Texas Nursing Home Resources

Key Points

• If a nursing home resident in Texas is in immediate danger, call 911.
• Report the facility to HHSC Complaint and Incident Intake: use the TULIP complaint portal, available 24 hours a day, 7 days a week, or call 1-800-458-9858, Monday through Friday, 7 a.m. to 7 p.m. Central time.
• Abuse of an elderly person or a person with a disability who lives at home is a different report: the Texas Abuse Hotline, 1-800-252-5400, 24 hours a day.
• The State Long-Term Care Ombudsman (1-800-252-2412) advocates for residents. Ombudsmen do not replace an HHSC investigation.
• A complaint to HHSC can trigger an investigation. It does not file a lawsuit, and it does not pay medical bills, pain, or a death.

If Someone Is in Immediate Danger

If a nursing home resident in Texas is in immediate danger, call 911. Do not wait on a complaint form.

After the person is safe, report the facility to HHSC Complaint and Incident Intake. That report is separate from a call to the Long-Term Care Ombudsman and separate from a civil injury claim.

How to File a Nursing Home Complaint in Texas

What Does the State Survey Agency Do?

Texas Health and Human Services Commission (HHSC) Complaint and Incident Intake takes complaints about nursing homes. Staff in HHS Regulatory Services review the complaint and decide whether an investigation is warranted. HHSC says it investigates most, but not all, complaints. The current instructions are on the HHSC complaint page.

Complaint and Incident Intake is the intake office. It is not a separate agency from HHSC. The Centers for Medicare & Medicaid Services sets federal requirements for Medicare- and Medicaid-certified nursing homes and oversees the state survey.

Reporting Options in Texas

• Online: HHSC says the TULIP complaint portal is the most direct way to file and is available 24 hours a day, 7 days a week. An online complaint gets an intake number when you submit it.
• Phone: Call 1-800-458-9858. Agents answer Monday through Friday, 7 a.m. to 7 p.m. Central time. If you call outside those hours, leave a voicemail. HHSC says an employee will return the call by the next workday.
• Email: You can also email ciicomplaints@hhs.texas.gov.
• Mail: Mail goes to Texas Health and Human Services, Complaint and Incident Intake, Mail Code E249, P.O. Box 149030, Austin, TX 78714-9030.
• Fax: The long-term care fax numbers are 877-438-5827 and 512-438-2724.

When you leave a message, say and spell your name, give a daytime phone number with the area code, name the facility and its address, and describe the complaint.

Mail or fax is accepted, and HHSC encourages the portal or the phone so it can get the facts sooner. Complaints are not accepted in person.

A report about abuse, neglect, or exploitation inside a facility licensed by a state agency goes to that agency, not to Adult Protective Services. Human Resources Code § 48.051(b) says so. Nursing homes are reported to HHSC at the number above.

Abuse of an elderly person or a person with a disability who lives at home is a different report: the Texas Abuse Hotline, 1-800-252-5400, 24 hours a day, or txabusehotline.org. The Texas Adult Protective Services guide explains that community path. DFPS says it cannot accept email reports.

Assisted living complaints also go to HHSC Complaint and Incident Intake. The license and the rules are not the same as a nursing facility. Use the Texas assisted living complaint guide for that setting.

Filing an Anonymous Complaint in Texas

Health and Safety Code § 260A.004 says an anonymous report of abuse, neglect, or exploitation, although not encouraged, shall be received and acted on in the same manner as a report that includes the reporter’s name. An anonymous report about a specific individual that accuses that individual of abuse, neglect, or exploitation need not be investigated.

HHSC says that if you remain anonymous, it cannot send you the result. If you give your name, HHSC keeps that name, and the name of the resident, confidential unless the law requires a release. The public copy of an investigation report under § 260A.007 deletes the name of the person who made the report.

