Right now. Before you do anything else.

Take photos of any wounds, bruises, rashes, or changes in your loved one’s body. Use your phone. Get close-up shots and wide shots. Make sure the date and time stamp is visible.

Give every document the facility gives you: discharge papers, care plans, medication lists, wound care notes, billing statements.

Write down what you saw, what you were told, who staff told you, and who you spoke with. Include names, dates, and times. Your memory will blur over the coming weeks. Paper does not.

If something looks wrong, photograph it before anyone has a chance to change it.

You have this legal right to your loved one’s complete medical record, not a summary, not a printout of the last visit. The full chart, every nurse’s note, every wound care log, every medication administration record, every repositioning log, every care plan, every physician order.

Federal law protects this right. Under 42 CFR 483.20(g)(1), every nursing home resident or their legal representative has the right to access all clinical records within 24 hours of an oral or written request, including weekends and holidays. If a facility tells you to wait for a “care conference” or says the records are being “processed,” they are in direct violation of federal resident rights.

Ask for the record in writing. Document the date you asked and who you spoke with.

Request the audit trail. If the facility uses electronic health records, request the “audit trail” or “metadata.” This electronic footprint shows every time a staff member created, viewed, edited, opened, or deleted an entry in the chart.

When you get the chart, read it the way an insurance adjuster would: every line, every checklist, every signature. Count the empty boxes in the repositioning log. Compare what the wound care logs say with what you witnessed. The gap between the chart and the truth is where the evidence lives.

You do not need a lawyer to file a report. You do not need proof. You need a concern.

• Call the Eldercare Locator at 1-800-677-1116. This is a free, nationwide service run by the U.S. Administration on Aging. Tell them what you saw. They will connect you to the right agency.
• Your local Adult Protective Services (APS) investigates abuse and neglect of vulnerable adults.
• Your state’s Long-Term Care Ombudsman is legally required by federal law to have a presence in every state. These are independent advocates who are legally authorized to enter nursing homes and assisted living facilities, investigate resident complaints, and push for accountability. Their services are free. Find your state’s Ombudsman at ltcombudsman.org.
• You have the right to file a complaint with your state’s Department of Health. Every state has a process for this. The Eldercare Locator will walk you through how to file in your state.

Filing a report does not mean you are suing anyone. It means you are putting the facility on notice. It means someone outside that building now knows what is happening inside it.

Before you make your next decision, look up this facility on Medicare Care Compare at medicare.gov/care-compare. Search the facility name. Here is what to look for:

• The Overall Rating (1 to 5 stars). A 1 or 2 star rating means “Much Below Average.”
• The Staffing Rating. This is the most important number on the page. Facilities with 1 or 2 stars in staffing frequently have “missed care,” meaning staff did not have enough time or personnel to turn residents, check for skin breakdown, or assist with basic functions.
• The Health Inspection Deficiency Reports. These describe exactly what state and federal inspectors found during their visits. Look for F-Tags. These are federal citation codes that identify specific problems.
• F688: Failure to prevent or treat pressure ulcers.
• F689: Failure to prevent or treat fall injuries.
• F676: Failure to assist with activities of daily living.
• F758: Failure to avoid unnecessary antipsychotic medications.
• F684: Failure to provide quality of care.

You should also search the facility name on ProPublica’s Nursing Home Inspect tool at projects.propublica.org/nursing-homes. ProPublica compiles years of inspection data in a searchable, readable format that is easier to navigate than the Medicare site.

If you have the medical chart, you now have the ability to conduct your own audit. Here is what to look for:

• Count the empty shifts in the Treatment and Administration Record (TAR). The TAR tracks whether residents are being repositioned, cleaned, and checked for skin breakdown. Each shift gets a checkbox. If you find 10, 20, or 30 empty shifts in a single month, you are looking at documented evidence that nobody received your loved one for days or weeks at a time.
• Compare the wound care logs to reality. If the log says “minor abrasion, healing, non-painful,” but you are looking at a wound with black tissue, exposed bone, or a sinus tract the size of your fist, the chart is lying. If the log says “wound resolved” on a date when the wound was visibly worsening, that entry is evidence of fraud.
• Check the admission status. If the admission record says your loved one was continent (able to use the toilet) but the facility placed them in adult diapers, ask why. In many neglect cases, facilities routinely place residents in diapers because they do not have enough staff to assist with toileting. Prolonged exposure to waste in a diaper is a direct cause of skin breakdown and pressure wound development.
• Check the Braden Social Assessment. This is a standard tool used at admission to evaluate a resident’s risk for pressure injury. If the score shows “moderate” or “high” risk but the documentation shows the facility identified the danger and did nothing about it, that is liability on paper.

If your loved one has suddenly declined and the facility is urging you to transition them to hospice care instead of transferring them to a hospital, stop and ask why.

In documented neglect cases across the country, facilities have used the hospice recommendation as a strategy to avoid mandatory reporting. Here is how it works: if a resident with a Stage 4 pressure wound is transferred to a hospital, hospital nurses are mandatory reporters. They will document the wound. They will report it. That report triggers a state investigation, and in some cases, a coroner’s review.

If the same resident is placed on hospice, the death is expected. It rarely triggers an investigation.

You have the right to refuse hospice. You have the right to transfer your loved one to a hospital at any time. If a facility pressures you to “keep them comfortable” instead of getting them emergency medical care, that pressure itself is a red flag.

If you believe neglect caused injury or death, know this: most nursing home abuse attorneys offer free consultations. You do not pay unless they take your case and win.

Visit nursinghomeabuseguide.org to find an attorney in your state. The site provides state-by-state listings and explains the legal process in plain language.

When you call, ask about the statute of limitations. Every state sets a different deadline for filing a lawsuit for an injury or death. In some states, this window is as short as one year. Miss the deadline and the courthouse door closes permanently, no matter how strong your evidence.

Do not assume you have time. Ask the question now.

As a family member, you have rights that facilities often do not tell you about. These rights are protected under the federal Nursing Home Reform Act.

• You have the right to visit at any time. Federal law protects your access to your loved one 24 hours a day, 7 days a week, subject to the resident’s consent. A facility cannot legally “ban” a family member from visiting because they asked questions or requested a medical record.
• You have the right to participate in care planning. The facility is required to include you in “Care Plan” meetings and in decisions about your loved one’s treatment.
• You have the right to file a complaint without retaliation. It is illegal for a facility to punish, discharge, or reduce care for a resident because a family member filed a complaint.
• You have the right to contact the Ombudsman at any time. The Long-Term Care Ombudsman program exists to protect residents. They will listen. They will investigate. They will advocate.

For a comprehensive overview of resident rights, visit Justice in Aging at justiceinaging.org. Their guide covers 25 of the most common problems families face in nursing homes and explains the federal protections that apply to each one.

These organizations exist because this problem is bigger than one family, one corporation, or one facility. They want to know what happened to your loved one.

• The National Center for Elder Abuse (ncea.acl.gov) provides state-by-state resources, research, and information on elder abuse in all its forms.
• The Long-Term Care Ombudsman program (ltcombudsman.org) is a federally mandated advocacy program with representatives in every state.
• The Eldercare Locator (1-800-677-1116) at eldercare.acl.gov connects families with local services for older adults, including legal assistance, transportation, housing, and caregiver support.

These organizations exist because this problem is in every state, in every city, affecting every kind of family. They want to know what happened in your case.