Choosing a place

Worried about nursing home or assisted living care? What to do

Updated October 15, 2026 · Reviewed against official sources

Seeing Mom or Dad with a bruise no one explained to you, or finding them in dirty clothes in the middle of the afternoon, would worry any family. Often there's a simple explanation, and the staff can clear it up right away. Other times the care plan needs adjusting. And in a few cases, it's something serious that needs to be reported. This article helps you sort out the steps calmly, knowing what resources exist and what rights your loved one has.

Working as a team

The staff at a care home (nurses, certified nursing assistants or CNAs, cooks, housekeeping staff) do demanding work, and in the vast majority of cases they do it with a lot of heart. The family is part of the team too: you know your loved one better than anyone. When something worries you, bringing it up early and respectfully is usually the fastest way to get it fixed.

Changes in your loved one worth bringing up

None of these changes on its own means something is wrong, but they all deserve a conversation with the staff:

• Bruises, cuts, or injuries no one told you about.
• Bedsores (pressure sores) that show up or get worse.
• Weight loss, dry lips, or signs they aren't drinking enough water.
• Dirty clothes or sheets, or hygiene that isn't the way it usually is.
• A lot of sleepiness or mood changes when the doctor hasn't changed their medicines.
• Your loved one seems afraid, withdraws, or is quieter than usual.
• Personal belongings or money are missing, or there are charges on their account you don't recognize.

If your loved one has dementia, they may not be able to tell you what's happening. In that case, changes in behavior and what you notice during your visits are even more valuable to the staff. Our guide on memory care explains some changes that are part of the disease.

What the CDC says about abuse

To keep the terms clear, the CDC describes five types of abuse of older people by a caregiver or another trusted person: physical, sexual, emotional or psychological, neglect (not meeting basic needs like food, water, hygiene, or medical care), and financial (using the person's money or property without permission). According to the CDC, about 1 in 10 older adults who live at home experience some type of abuse. It can happen anywhere, including in the family, which is why there are ways to get help in every setting.

What to do, step by step

1. If there's immediate danger, call 911. A serious injury, an assault that is happening, or a person who isn't responding are emergencies. Then let the care home know.
2. Write down what you saw. The date, the time, what you noticed, who was on shift, and what you were told. If your loved one agrees, a photo can help make sure everyone is talking about the same thing.
3. Talk with the staff. Start with the charge nurse on that shift and, if needed, ask for a meeting with the Director of Nursing, the social worker, or the administrator. Nursing homes certified by Medicare and Medicaid must have a process for receiving and resolving complaints. Ask what they're going to do and when you'll talk again. If the issue has to do with daily care, you can ask for a care plan meeting; see how to prepare for the care plan meeting.
4. Call the long-term care ombudsman if the concern continues or if you'd like support from the start. This program exists in every state under federal law. Its services are free and confidential, and the ombudsman acts with the permission of the resident or their representative. The ombudsman doesn't fine anyone: they listen, explain rights, and help residents, families, and staff find a solution.
5. File a complaint with the State Survey Agency if you think a formal review is needed. This is the office that inspects nursing homes. According to Medicare.gov, you can file by phone, mail, online, or in person, and you can also file anonymously. To get your state's contact information, you can call 1-800-MEDICARE (1-800-633-4227).
6. Adult Protective Services (APS) is another resource. In some states, APS also handles situations inside care facilities; in others, those cases go to a different office. You can find your state's contact on the website of the national APS association (NAPSA).
7. If there was a physical or sexual assault, or a theft, you can also report it to the police.

If you're not sure where to start, the Eldercare Locator (1-800-677-1116), a free service of the federal government, can give you contact information for the ombudsman and for services in your area.

Your loved one's rights

People who live in a certified nursing home have rights protected by federal law: to be treated with dignity, to live free from abuse, to take part in their care plan, and to file complaints without retaliation. If you're worried that speaking up could affect how your loved one is treated, tell the ombudsman: part of their job is to support the resident through that process. You'll find more detail in our guide on resident rights and how to file a complaint.

If you're thinking about moving

Sometimes, even with goodwill on all sides, another place is a better fit for what your loved one needs. Before you decide, talk with the staff and the ombudsman, and check the notice period in the contract. To look at other options, you can review star ratings and inspections in context with how to read Medicare star ratings, use our guided search, and compare places with our compare tool. If you need a place on short notice, see our urgent help page.

Speaking up about what worries you isn't "making a scene." It's taking care of your loved one, and a good team appreciates it.

💬Frequently asked questions

Do I need proof to talk to the ombudsman or the state?

No. It's enough to describe what you saw. Your notes with dates and times help them understand the situation.

Can I file a complaint without giving my name?

According to Medicare.gov, complaints to the state agency can be anonymous. The ombudsman, for their part, keeps things confidential and acts with the resident's permission.

What if my loved one doesn't want me to say anything?

If your loved one can make their own decisions, their wishes count. You can ask the ombudsman to talk with them and explain their options. In an emergency, always call 911.

What if the concern is about another resident?

Tell the staff. They are responsible for caring for all residents, and the ombudsman can also guide you.

Sources

• CDC, "About Abuse of Older Persons": https://www.cdc.gov/elder-abuse/about/index.html (accessed October 15, 2026)
• Medicare.gov, "Filing a complaint": https://www.medicare.gov/providers-services/claims-appeals-complaints/complaints (accessed October 15, 2026)
• CMS, contact information for state survey agencies: https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/contact-information (accessed October 15, 2026)
• eCFR, 42 CFR 483.10 (resident rights): https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483/subpart-B/section-483.10 (accessed October 15, 2026)
• ACL, Long-Term Care Ombudsman Program: https://acl.gov/sites/default/files/programs/2019-08/Long_Term_Care_Ombudsman_Program%202019.pdf (accessed October 15, 2026)
• Consumer Voice, ombudsman fact sheet: https://theconsumervoice.org/wp-content/uploads/2025/04/Ombudsman-Fact-Sheet.pdf (accessed October 15, 2026)
• NAPSA, "Help in Your Area": https://www.napsa-now.org/help-in-your-area/ (accessed October 15, 2026)
• Eldercare Locator: https://eldercare.acl.gov/ (accessed October 15, 2026)

This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.

👉Keep reading

Rights and complaints

Federal nursing home resident rights, how to resolve concerns with the staff, what the ombudsman does and how to file a formal complaint.

Care plan meeting

What a nursing home care plan meeting is, how often the MDS assessment is done, who takes part, what to bring and what to ask the care team.

How to read star ratings

What Care Compare star ratings measure for a nursing home: inspections, staffing, and quality. What the abuse icon and the SFF program mean.

Choosing a place for care

How to choose a nursing home: assess the need, check the license, star ratings and inspections, visit, what to ask and how to read the contract.