion article, the evidence that carried the day came from families’ contemporaneous accounts of unanswered call bells and unsafe conditions.
3. Tell the facility in writing. Address a written grievance to the administrator and the grievance official, describe the events, and ask for the written decision the federal rule requires. Ask when the facility reported the incident to the state and to the police, because the two-hour rule means it should already have done so.
4. Report to the state the same day. The state health department that licenses the facility investigates complaints and can cite the facility, impose penalties, and, in serious cases, place it under a monitor. The Long-Term Care Ombudsman investigates on the resident’s behalf and can intervene directly. Report to both. Where to call is set out below.
5. Call the police if a crime is suspected. Assault, sexual abuse, theft, and criminal neglect are crimes in every state, and the state Attorney General’s Medicaid Fraud Control Unit prosecutes abuse in facilities that receive Medicaid.
6. Request the records. The resident’s medical record, the incident report, the care plan, and the facility’s most recent survey results. A health care agent or guardian has the authority to obtain them; a family member without that authority should get it, as our article on who makes medical decisions without a proxy explains.
7. Consider whether the resident should stay. Sometimes the answer is to move. Sometimes moving is not possible quickly, and the family’s presence becomes the safeguard. Visit at unpredictable hours, and know that under 42 C.F.R. 483.10(f)(4) the facility “must provide immediate access to any resident” by the Ombudsman, the resident’s representative, and immediate family.
8. Consult counsel about a civil claim. Each state gives residents a private right of action against a facility that violates their rights, with attorney’s fees in some circumstances, and the deadlines run from the injury. Our firm handles the planning, agreement, and rights side of these matters and refers litigation to counsel who try these cases.

Where Do You Report in New Jersey?

The Department of Health licenses nursing homes and assisted living facilities and takes complaints 24 hours a day at 1-800-792-9770, anonymously if the caller prefers. The Long-Term Care Ombudsman investigates abuse, neglect, and exploitation of facility residents aged 60 and over at 1-877-582-6995. New Jersey’s Adult Protective Services program does not cover licensed facilities: under N.J.S.A. 52:27D-407, a “vulnerable adult” is one “who resides in a community setting,” and the definition of community setting excludes “residential health care facilities, rooming houses or boarding homes or any other facility or living arrangement subject to licensure by, operated by, or under contract with, a State department or agency.” For facility residents, the Ombudsman is the protective agency. The Attorney General’s Medicaid Fraud Control Unit investigates and prosecutes “complaints of patient or resident abuse or neglect in health care facilities receiving Medicaid funding such as nursing homes” and can be reached at 609-292-1272 or through its online reporting form.

New Jersey imposes a reporting duty on professionals. Under N.J.S.A. 52:27G-7.1, “any caretaker, social worker, physician, registered or licensed practical nurse or other professional, who, as a result of information obtained in the course of his employment, has reasonable cause to suspect or believe that an institutionalized elderly person is being or has been abused or exploited, shall report such information in a timely manner to the ombudsman,” with immunity for good-faith reports and a fine of up to 5,000 dollars for failing to report. Anyone else may report. The resident’s right to be free from abuse is in the licensing regulation, N.J.A.C. 8:39-4.1(a)5, “to be free from physical and mental abuse and/or neglect,” and the Nursing Home Act, N.J.S.A. 30:13-5(i), guarantees the right to “present grievances on behalf of himself or others to the nursing home administrator, State governmental agencies or other persons without threat of discharge or reprisal.” A caretaker who “unreasonably neglects to do or fails to permit to be done any act necessary for the physical or mental health” of a person 60 or older commits a third-degree crime under N.J.S.A. 2C:24-8. Families who suspect their loved one is being mistreated by an in-home aide, as opposed to a facility, can borrow a camera free for 30 days through the Division of Consumer Affairs’ Safe Care Cam program.

Where Do You Report in New York?

The Department of Health’s Nursing Home Complaint and Discharge Appeal Hotline is 1-888-201-4563, and its centralized complaint line for adult care facilities and assisted living is 1-866-893-6772. The Long Term Care Ombudsman Program is at 1-855-582-6769. The Justice Center for the Protection of People with Special Needs does not cover nursing homes; its jurisdiction under Social Services Law 488 runs to mental health, developmental disability, and similar programs.

