What to Do After Nursing Home Neglect

Reviewed by Jett Palmore (JP), Editor-in-Chief — Elder Abuse & Nursing Home Neglect Litigation Practice. Updated May 2026.

Discovering nursing home neglect or abuse triggers a situation where urgent protective action, careful evidence preservation, and legal consultation all need to happen simultaneously. This guide explains what to do at each stage — from the immediate discovery through the attorney consultation — in a way that protects both your loved one's safety and your eventual legal position.

Step 1: Ensure Immediate Safety First

Before any other consideration, address the resident's immediate safety and medical needs. If the resident is in immediate danger — active physical abuse, severe dehydration, infected stage 4 pressure wounds causing systemic infection, unresponsive from medication error — call 911 for emergency medical transport. The resident's life and health take absolute priority over evidence preservation or legal strategy.

For situations that are serious but not immediately life-threatening — ongoing pressure sore development, unexplained weight loss, unexplained bruising — the immediate priority shifts to documentation and protective reporting while the resident remains in the facility. Transfer can follow once a receiving facility has been identified and arrangements made.

Step 2: Report to the Long-Term Care Ombudsman and Adult Protective Services

Every state has a Long-Term Care Ombudsman (LTCO) program, federally mandated under the Older Americans Act, that investigates complaints about nursing homes and advocates for residents. The LTCO has legal access to nursing home facilities, the right to speak privately with residents, and the authority to inspect records related to a complaint. LTCO services are free. Report the specific complaint — what happened, to which resident, on what dates — as specifically as possible. The LTCO investigation creates an official record that is separate from and independent of any legal proceeding.

Adult Protective Services (APS) investigates abuse and neglect of vulnerable adults, including nursing home residents. APS has investigative authority and can require facility cooperation. Like the LTCO, APS creates a documented investigation record that is independent of the civil litigation. File a report immediately upon discovering suspected abuse or severe neglect. Many states have mandatory reporting requirements that apply to healthcare providers and others in regular contact with vulnerable adults — but family members are also entitled to file APS reports.

Also consider reporting directly to the state health department, which has licensing authority over nursing homes and conducts complaint investigations independently of the LTCO and APS systems. A complaint to the state health department can trigger an on-site inspection and CMS Form 2567 deficiency citations — the regulatory documentation that becomes powerful evidence in subsequent litigation.

Step 3: Request Medical Records Immediately and Formally

Nursing home records — nursing notes, medication administration records (MARs), care plans, incident reports, wound assessments, nutritional records, physician orders — are the evidentiary foundation of any neglect case. They must be requested immediately and in writing for two reasons: first, they may be altered or supplemented after a complaint is made, and having a request documented creates a baseline for what was in the records at the time; second, nursing home records are sometimes lost or destroyed during facility ownership transitions, building consolidations, or deliberately.

Under HIPAA, the resident (or their authorized representative — guardian, conservator, or healthcare proxy with appropriate authority) has the right to request and receive copies of all medical records within 30 days of request. Send the request by certified mail with return receipt to the nursing home's medical records department and to the administrator. Request: all nursing notes, all physician orders, all medication administration records, all care plans and care plan revisions, all incident reports, all accident reports, all wound assessments and photographs, nutritional assessments and intake records, and all records related to falls, pressure injuries, or medications administered to the resident.

If you are concerned about imminent record alteration — particularly in cases involving suspected physical abuse — also consider requesting records from the state health department (which may have copies of inspection-related records) and sending a written preservation demand to the facility's administrator and legal counsel, if known.

Step 4: Document All Injuries with Photographs

Photograph all visible injuries thoroughly: pressure sores at every stage of documentation (including before and after wound treatment), bruising, lacerations, and any other physical evidence of harm. Use a camera or smartphone; ensure the date and time are embedded in the image metadata. If the facility has a physician or nurse practitioner examine the injuries, obtain a copy of their written assessment as well — an independent clinical description of the injury created by the treating provider is more credible than photographs alone.

For pressure sores: photograph the wound with a ruler or scale item for reference; photograph the surrounding tissue; photograph any wound dressing before and after removal; and request the facility's wound care photographs if they exist (they are part of the medical record). Stage 3 and 4 wounds that have progressed significantly should be documented at each stage of severity, and the photographs should be dated.

For bruising: photograph immediately, as bruising changes color and appearance over days. Note the location precisely — bilateral bruising, bruising over bony prominences inconsistent with self-injury, and patterned bruising are particularly significant. A forensic photograph with a color scale reference is ideal if available.

Step 5: Transfer the Resident If Necessary

If the resident is in ongoing danger — continuing abuse, a pattern of severe neglect that the facility is not addressing, or a situation where you do not trust the facility's commitment to correction — transfer the resident. Transferring does not waive your legal claim. The harm has already occurred; the claim is preserved regardless of where the resident subsequently receives care.

Before transferring: identify a receiving facility and obtain a transfer summary from the nursing home documenting the resident's current condition and care needs; notify the new facility of the ongoing issues so they can be monitored for continuation of harm; and document the resident's condition at the time of transfer — weight, wound status, functional status — as a baseline for the new facility. Keep the transfer summary, because it documents the condition the resident was in when they left the facility that caused the harm.

Some families hesitate to transfer because they believe it will anger the facility and lead to worse care — a concern that, if the situation is bad enough to consider legal action, suggests the transfer is already warranted. The resident's safety and ongoing care quality are the priority; the legal case can be pursued regardless of where the resident subsequently resides.

Step 6: Consult an Elder Abuse Attorney Before Taking Any Further Action

Before engaging further with the nursing home administration, accepting any offer from the facility, or providing any statements to facility representatives or their insurance carrier, consult an elder abuse attorney. Elder abuse attorneys — particularly those with nursing home neglect experience — understand the applicable statutes, the regulatory evidence framework, the arbitration clause challenge strategies, and the litigation dynamics of these cases in a way that general practice attorneys often do not.

The consultation serves several purposes: the attorney evaluates whether the case meets the legal threshold for viable claims; advises on whether any action taken so far (including any preliminary conversations with the facility) is problematic; identifies any statute of limitations deadlines that require urgent action; develops a document preservation strategy including potential litigation hold letters to the facility; and advises on whether any existing arbitration clause is worth challenging and on what basis.

Many elder abuse attorneys work on contingency (a percentage of the recovery, paid only if successful) or under elder abuse statute fee-shifting provisions (where the statute requires the defendant to pay the plaintiff's attorney fees upon prevailing). This means free initial consultations are standard, and many qualified elder abuse attorneys take cases with no upfront cost to the family. The absence of cost to consult makes early consultation the obvious first step, even before you are certain legal action is the right path.

See also: how claims work, common misconceptions, and the FAQ. Return to the calculator.