What people report about assisted living and residential care across America
The federal fiscal year 2025 ombudsman reports include 55,660 closed complaints about residential care communities, a category that includes assisted living and other residential settings. Care was the largest complaint category: 12,873 records, or 23.1%. Autonomy, choice and rights accounted for 8,176 (14.7%); environment accounted for 6,144 (11.0%).
These records can help families choose questions to ask. They cannot tell you the chance that a particular resident will receive poor care, or rank states from safest to least safe.
What the records count
The published FFY 2025 National Ombudsman Reporting System reports total 201,815 complaints across 52 reported jurisdictions: the 50 states, D.C. and Puerto Rico. Of these, 55,660 concern residential care communities, 143,252 nursing facilities and 2,903 other settings. The reporting year runs from October 1, 2024 through September 30, 2025.
Residential care communities are a broader reporting category than facilities using the name “assisted living.” The NORS definition includes regulated assisted living, board-and-care, adult foster or family homes and other qualifying residential settings. Other settings are a separate, optional program scope, including services outside the long-term-care-facility categories. NORS case and setting definitions.
NORS counts complaints reported through ombudsman casework and closed within the fiscal year. A case can contain more than one complaint. Verification is a separate field; the complaint total is not a count of proven regulatory violations or residents harmed.
All reported jurisdictions and settings
Other-setting figures below equal each jurisdiction’s all-setting total minus its nursing-facility and residential-care-community totals. This explicit derivation reconciles to the published national other-setting total. Puerto Rico is included throughout.
| Jurisdiction | Residential care communities | Nursing facilities | Other settings | All settings |
|---|---|---|---|---|
| Alabama | 123 | 1,132 | 0 | 1,255 |
| Alaska | 222 | 105 | 0 | 327 |
| Arizona | 1,260 | 1,283 | 0 | 2,543 |
| Arkansas | 142 | 698 | 4 | 844 |
| California | 8,486 | 17,029 | 247 | 25,762 |
| Colorado | 2,985 | 4,127 | 314 | 7,426 |
| Connecticut | 698 | 2,554 | 1 | 3,253 |
| Delaware | 36 | 272 | 1 | 309 |
| District of Columbia | 124 | 102 | 84 | 310 |
| Florida | 1,477 | 2,352 | 4 | 3,833 |
| Georgia | 1,201 | 4,297 | 1 | 5,499 |
| Hawaii | 42 | 118 | 0 | 160 |
| Idaho | 606 | 456 | 5 | 1,067 |
| Illinois | 1,370 | 6,166 | 0 | 7,536 |
| Indiana | 417 | 1,134 | 0 | 1,551 |
| Iowa | 265 | 1,025 | 100 | 1,390 |
| Kansas | 171 | 667 | 0 | 838 |
| Kentucky | 580 | 2,297 | 3 | 2,880 |
| Louisiana | 83 | 980 | 0 | 1,063 |
| Maine | 447 | 551 | 285 | 1,283 |
| Maryland | 613 | 3,365 | 0 | 3,978 |
| Massachusetts | 407 | 3,042 | 0 | 3,449 |
| Michigan | 319 | 3,539 | 0 | 3,858 |
| Minnesota | 3,330 | 2,543 | 323 | 6,196 |
| Mississippi | 313 | 1,320 | 6 | 1,639 |
| Missouri | 348 | 1,949 | 0 | 2,297 |
| Montana | 213 | 362 | 0 | 575 |
| Nebraska | 272 | 1,168 | 0 | 1,440 |
| Nevada | 4,973 | 6,061 | 28 | 11,062 |
| New Hampshire | 91 | 416 | 0 | 507 |
| New Jersey | 2,121 | 11,628 | 186 | 13,935 |
| New Mexico | 398 | 908 | 2 | 1,308 |
| New York | 4,119 | 18,466 | 0 | 22,585 |
| North Carolina | 1,005 | 1,965 | 22 | 2,992 |
| North Dakota | 114 | 199 | 0 | 313 |
| Ohio | 2,260 | 7,340 | 124 | 9,724 |
| Oklahoma | 741 | 4,404 | 2 | 5,147 |
| Oregon | 2,560 | 1,038 | 8 | 3,606 |
| Pennsylvania | 1,254 | 4,857 | 68 | 6,179 |
| Puerto Rico | 1,593 | 15 | 0 | 1,608 |
| Rhode Island | 424 | 1,619 | 29 | 2,072 |
| South Carolina | 790 | 1,671 | 232 | 2,693 |
| South Dakota | 153 | 243 | 0 | 396 |
| Tennessee | 601 | 2,999 | 0 | 3,600 |
| Texas | 1,209 | 7,205 | 1 | 8,415 |
| Utah | 1,045 | 1,415 | 0 | 2,460 |
| Vermont | 107 | 281 | 22 | 410 |
| Virginia | 544 | 2,264 | 23 | 2,831 |
| Washington | 1,497 | 1,452 | 2 | 2,951 |
| West Virginia | 58 | 833 | 0 | 891 |
| Wisconsin | 1,423 | 1,242 | 766 | 3,431 |
| Wyoming | 30 | 98 | 10 | 138 |
| All 52 | 55,660 | 143,252 | 2,903 | 201,815 |
The concerns reported in each setting
Care-category complaints account for 23.1% of residential-care-community complaints (12,873 of 55,660), compared with 34.3% of nursing-facility complaints (49,179 of 143,252). These percentages describe the mix of complaints within each setting. They do not measure a resident’s risk of receiving poor care.
