Which states have the fewest assisted living and residential care complaints per bed?
Hawaii’s ombudsman program closed 4.9 assisted living and residential care complaints per 1,000 licensed beds in federal fiscal year 2025, the lowest rate of any state, against 34.2 nationally. Michigan, Iowa, Louisiana and Alabama had the next-lowest rates.
How often does an ombudsman visit assisted living and residential care homes?
Nationally, ombudsman programs visited 58.4% of residential care homes at least once in federal fiscal year 2025 and 28.1% every quarter without waiting for a complaint. Among the five states with the fewest complaints per bed, the share of homes with a routine quarterly visit runs from none to nearly all.
Hawaii: almost no home had an ombudsman visit every quarter
A Hawaii family with a concern should contact the ombudsman program rather than wait for a visit. Only 4 of the state’s 1,736 residential care homes had a routine ombudsman visit every quarter.
Michigan: most homes went the whole year without seeing an ombudsman
Michigan’s program visited 1,380 of its 4,333 residential care homes during the year and gave none of them a routine visit every quarter. Ask any Michigan home you tour when an ombudsman last came by.
Iowa: a yearly ombudsman visit is likely, a routine quarterly one is not
An ombudsman stopped by 300 of Iowa’s 493 residential care homes during the year, and only 2 had a routine visit every quarter.
Louisiana: an ombudsman reached nearly every home during the year
All but 10 of Louisiana’s 157 residential care homes had at least one ombudsman visit during the year.
Alabama: quarterly ombudsman visits almost everywhere
Routine quarterly visits reached 308 of Alabama’s 331 residential care homes.
Assisted living and residential care complaints per bed by state
| State | Complaints | Licensed beds | Per 1,000 beds |
|---|---|---|---|
| Hawaii | 42 | 8,493 | 4.9 |
| Michigan | 319 | 59,896 | 5.3 |
| Iowa | 265 | 28,747 | 9.2 |
| Louisiana | 83 | 8,434 | 9.8 |
| Alabama | 123 | 11,533 | 10.7 |
| Kansas | 171 | 15,957 | 10.7 |
| Florida | 1,477 | 119,041 | 12.4 |
| Missouri | 348 | 27,643 | 12.6 |
| Delaware | 36 | 2,822 | 12.8 |
| Nebraska | 272 | 21,226 | 12.8 |
| New Hampshire | 91 | 6,769 | 13.4 |
| Virginia | 544 | 39,378 | 13.8 |
| Arkansas | 142 | 10,238 | 13.9 |
| Texas | 1,209 | 82,674 | 14.6 |
| West Virginia | 58 | 3,715 | 15.6 |
| Massachusetts | 407 | 23,844 | 17.1 |
| Indiana | 417 | 23,213 | 18.0 |
| Pennsylvania | 1,254 | 66,994 | 18.7 |
| Wyoming | 30 | 1,506 | 19.9 |
| Washington | 1,497 | 74,989 | 20.0 |
| Wisconsin | 1,423 | 64,265 | 22.1 |
| North Dakota | 114 | 5,081 | 22.4 |
| Maryland | 613 | 26,486 | 23.1 |
| Illinois | 1,370 | 54,743 | 25.0 |
| North Carolina | 1,005 | 39,600 | 25.4 |
| Tennessee | 601 | 23,657 | 25.4 |
| Georgia | 1,201 | 45,824 | 26.2 |
| Arizona | 1,260 | 44,593 | 28.3 |
| South Dakota | 153 | 5,310 | 28.8 |
| Ohio | 2,260 | 76,690 | 29.5 |
| Vermont | 107 | 3,381 | 31.6 |
| Mississippi | 313 | 8,744 | 35.8 |
| South Carolina | 790 | 22,054 | 35.8 |
| Montana | 213 | 5,905 | 36.1 |
| Minnesota | 3,330 | 83,100 | 40.1 |
| California | 8,486 | 209,953 | 40.4 |
| Kentucky | 580 | 14,142 | 41.0 |
| Alaska | 222 | 4,964 | 44.7 |
| Connecticut | 698 | 14,000 | 49.9 |
| Idaho | 606 | 11,106 | 54.6 |
| Maine | 447 | 8,061 | 55.5 |
| District of Columbia | 124 | 2,018 | 61.4 |
| New Mexico | 398 | 6,461 | 61.6 |
| Oklahoma | 741 | 11,747 | 63.1 |
| New Jersey | 2,121 | 31,502 | 67.3 |
| Puerto Rico | 1,593 | 23,194 | 68.7 |
| Oregon | 2,560 | 36,909 | 69.4 |
| New York | 4,119 | 52,805 | 78.0 |
| Utah | 1,045 | 12,755 | 81.9 |
| Rhode Island | 424 | 5,026 | 84.4 |
| Colorado | 2,985 | 25,754 | 115.9 |
| Nevada | 4,973 | 10,272 | 484.1 |
| National | 55,660 | 1,627,214 | 34.2 |
See the five states with the most complaints per 1,000 beds.
Questions to ask an assisted living or residential care home
Ask each home you are considering these questions, and ask for the answers in writing:
- Care: How will you record the help my family member needs, and what happens when those needs change?
- Environment: Can we see the bedroom, bathroom and shared spaces my family member would use, not a model room?
- Choice and rights: How can my family member choose daily routines and raise a concern?
Frequently asked questions
Which state has the fewest assisted living and residential care complaints?
Wyoming’s ombudsman program closed 30 assisted living and residential care complaints in federal fiscal year 2025, the fewest of any state, and Wyoming also has the fewest licensed beds. Counted per 1,000 licensed beds, Hawaii had the fewest, 4.9, against 34.2 nationally.
Which state has the most assisted living and residential care complaints per bed?
Nevada’s ombudsman program closed 484.1 assisted living and residential care complaints per 1,000 licensed beds in federal fiscal year 2025, more than four times the next state’s rate, against 34.2 nationally.
Does a low assisted living and residential care complaint rate mean better care?
A low assisted living and residential care complaint rate means a state’s ombudsman program closed fewer complaints for each licensed bed, not that its homes give better care.
How do I file a complaint about an assisted living or residential care home?
You can file a complaint about an assisted living or residential care home with the long-term care ombudsman program in the home’s state. Residents, family members, friends, the home’s staff and other concerned people can all bring a complaint. The program can also refer a complaint to the state’s licensing agency, adult protective services or law enforcement.
Find the ombudsman program for the home’s state through the Administration for Community Living.
Sources
Our study What people report about assisted living and residential care across America gives every state’s complaint totals by setting and the categories families raise most. The counting rules are in how we calculated the results. Complaint counts and licensed beds for federal fiscal year 2025 come from the National Ombudsman Reporting System, published by the National Ombudsman Resource Center. Download the ranked table.