Types of Complaints Investigated

HHSC reviews complaints about nursing home care, including abuse, neglect, exploitation, quality of care, and resident rights. It does not investigate every report. The complaint page says HHS Regulatory Services does not investigate a matter that is not a violation of a regulation or statute it enforces, a complaint intended to harass the facility, a complaint it already investigated, or, with limited exceptions, an issue that occurred more than one year ago.

That one-year screen is a survey rule. It is not the deadline for a lawsuit. A civil claim can already be closed, or still be open, on a different clock.

What Information to Include in Your Complaint

HHSC asks you to have this ready when you can:

• Your name, mailing address, email, and daytime phone number, unless you are filing anonymously.
• Your relationship to the resident.
• The facility’s name and address.
• How you learned about what happened, including whether you saw it.
• The resident’s name, date of birth, how the resident pays for care, and the room or unit.
• The date, time, and place, and the names of staff, witnesses, and anyone else who may know what happened.
• Whether the problem looks isolated or whether other residents have the same problem.

A Social Security number is on HHSC’s list of information to have if possible. You can still file if you do not have every item.

What Happens After You File a Complaint in Texas

HHSC says each complaint is prioritized by what it alleges, how immediate it is, and the risk. For a long-term care provider, HHSC says it must investigate a threat of imminent danger of death or serious bodily harm within 24 hours.

For a report of abuse, neglect, or exploitation in a facility covered by Health and Safety Code Chapter 260A, § 260A.007 sets when the department must begin the investigation. Chapter 260A defines a facility to include an institution under § 242.002 and an assisted living facility. HHSC’s complaint page lists nursing homes among the providers reported to Complaint and Incident Intake. The investigation must begin within 24 hours after receipt when the report alleges any of the following:

• A resident’s health or safety is in imminent danger.
• A resident has recently died because of the conduct alleged.
• A resident has been hospitalized or treated in an emergency room because of the conduct alleged.
• A resident has been a victim of an act or attempted act described in Penal Code §§ 21.02, 21.11, 22.011, or 22.021.
• A resident has suffered bodily injury, as Penal Code § 1.07 defines that term, because of the conduct alleged.

If the report alleges circumstances that could result in abuse, neglect, or exploitation and that could place a resident’s health or safety in imminent danger, the investigation must begin before the end of the next working day. These are start times. They are not a promise that HHSC will finish every complaint on a set day.

Section 260A.007 also says the written investigation report is prepared not later than the 30th day after the investigation is complete. That is a deadline for the report after the investigation ends. It is not a deadline to finish the investigation.

The same section requires an unannounced investigation, and an unannounced visit to investigate abuse or neglect. HHSC says investigations are unannounced and may be conducted on site or off site. Within 24 hours after a report in the categories above, the department must also report it to the law enforcement agency described in the statute.

If you gave contact information, HHSC says you receive an acknowledgement. When the investigation is finished, you are notified of the result in writing or by phone. Anonymous complainants are not notified. Surveyors may call you for more detail. Inspection results for Medicare-certified homes are posted on Medicare Care Compare.

If surveyors find the facility failed to meet a requirement, they can cite a deficiency. For a Medicare- or Medicaid-certified nursing home, 42 CFR 488.406 lists remedies that include the following, in addition to termination of the provider agreement:

• temporary management
• denial of payment for new admissions
• civil money penalties
• state monitoring
• transfer of residents
• closure and transfer of residents
• a directed plan of correction
• directed in-service training

After notice and an opportunity for a hearing, Health and Safety Code § 242.061 allows the department to deny, suspend, or revoke a license when it finds a repeated or substantial violation, or another ground the section lists. A citation or a remedy does not award money to the resident.

