Abuse in Nursing Homes and Elder Care: Resident Rights, the Federal Two-Hour Reporting Rule, and Where Families Can Turn

Reviewed by Survivor Rights Center · Updated 2026-10-21

The resident's right to be free from abuse

Federal participation rules for nursing facilities state that the resident has the right to be free from abuse, neglect, misappropriation of resident property and exploitation, including freedom from corporal punishment and involuntary seclusion. These rights apply to facilities that participate in Medicare or Medicaid.

How fast facilities must report

Under 42 CFR 483.12, when there is an allegation of abuse, neglect, exploitation or mistreatment, the facility must ensure it is reported immediately, and no later than 2 hours after the allegation is made if it involves abuse or results in serious bodily injury, or no later than 24 hours otherwise. The report goes to the facility administrator and to other officials, including the State Survey Agency and adult protective services where state law gives them jurisdiction.

A separate federal law, 42 U.S.C. 1320b-25, applies to long-term care facilities that receive at least $10,000 in federal funds in a year. Each covered individual, such as an owner, operator, employee or contractor, must report any reasonable suspicion of a crime against a resident to the Secretary of Health and Human Services and to local law enforcement: within 2 hours if there is serious bodily injury, otherwise within 24 hours. A covered individual who fails to report can face a civil money penalty of up to $200,000.

Warning signs families notice

Residents with dementia or communication disabilities may not be able to report abuse themselves. Families and visitors are often the first to notice.

• Unexplained bruises, injuries, infections or bleeding
• Fear of one staff member, or agitation when that person is on shift
• Sudden changes in mood, sleep or eating, especially in a resident who cannot communicate easily
• Torn or stained clothing or bedding, or missing personal items
• Staff who discourage visits or will not let family speak to the resident alone

Who can be responsible

Depending on the facts, claims may involve the individual who caused harm and the facility or its operator. In general, these cases look at staffing levels, background screening, supervision, and how the facility handled earlier complaints and its federal reporting duties. State inspection reports and complaint findings can show patterns.

Records to request

• The resident's medical chart, care plan and nursing notes
• Incident reports and the facility's investigation of the allegation
• Staffing schedules for the dates in question
• State survey and complaint inspection reports for the facility
• Photos of injuries and a written timeline of what you observed

Where to get help

If someone is in immediate danger, call 911. The Eldercare Locator, a public service of the federal Administration for Community Living, connects families to local services at 1-800-677-1116. The National Adult Protective Services Association lists state reporting numbers for Adult Protective Services. RAINN's National Sexual Assault Hotline is available 24/7 at 800-656-4673.

Frequently asked questions

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