A different calculation asks what share of care-category complaints across the two settings occurred in residential care communities: 12,873 divided by 62,052 is 20.7%. That denominator excludes other settings. It must not be presented as the 23.1% within-setting share.
| Category | RCC complaints | Share of RCC complaints | NF complaints | Share of NF complaints | Other complaints |
|---|---|---|---|---|---|
| A . Abuse, gross neglect, exploitation | 5,484 | 9.9% | 14,093 | 9.8% | 301 |
| B . Access to information | 1,239 | 2.2% | 3,174 | 2.2% | 42 |
| C . Admission, transfer, discharge, eviction | 5,287 | 9.5% | 12,747 | 8.9% | 309 |
| D . Autonomy, choice, rights | 8,176 | 14.7% | 21,951 | 15.3% | 350 |
| E . Financial, property | 4,001 | 7.2% | 7,816 | 5.5% | 81 |
| F . Care | 12,873 | 23.1% | 49,179 | 34.3% | 546 |
| G . Activities and community integration and social services | 2,224 | 4.0% | 5,456 | 3.8% | 143 |
| H . Dietary | 3,641 | 6.5% | 9,152 | 6.4% | 49 |
| I . Environment | 6,144 | 11.0% | 8,679 | 6.1% | 71 |
| J . Facility policies, procedures and practices | 4,046 | 7.3% | 6,491 | 4.5% | 155 |
| K . Complaints about an outside agency (non-facility) | 691 | 1.2% | 1,082 | 0.8% | 619 |
| L . System and others (non-facility) | 1,854 | 3.3% | 3,432 | 2.4% | 237 |
How to use these numbers
Complaint volume, access to reporting, ombudsman program activity and care quality are different questions. These totals alone cannot separate their contributions. A low count does not establish good care or poor reporting access; a high count does not establish worse care or better access. No cause is inferred from the spread across states.
This page makes no year-to-year trend claim. The retained coding review identifies revisions to complaint examples, disposition guidance and program-activity reporting; it does not establish a consistent full historical series. NORS revisions chart.
Frequently asked questions
Are these CMS inspection citations? No. These are ombudsman program reports. CMS nursing-home deficiency files are a different source with a different unit of counting.
Where can I find the reports or ombudsman program information? The National Ombudsman Resource Center data page publishes the FFY 2025 reports. The Administration for Community Living program page explains the program and links to help.
Questions to bring to a visit
Use the complaint categories as prompts for a conversation, then ask each home for its own written answers:
- Care: How will you record the help my family member needs, and what happens when those needs change?
- Choice and rights: How can residents choose daily routines and raise a concern?
- Environment: Can we see the bedroom, bathroom and shared spaces the resident would actually use?
- Admission and discharge: Which circumstances could require a move, and where are those terms explained?
These are suggested questions, not a finding about any particular home. The Administration for Community Living explains the ombudsman program and links to local help with residents’ concerns.
Sources and downloads
Read how we calculated the results. Download the complete jurisdiction table and complaint categories. The National Ombudsman Resource Center provides the original FFY 2025 reports. These downloads preserve the three setting categories; they are not a list of individual residents or cases.
Related: Five states with the most residential-care complaints per 1,000 beds and the five states with the fewest.