Which states have 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, over four times the next state’s rate, against 34.2 nationally. Colorado, Rhode Island, Utah and New York had the next-highest rates.

Residential care complaints per 1,000 licensed beds, federal fiscal year 2025: the five highest state rates and the national rate.
Nevada4,973 complaints · 484.1 per 1,000 beds

Colorado2,985 complaints · 115.9 per 1,000 beds

Rhode Island424 complaints · 84.4 per 1,000 beds

Utah1,045 complaints · 81.9 per 1,000 beds

New York4,119 complaints · 78.0 per 1,000 beds

National55,660 complaints · 34.2 per 1,000 beds

What stands out among the states with the highest rates

Nevada and New York: far more complaints for each home

A family in Nevada or New York with a concern about an assisted living or other residential care home is far from alone. Nevada’s ombudsman program closed 6.7 residential care complaints for every home in federal fiscal year 2025, and New York’s closed 5.7, against 0.8 nationally.

Colorado: an ombudsman visits nearly every home every quarter

In Colorado, an ombudsman is very likely to visit your parent’s home every quarter, whether or not anyone has complained. The program made those routine visits to 629 of its 670 homes in federal fiscal year 2025. Nationally, programs visited 28.1% of homes that often.

Utah: assisted living is a bigger part of the ombudsman’s caseload

In Utah, assisted living and other residential care make up a bigger part of the ombudsman’s caseload than in most states. Of the complaints the program closed about nursing homes and residential care, 42.5% were about residential care, against 28.0% nationally.

Assisted living and residential care complaints per bed in every state, the District of Columbia and Puerto Rico

Rank (1 = highest rate) State Complaints Licensed beds Per 1,000 beds
1 Nevada 4,973 10,272 484.1
2 Colorado 2,985 25,754 115.9
3 Rhode Island 424 5,026 84.4
4 Utah 1,045 12,755 81.9
5 New York 4,119 52,805 78.0
6 Oregon 2,560 36,909 69.4
7 Puerto Rico 1,593 23,194 68.7
8 New Jersey 2,121 31,502 67.3
9 Oklahoma 741 11,747 63.1
10 New Mexico 398 6,461 61.6
11 District of Columbia 124 2,018 61.4
12 Maine 447 8,061 55.5
13 Idaho 606 11,106 54.6
14 Connecticut 698 14,000 49.9
15 Alaska 222 4,964 44.7
16 Kentucky 580 14,142 41.0
17 California 8,486 209,953 40.4
18 Minnesota 3,330 83,100 40.1
19 Montana 213 5,905 36.1
20 South Carolina 790 22,054 35.8
21 Mississippi 313 8,744 35.8
22 Vermont 107 3,381 31.6
23 Ohio 2,260 76,690 29.5
24 South Dakota 153 5,310 28.8
25 Arizona 1,260 44,593 28.3
26 Georgia 1,201 45,824 26.2
27 Tennessee 601 23,657 25.4
28 North Carolina 1,005 39,600 25.4
29 Illinois 1,370 54,743 25.0
30 Maryland 613 26,486 23.1
31 North Dakota 114 5,081 22.4
32 Wisconsin 1,423 64,265 22.1
33 Washington 1,497 74,989 20.0
34 Wyoming 30 1,506 19.9
35 Pennsylvania 1,254 66,994 18.7
36 Indiana 417 23,213 18.0
37 Massachusetts 407 23,844 17.1
38 West Virginia 58 3,715 15.6
39 Texas 1,209 82,674 14.6
40 Arkansas 142 10,238 13.9
41 Virginia 544 39,378 13.8
42 New Hampshire 91 6,769 13.4
43 Nebraska 272 21,226 12.8
44 Delaware 36 2,822 12.8
45 Missouri 348 27,643 12.6
46 Florida 1,477 119,041 12.4
47 Kansas 171 15,957 10.7
48 Alabama 123 11,533 10.7
49 Louisiana 83 8,434 9.8
50 Iowa 265 28,747 9.2
51 Michigan 319 59,896 5.3
52 Hawaii 42 8,493 4.9
National 55,660 1,627,214 34.2

See the five states with the fewest 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?
  • Choice and rights: How can my family member choose daily routines and raise a concern?
  • Admission and discharge: Which circumstances could require a move, and where are those terms explained?

Frequently asked questions

Which state has the most assisted living and residential care complaints?

California’s ombudsman program closed 8,486 assisted living and residential care complaints in federal fiscal year 2025, the most of any state. California also has the most licensed beds, and its rate of 40.4 complaints per 1,000 beds is above the national rate of 34.2.

Which state has 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.

Does a high assisted living and residential care complaint rate mean worse care?

A high assisted living and residential care complaint rate means a state’s ombudsman program closed more complaints for each licensed bed, not that its homes give worse 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.