When Patricia noticed bruises on her mother’s forearms during a Sunday visit, she asked the caregiver what happened. The caregiver said her mother had bumped into the doorframe. Patricia wanted to believe that. She told herself it was probably true. But the bruises showed up again two weeks later, in different places, and this time no one had an explanation ready.
She did not know what to do. She did not want to cause trouble. She did not want to get anyone fired. She just wanted to know that her mother was safe. It took her three more weeks to pick up the phone, and when she finally called the state licensing agency, the first thing the person on the other end said was, “You did the right thing by calling.”
If you have concerns about a care home, whether it is something you saw, something your family member told you, or something that just does not feel right, you have the right to file a complaint. The process exists to protect residents. Using it is not causing trouble. It is doing what the system was built for.
Here is how it works, step by step.
When you should file a complaint
Not every concern requires a formal complaint. A care home that serves lunch later than you prefer, or a caregiver who is friendly but not your favorite personality, are issues to raise directly with the home’s administrator. A formal complaint is appropriate when the concern involves safety, health, or a violation of licensing standards.
File a complaint if you observe or suspect any of the following.
Physical abuse or rough handling. Unexplained bruises, scratches, or injuries. A resident who flinches when a caregiver approaches. Any use of physical force.
Neglect. A resident who is not being fed adequately, not being bathed, not receiving medications on time, or being left in soiled clothing. Bedsores (pressure ulcers) that develop after admission are a classic indicator of neglect, as the Centers for Medicare and Medicaid Services notes in its survey guidance.
Emotional abuse. Yelling, threatening, belittling, or isolating a resident. This is harder to document but just as serious.
Medication errors. Missed doses, wrong medications, or medications given without a valid prescription. Our guide on medication management in care homes explains how small homes are supposed to handle medications and what should concern you.
Unsafe conditions. Broken smoke detectors, blocked exits, unsanitary kitchens, malfunctioning heating or cooling, or pest infestations. These are licensing violations in every state.
Insufficient staffing. Residents left unsupervised for extended periods. Calls for help going unanswered. Caregivers who are clearly overwhelmed because there are too few of them for the number of residents.
Financial exploitation. A resident’s money or belongings going missing. Unauthorized charges. Pressure to change a will or sign financial documents.
Licensing violations. Operating without a current license, exceeding the licensed capacity, or employing caregivers who have not passed background checks.
Our guide on red flags to watch for when touring a care home covers many of these warning signs in detail. If you are seeing those red flags after your family member has already moved in, a complaint is the appropriate next step.
When to call 911 instead
Some situations are emergencies. If your family member is in immediate physical danger, if you witness an assault, if a medical emergency is being ignored, or if a resident has gone missing, call 911 first. File the complaint after the immediate danger is addressed.
The complaint process is designed for investigation and correction. It is not designed for emergencies. When someone is being hurt right now, law enforcement and emergency medical services are the right call.
Who to file with
There are three agencies that handle complaints about care homes, and they serve different functions. In many cases, you should contact more than one.
State licensing agency
Every state has an agency responsible for licensing and overseeing residential care homes. This is the agency that issued the home’s license, conducts inspections, and has the power to cite, fine, or shut down a facility. When you file a complaint with the state licensing agency, you are triggering the regulatory enforcement process.
The specific agency varies by state. In California, it is the Department of Social Services, Community Care Licensing Division. In Washington, it is the Department of Social and Health Services. In Florida, it is the Agency for Health Care Administration. Our guide on care home licensing across all 50 states lists the responsible agency and contact information for every state.
Most state agencies accept complaints by phone, online, or in writing. Many have a dedicated complaint hotline that is staffed during business hours.
Long-Term Care Ombudsman
The Long-Term Care Ombudsman program is a federally mandated advocacy program that exists in every state, established under the Older Americans Act. Ombudsmen are trained advocates who work on behalf of residents in care facilities. They investigate complaints, mediate disputes, and advocate for residents’ rights.
The Ombudsman is not a regulator. They cannot issue citations or fines. But they can investigate concerns, work with the facility to resolve problems, and escalate issues to the licensing agency when necessary. They are particularly valuable for complaints that fall into gray areas, situations where the care is not technically illegal but is not meeting the resident’s needs.
You can find your local Ombudsman through the Eldercare Locator by calling 1-800-677-1116 or searching online.
