Sexual Abuse in Nursing Homes and Assisted Living

People live in nursing homes and assisted living because they need care and protection. Sexual abuse of a resident is a crime and a serious failure of care, whoever commits it. This page explains the rules facilities must follow to prevent and report abuse, who may be responsible, and how a civil claim may work.

What nursing home sexual abuse can involve

Sexual abuse in a care facility means any sexual contact or conduct that a resident did not agree to or could not agree to. Federal rules name sexual abuse as one of the kinds of abuse a nursing home must never allow.1 It can take many forms, including:

• Unwanted touching during bathing, dressing or toileting
• Sexual contact with a resident who cannot consent because of dementia or another condition
• Exposure, sexual comments, or taking photos or video of a resident
• Sexual assault by a staff member, another resident or a visitor
• Using a resident’s need for care to pressure or threaten them

Many survivors live with dementia, the effects of a stroke or other conditions that make it hard to speak up or to be believed. Some cannot describe what happened at all. That does not make their experience any less real. It is one reason facilities have strict duties to watch for abuse and report it quickly.

Abuse can happen alongside neglect, such as missed checks, short staffing or poor supervision. If your main concern is care that was missed rather than sexual abuse, nursing home neglect is part of our personal injury practice.

Who may be responsible

The person who committed the abuse is responsible for what they did. Other people and organizations may also be legally responsible, depending on the facts and the law of the state. This is never automatic. It usually turns on what the facility knew, what it should have known, and what it did about it.

• The person who committed the abuse, whether an aide, nurse, other employee, contractor or visitor
• The facility, if it failed to screen, train or supervise staff, or ignored warnings
• The company that owns or manages the facility, depending on who made decisions about staffing and safety
• A staffing agency that placed the worker, depending on its role in hiring and oversight

Sometimes the harm comes from another resident. That resident may have a brain illness and may not understand what they did. In those cases, the focus is usually on the facility: whether it knew about earlier incidents, assessed the risk, and took reasonable steps to keep residents safe from one another. Every resident deserves safety and dignity, including the person whose behavior caused harm.

These questions are similar to the ones in other cases against organizations, which we cover on our institutional abuse page.

Federal rules that protect nursing home residents

Nursing homes that take part in Medicare or Medicaid must follow federal rules. One of them, 42 CFR 483.12, gives each resident the right to be free from abuse, including sexual abuse.1 Under that rule, a facility must:

• Not employ people who were found guilty of abuse by a court, who have an abuse finding on a state nurse aide registry, or who were disciplined by a licensing board for abuse
• Have written policies that prohibit and prevent abuse, and train staff on them
• Report an allegation of abuse right away to the administrator and to state officials, including the state survey agency, and no later than 2 hours after the allegation is made
• Protect residents from further abuse while it investigates
• Report the results of its investigation to state officials within 5 working days

Assisted living is different. It is licensed and regulated mainly by each state, and the rules vary a great deal. Many federal nursing home rules do not apply to assisted living. A lawyer can look at which state rules covered the place where your loved one lived.

Reporting suspected crimes under the Elder Justice Act

A federal law passed as part of the Elder Justice Act adds another layer. It is found at 42 U.S.C. 1320b-25, also known as Section 1150B of the Social Security Act.2 It applies to long-term care facilities that received at least $10,000 in federal funds in the year before.

Under this law, the facility’s owners, operators, employees, managers, agents and contractors must report any reasonable suspicion of a crime against a resident to federal officials and at least one law enforcement agency. If the suspected crime caused serious bodily injury, the report is due within 2 hours. Otherwise, it is due within 24 hours.2

The law also bars a facility from punishing an employee who makes a report. A person who fails to report can face civil money penalties.2

Reports do not always happen. In a 2019 review, the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) estimated that 1 in 5 high-risk emergency room claims for skilled nursing facility residents in 2016 were the result of potential abuse or neglect. It found that facilities failed to report 43 of the 51 sampled incidents it reviewed to state agencies.3 The U.S. Government Accountability Office also found that abuse citations in nursing homes more than doubled between 2013 and 2017.4

Inspection reports, ombudsmen and Adult Protective Services

Families have several places to look for information and to ask for help. You can use more than one.

Where families can turn

1. Look up inspection records

   Medicare’s Care Compare tool shows ratings and state inspection results for nursing homes that take part in Medicare or Medicaid, including problems inspectors cited.5

2. Contact the long-term care ombudsman

   Every state has a long-term care ombudsman program. Ombudsmen are advocates for residents of nursing homes, assisted living and similar homes. They can help with complaints and explain residents’ rights.6

3. Report to Adult Protective Services

   Adult Protective Services (APS) agencies respond to reports of abuse, neglect and exploitation of older adults and adults with disabilities. Their role in care facilities differs by state.7

4. Tell the state survey agency

   The state agency that inspects nursing homes also takes complaints. It can open its own investigation.

5. Call the police

   Sexual abuse is a crime. If someone is in danger now, call 911. You can also report to local law enforcement at any time.