Recognizing Signs of Nursing Home Abuse in Texas

Warning signs are not proof. They are reasons to ask questions, write down what you see, and report if you are concerned:

• Physical abuse: unexplained bruises, cuts, fractures, or burns; injuries in different stages of healing; restraint marks; or a resident who flinches when a caregiver approaches.
• Emotional abuse: withdrawal, depression, anxiety, or fear around particular staff. A resident who becomes unusually quiet or agitated may be facing verbal threats or intimidation.
• Sexual abuse: bruising or bleeding around the genitals, torn or stained undergarments, a sexually transmitted infection, or a sudden change in behavior.
• Neglect: poor hygiene, sudden weight loss, dehydration, an untreated bedsore, an unclean room, or an untreated infection.
• Financial exploitation: unexplained withdrawals, missing belongings, sudden changes to a will or power of attorney, or unpaid bills when the resident has the money to pay them.

Documenting and Reporting Suspected Abuse

A written record helps you answer questions from HHSC and, if you ask for one later, from a lawyer. It does not replace the report. Do not delay a 911 call in order to build a file.

Keep what you are allowed to have:

1. Photographs of injuries and of the room, for your own file.
2. Notes with dates, times, and places.
3. Medical records that document an injury or a change in health.
4. Names of witnesses, including other residents, visitors, and staff.
5. Notes of what staff or management said when you raised the concern.

HHSC asks you not to send documents, pictures, or video with the complaint. Tell them you have those materials. The instruction is on the HHSC complaint page.

Texas's Legal Framework for Nursing Home Complaints

A complaint to HHSC can trigger an investigation. It does not file a lawsuit, and it does not pay medical bills, pain, or a death. Those are separate.

Many claims about medical care, or about skilled nursing or personal care, are health care liability claims. Civil Practice and Remedies Code § 74.251 says no health care liability claim may be commenced unless the action is filed within two years from the occurrence of the breach or tort, or from the date the medical or health care treatment that is the subject of the claim, or the hospitalization for which the claim is made, is completed.

The same section says a claimant must bring the claim not later than 10 years after the act or omission. That 10-year limit is a statute of repose. Section 74.251 applies notwithstanding any other law, subject to that repose, and it has a special filing rule for a minor under 12.

The two years run from the breach, the tort, or the end of that treatment or hospitalization. They do not run from the day the family learns of the injury.

A bodily-injury suit that is not a health care liability claim is often brought under Civil Practice and Remedies Code § 16.003(a), which generally requires the suit within two years after the cause of action accrues. An action for injury resulting in death must be brought not later than two years after the day the cause of action accrues, and § 16.003(b) says that cause of action accrues on the death of the injured person.

Which statute applies depends on the facts. This page is general information. It is not a determination of the deadline in any particular case. A longer explanation of pleading a Texas nursing home injury claim is on the Texas nursing home lawsuits page.

Health and Safety Code § 242.501 requires a statement of the rights of a resident in a nursing facility. The statement must be consistent with Human Resources Code Chapter 102, and it must address the rights the section lists, including the right to be free from abuse and exploitation and the right to complain about the institution. Medicare- and Medicaid-certified homes are also subject to 42 CFR 483.12, the federal right to be free from abuse, neglect, and exploitation.

The form on this page asks for a consult about an injury or neglect claim. It does not submit your complaint to HHSC.

Contacting the Long-Term Care Ombudsman in Texas

The State Long-Term Care Ombudsman advocates for people who live in a nursing facility or an assisted living facility. Ombudsmen listen to concerns, explain rights, and help resolve complaints about care. They do not license the facility, and they do not replace an HHSC investigation.

Call 1-800-252-2412 or email ltc.ombudsman@hhs.texas.gov. Services are free, confidential, and available statewide.

National Resources

These lines do not take a Texas nursing home complaint. HHSC does. They can help you find other services:

• Eldercare Locator: 1-800-677-1116. The Administration for Community Living says this line connects older adults and their families with local services. See the Eldercare Locator.
• National Center on Elder Abuse: 855-500-3537. The Administration for Community Living lists that number as an information line for the center. It is not the Texas complaint number. See ACL’s national resource centers.
• National Adult Protective Services Association: a national association for Adult Protective Services programs. Its site is napsa-now.org.