Adult Protective Services
If your concern involves abuse, neglect, or exploitation of a vulnerable adult, you should also contact Adult Protective Services (APS). APS investigates allegations of maltreatment of older adults and adults with disabilities, regardless of where they live. In many states, certain professionals (doctors, nurses, social workers) are mandatory reporters required by law to contact APS when they suspect abuse. Family members can report as well.
APS contact information varies by county. The Eldercare Locator can connect you to your local APS office.
In serious cases, filing with all three agencies is appropriate. They serve different functions and communicate with each other, but each brings a different set of tools. The licensing agency can enforce regulatory standards. The Ombudsman can advocate for the resident. APS can investigate abuse and arrange protective interventions.
How to document your concerns before filing
A well-documented complaint is more likely to be investigated promptly and thoroughly. Before you file, take time to organize what you know.
Write down what you observed. Include dates, times, and specific details. “On March 12 at approximately 2:00 p.m., I noticed two bruises on my mother’s left forearm, each approximately two inches long” is far more useful to an investigator than “my mother has been getting bruised.” Be factual. Describe what you saw, heard, or smelled, not what you think happened.
Take photographs. If you can see physical evidence, such as injuries, unsanitary conditions, or safety hazards, photograph it. Include a timestamp if your phone does not add one automatically. Keep the originals on your phone and make copies.
Keep a log. If the problem has been developing over time, write a chronological log of what you have noticed and when. This pattern evidence is valuable to investigators because it shows that a problem is ongoing, not a one-time incident.
Save communications. If you have raised concerns with the care home in writing (emails, texts, letters), save those records. If you raised concerns verbally, write down the date, who you spoke with, and what was said, as close to the conversation as possible.
Talk to your family member if you can. Ask open-ended questions. “How are things going here? Is there anything that has been bothering you?” Listen carefully. Some residents are afraid to report problems because they fear retaliation or do not want to be a burden. What they do not say can be as telling as what they do say.
Our guide on how to read a care home inspection report can help you understand what regulators look for during inspections. If your concerns align with common citation categories, that context can strengthen your complaint.
Filing the complaint step by step
The process varies slightly by state, but the general steps are consistent.
Step 1: Contact the state licensing agency. Call the complaint hotline, visit the agency’s website, or submit a written complaint by mail. Provide the name and address of the care home, your relationship to the resident (if you choose to share it), and a detailed description of your concern. Be specific about what you observed, when, and why it concerns you.
Step 2: Request confidentiality if desired. You have the right to file anonymously or to provide your name with a request that it not be shared with the care home. State this clearly at the time of filing.
Step 3: Ask for a complaint reference number. Most agencies assign a case or reference number that you can use to follow up. Write it down and keep it somewhere accessible.
Step 4: File with the Ombudsman if appropriate. If your concern involves resident rights, quality of life, or care quality that may not rise to a clear licensing violation, the Ombudsman may be the more effective channel. You can also file with both the licensing agency and the Ombudsman simultaneously.
Step 5: Contact APS if abuse or neglect is involved. This step is in addition to, not instead of, filing with the licensing agency. APS has its own investigation process and can take protective action independent of the licensing system.
Step 6: Keep copies of everything you submit. Whether you file by phone, online, or in writing, keep your own record of what you reported, when, and to whom.
What happens during an investigation
After you file a complaint, the licensing agency assigns it a priority level based on the severity of the allegation.
Immediate jeopardy complaints, those involving imminent danger to a resident’s health or safety, are typically investigated within 24 to 48 hours. An investigator will make an unannounced visit to the care home, interview staff and residents, review records, and document findings.
Non-immediate complaints are investigated on a timeline that varies by state, usually within a few days to a few weeks. The investigation follows the same general process: an unannounced visit, interviews, record review, and documentation.
During the investigation, the investigator will determine whether the complaint is substantiated (the evidence supports the allegation), unsubstantiated (the evidence does not support it), or inconclusive. If the complaint is substantiated, the agency will issue a citation or deficiency notice to the care home, which may require the home to submit a plan of correction. For serious violations, the agency may impose fines, place conditions on the license, or revoke the license entirely.
You may or may not be notified of the outcome, depending on the state. In many states, investigation results become part of the public record and can be found on the licensing agency’s website. In California, for example, complaint investigation results are posted on the Community Care Licensing Division’s facility search tool.
The Ombudsman’s role as your advocate
The Long-Term Care Ombudsman program deserves special attention because it serves a different function than the regulatory agencies. While the licensing agency enforces rules and APS investigates abuse, the Ombudsman advocates for residents.