New York’s mandatory reporting statute is Public Health Law 2803-d. It requires “any operator or employee” of a nursing home, and any “nursing home administrator, physician, registered professional nurse, licensed practical nurse” and other listed professionals, to report “when they have reasonable cause to believe that a person receiving care or services in a residential health care facility has been abused, mistreated, neglected or subjected to the misappropriation of property.” Reports “shall be made immediately by telephone and in writing within forty-eight hours to the department.” Good-faith reporters have immunity; a professional who fails to report commits unprofessional conduct and is subject to a civil penalty. The Department’s regulation at 10 NYCRR 415.4(b) requires the facility to ensure that alleged violations “are reported immediately to the administrator of the facility and, when required by law or regulation, to the Department of Health,” to document that “all alleged violations are thoroughly investigated,” and to “prevent further potential abuse while the investigation is in progress.” A caregiver who intentionally or recklessly injures a “vulnerable elderly person” commits endangering the welfare of a vulnerable elderly person in the second degree, a class E felony under Penal Law 260.32, and in the first degree, a class D felony under Penal Law 260.34, where the injury is serious. Residents also have a private right of action under Public Health Law 2801-d, described in our article on New York’s nursing home enforcement settlements.

Where Do You Report in Connecticut?

The Department of Public Health’s Facility Licensing and Investigations Section takes nursing home complaints through its online complaint form. The Long-Term Care Ombudsman is at 1-866-388-1888. Under General Statutes 17a-870 and 17a-873, the Ombudsman’s office covers skilled nursing facilities, nursing facilities, board and care homes, and “any other adult care home similar to a facility or nursing facility or board and care home,” and must “identify, investigate and resolve complaints that are made by, or on behalf of, residents.” Under General Statutes 19a-550(b)(21), every nursing home resident “is entitled to file a complaint with the Department of Social Services and the Department of Public Health regarding patient abuse, neglect or misappropriation of patient property.”

Connecticut’s mandatory reporting statute, General Statutes 17b-451, requires a long list of professionals, including any “nursing home administrator, nurse’s aide or orderly in a nursing home facility or residential care home” and any “staff person employed by a nursing home facility,” who has “reasonable cause to suspect or believe that any elderly person has been abused, neglected, exploited or abandoned” to report “not later than twenty-four hours after such suspicion or belief arose” to the Commissioner of Social Services. Reporters are immune from liability. A mandated reporter who fails to report must retake training the first time and is fined up to 500 dollars thereafter, and an intentional failure is a misdemeanor. The resident’s right under 19a-550(b)(9) is to be “free from mental and physical abuse, corporal punishment, involuntary seclusion and any physical or chemical restraints imposed for purposes of discipline or convenience.” Criminal abuse of an elderly, blind, or disabled person is a felony under General Statutes 53a-321 and 53a-322 and a class A misdemeanor under 53a-323. Connecticut also gives residents a right the other two states do not: under General Statutes 19a-550b, “a resident shall have the right to use technology of the resident’s choice that facilitates virtual monitoring or virtual visitation,” at the resident’s expense, with a conspicuous notice on the door and consent or accommodation for a roommate. A family that wants a camera in a Connecticut nursing home room may install one.

How Do You Check a Facility’s Record?

Medicare’s Care Compare tool rates every certified nursing home and, since 2019, marks facilities with an abuse icon. The July 2026 edition of the Centers for Medicare and Medicaid Services’ rating guide explains that the icon identifies facilities with a “harm-level abuse citation in the most recent survey cycle,” meaning residents “were found to be harmed,” or “repeat abuse citations” for potential harm in consecutive cycles, and that “nursing homes that receive the abuse icon have their health inspection rating capped at a maximum of two stars.” State inspection reports are public in all three states through the state health department, as our article on choosing a facility describes for assisted living. And the facility itself must show you its last three years of survey and complaint reports on request. A family choosing a nursing home should read them before signing, and a family with a relative already in one should read them when something goes wrong, because a facility with repeat citations for the same deficiency has a management problem the family cannot fix from the hallway.

What Should You Not Do?

Do not confront a staff member in a way that ends the conversation; document and report instead. Do not accept the facility’s internal investigation as the last word. Do not remove the resident abruptly without a plan for where they go, unless immediate danger requires it, because a hospital emergency room is not a discharge plan and the facility’s obligations to readmit are governed by rules described in our article on refusal to readmit after a hospital stay. Do not sign anything the facility presents in the aftermath, including a “resolution” of the grievance or a revised agreement, without reading it. And do not assume that reporting will make things worse. The right to complain without reprisal is federal law, the Ombudsman exists to enforce it, and in our experience the facilities that retaliate are the ones whose records already show why.

Plan Well. Live Better.

The families who protect a relative in a nursing home are the ones who know the rules before they need them and who write things down. At Milvidskiy Law Group, we help families understand a resident’s rights, hold facilities to their agreements, and put in place the health care and financial authority a family needs to act, and we refer cases that belong in court to counsel who try them. Learn more about our elder law services.

This article is for general informational purposes only and does not constitute legal or medical advice. Reading it does not create an attorney-client relationship. Reporting duties, hotlines, and criminal statutes change, and how they apply depends on the facility’s licensure and the facts. The federal regulations and the New Jersey, New York, and Connecticut statutes, regulations, and agency contacts described were verified in September 2026 and should be confirmed before relying on them.