Criminal cases against caregivers are often handled by a state Medicaid Fraud Control Unit. Despite the name, these units also investigate and prosecute patient abuse and neglect. In federal fiscal year 2025, they reported 329 convictions for patient abuse or neglect. Nurse’s aides were the largest group of providers convicted in those cases.8

Warning signs and failures that can matter

Signs of sexual abuse in an older adult can be hard to see. A change in the person may be the only clue, especially when they cannot explain what happened. Families sometimes notice:

• Injuries, pain or infections that no one can explain
• New fear of a certain staff member, resident or room
• Sudden changes in mood, sleep or eating
• Pulling away from bathing, dressing or other care
• Torn or stained clothing or bedding
• Staff who seem to discourage visits or questions

In a civil case, the focus is often on what the facility did or failed to do. Failures that can matter include:

• Hiring without proper background or registry checks
• Ignoring earlier complaints about a worker
• Too few staff to supervise residents, especially at night
• No plan to protect residents from a resident with known risky behavior
• Failing to report or investigate an allegation
• Letting an accused worker keep caring for residents

Evidence that may matter

You do not need to gather everything before you reach out. A lawyer can often request records that families cannot get on their own. Evidence that may matter includes:

• The resident’s medical chart, care plan and nursing notes
• Incident reports and the facility’s own investigation
• State inspection reports and complaint findings
• Staffing schedules and call-light or door records
• Police, APS and ombudsman records
• Hospital or forensic exam records
• Your own notes, texts, photos and a timeline of what you saw
• The worker’s personnel file and any earlier complaints

If you are worried that records or video could be lost, tell a lawyer early. A lawyer can send a letter asking the facility to keep evidence.

Deadlines vary by state

Every state sets its own deadline for filing a civil claim, called a statute of limitations. The time allowed depends on the state, the type of claim, who the defendant is and when the harm was discovered. Some states have extra steps for claims against health care providers, such as giving notice or getting an expert review before a lawsuit is filed.

If the facility is run by a government, such as a county nursing home or a state veterans home, a notice of claim may be required within a much shorter time. Missing that step can end a claim.

If the resident has died, a family member or the estate may be able to bring a claim. A wrongful death claim may be possible when abuse, or the failures around it, contributed to a death. These claims have their own deadlines and their own rules about who can file.

Criminal cases, civil claims and privacy

A criminal case is brought by a prosecutor. It can lead to prison or other penalties for the person who committed the abuse. A civil claim is brought by the survivor or their family and asks for money damages for the harm. The two can happen at the same time, and a civil claim can go forward even if no one was charged.

A family member can often act for a resident who cannot manage their own affairs, for example as a guardian, as an agent under a power of attorney, or through the estate. Who can act depends on state law.

Families often worry about their loved one’s dignity. Depending on the court and the state, it may be possible to ask a judge to let the survivor proceed under initials or a pseudonym, and to keep medical details sealed. That decision belongs to the court, so it cannot be promised.

How CBW reviews these claims

We start by listening. We ask where the resident lived, when the abuse happened or was discovered, what the facility was told and what it did. Then we look at who may be responsible, which state’s laws apply and what deadlines may be running.

The review is free and confidential. If we take the case, there are no attorney’s fees unless we recover for you. We cannot promise a result, but we will explain your options honestly. You can read about the other settings we review on our sexual assault and abuse page. If a paid caregiver abused someone in their own home, our page on home health care sexual abuse may help.

What happened to your loved one was not their fault, and it is not yours.

Questions

Questions families ask about nursing home sexual abuse

Short answers to common questions. Every situation is different, and the law varies by state.

Can a family member bring a claim for a resident with dementia?

Often, yes. A guardian, an agent under a power of attorney, or another legal representative may be able to act for a resident who cannot manage their own affairs. Who can act, and how, depends on state law.

You do not need to have that paperwork in place before you contact us. We can talk through the options with you.

What if the abuse was by another resident?

Facilities have a duty to protect residents from abuse by anyone, including other residents.1 A claim in this situation usually focuses on the facility: whether it knew about earlier incidents, assessed the risk and took reasonable steps to keep people safe.

The resident who caused harm may have an illness that affects their judgment. We approach these cases with respect for everyone involved.

How quickly must a nursing home report sexual abuse?

Under federal rules, a nursing home must report an allegation of abuse to the administrator and to state officials right away, and no later than 2 hours after the allegation is made.1 Separately, facility staff and others must report a reasonable suspicion of a crime within 2 hours if there is serious bodily injury, or within 24 hours otherwise.2

Do the same federal rules cover assisted living?

Mostly, no. Assisted living is licensed and regulated by each state, and the rules differ. The long-term care ombudsman program does serve people in assisted living, and APS may be able to help.67 A lawyer can look at which state rules applied.

Where can I look up a nursing home’s inspection history?

Medicare’s Care Compare tool lists ratings and inspection results for nursing homes that take part in Medicare or Medicaid.5 Your state survey agency may also have inspection and complaint reports. A clean record does not mean nothing happened.

What if my loved one has passed away?

A family member or the person handling the estate may be able to bring a claim. If abuse or the failures around it contributed to the death, a wrongful death claim may be possible. These claims have their own deadlines, so it helps to ask early.

Will my loved one have to testify?

Not always. Every case is different. Many civil cases are resolved without a trial, but no one can promise that. If testimony is needed, courts can sometimes make arrangements for people who are frail or have memory loss. A settlement, if one is reached, is not an admission of fault.

What does it cost to talk with CBW?

Nothing. The review is free and confidential, and contacting us does not create an attorney-client relationship. If we take the case, there are no attorney’s fees unless we recover for you.

Tell Us Your Story

You trusted a facility to care for someone you love. If that trust was broken, you deserve to be heard.

You can tell us as much or as little as you want. There is no cost, and asking does not commit you to anything.

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This page is general information, not legal advice, and reading it or contacting us does not create an attorney-client relationship. Allegations described anywhere on this site are allegations unless a court or agency has found otherwise. No outcome can be promised. Laws and deadlines vary by state.