An Ombudsman can visit the care home, speak with your family member privately, observe conditions, and work with the facility to resolve problems. They can attend care plan meetings on the resident’s behalf. They can help residents understand their rights. And they can escalate issues to the licensing agency when informal resolution fails.
Ombudsmen also have unique access. Federal law requires that care facilities allow Ombudsmen to enter and speak with residents without interference. This access makes them particularly effective at identifying problems that may not be visible during a scheduled inspection.
If your family member is uncomfortable speaking up for themselves, or if you are worried about raising concerns directly with the care home, the Ombudsman can serve as a buffer. They are experienced at navigating these situations while protecting the resident’s interests and relationships.
The Administration for Community Living oversees the national Ombudsman program and provides information on how the program works in each state.
Your right to be protected from retaliation
Federal and state laws are clear: a care home cannot retaliate against a resident or family member for filing a complaint. Retaliation includes reducing care, limiting visits, threatening discharge, verbal intimidation, or any change in treatment that appears connected to the complaint.
This protection exists because the complaint system only works if people use it. And people will not use it if they are afraid of consequences.
If you experience or suspect retaliation after filing a complaint, document it the same way you documented the original concern. Dates, times, specific incidents. Report the retaliation to both the state licensing agency and the Ombudsman. Retaliation is treated as a separate, serious violation.
In practice, retaliation is uncommon in small residential care homes, particularly well-run ones that take complaints as opportunities to improve. But the protection is there if you need it.
Following up after you file
Filing a complaint is not the end of the process. Following up ensures that your concern receives the attention it deserves.
Check the status. Call the licensing agency periodically and reference your complaint number. Ask whether an investigation has been opened, whether it has been completed, and whether you can learn the outcome.
Continue observing. After you file, keep visiting your family member regularly and continue documenting what you see. If the problem persists or worsens, file a follow-up complaint with the new information. A pattern of repeated complaints about the same issue carries significant weight. Our guide on staying involved after placement explains how regular visits and engagement help you monitor care quality over time.
Know your escalation options. If the state agency does not act, or if the action taken does not resolve the problem, you can escalate. Contact the state Ombudsman. Contact your state legislator’s office, which can sometimes prompt agency action. For facilities that receive federal funding, you can contact the CMS regional office responsible for your state. For care homes receiving Medicaid funds, CMS has oversight authority that goes beyond the state level.
What to do if nothing changes
Sometimes the system does not work as it should. An investigation finds no violation. A citation is issued but the home does not improve. The problem you reported continues.
If you have filed a complaint, followed up, and the situation has not changed, you have a decision to make. You can continue to advocate through the regulatory process, escalating to higher authorities and documenting the ongoing problem. This matters because it creates a record that may eventually lead to meaningful enforcement action.
But you also have the right to move your family member to a different care home. You are not required to wait for the system to fix a problem while your family member’s wellbeing is at risk. Finding a new placement is stressful, but it may be the most direct way to ensure safety. Our guide on how to find a care home can help you start that search, and our guide on comparing care homes can help you evaluate alternatives.
If the situation involves criminal conduct, such as physical or sexual abuse, theft, or fraud, contact local law enforcement in addition to the regulatory agencies. The licensing system addresses licensing standards. Criminal behavior requires a criminal response.
A note about small care homes specifically
Small residential care homes, the board and care homes, adult family homes, and personal care homes that serve six to fifteen residents, operate in a regulatory environment that varies dramatically by state. Some states inspect these homes annually. Others inspect only in response to complaints. Some states have robust licensing standards with detailed requirements for staffing, training, and resident rights. Others have minimal oversight.
This means that in some states, your complaint may be the only mechanism that triggers a review of a home’s practices. The licensing agency may not have visited the home in over a year. Your call may be the reason they show up.
This is not a flaw in the system that you need to accept quietly. It is a reality that makes your willingness to report concerns even more important. The National Center on Elder Abuse tracks trends in state oversight and publishes research on the effectiveness of complaint-driven enforcement.
What to do right now
If you are reading this because something is wrong, here is what to do today.
Write down what you have observed. Be specific about dates, times, and details. Take photographs if applicable.
Look up your state’s licensing agency using our guide on care home licensing across all 50 states, or search your state’s department of health or social services website for the residential care complaint line.
Call and file the complaint. You do not need to have perfect documentation. You do not need to be certain. If something concerns you, report it and let the investigators determine what happened.
If your family member is in immediate danger, call 911 first.
You are not causing trouble. You are not being difficult. You are doing exactly what a family member is supposed to do: making sure the person you love is safe.