reporting someone to social services for neglect

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How to Make an Anonymous CPS Report Online & Over the Phone

Last Updated: January 6, 2024 Fact Checked

How to Anonymously Report to CPS

• State Phone Numbers & Websites

Other Important Hotlines

• Who Can Report

How to Recognize Child Abuse

This article was co-authored by Clinton M. Sandvick, JD, PhD and by wikiHow staff writer, Janice Tieperman . Clinton M. Sandvick worked as a civil litigator in California for over 7 years. He received his JD from the University of Wisconsin-Madison in 1998 and his PhD in American History from the University of Oregon in 2013. There are 7 references cited in this article, which can be found at the bottom of the page. This article has been fact-checked, ensuring the accuracy of any cited facts and confirming the authority of its sources. This article has been viewed 390,404 times.

Any suspected child abuse or neglect is a serious issue, and it’s important to report it to Child Protective Services (CPS) as soon as possible. In the United States, CPS is managed on a state level, so it’s essential to contact your state’s CPS branch online or over the phone to make an anonymous report. We’ll walk you through everything you need to know about the reporting process, including useful phone numbers, websites, and hotlines. We’ll also cover the different types of child abuse and how to recognize them so you can be as informed as possible when making your report.

Things You Should Know

• Make an anonymous report online or over the phone using your state’s designated website and phone number.
• Provide as much detail as you can in your report, including the events or observations that caused you to suspect abuse.
• Call the Childhelp National Hotline at 1-800-422-4453 for additional advice on how to report child abuse.

• Check the State Phone Numbers & Websites for Reporting section below to find the best ways to report child abuse in your state.

• “Whenever I see Jake, an 8-year-old kid in my neighborhood, he’s always covered in bruises. I’m worried that his parents might be abusing him at home.”
• “Casey Perkins, a 12-year-old in my child’s class, frequently comes to school in dirty clothes, and she has an obvious body odor. My child also notices that she asks other students for part of their lunches—I’m concerned that she might be neglected at home.”
• “I volunteer at a summer camp, and I’m seriously concerned that Randall Ramirez, a 9-year-old kid there, might be getting sexually abused at home. They always seem to be in pain when they’re sitting down, and they tested positive for an STI at the infirmary.”

• Call the Childhelp Hotline at 1-800-422-4453 to learn if/how you can follow up on your case.

State Phone Numbers & Websites for Reporting

• * means that the website is meant for mandated reporters only
• ** means that the website may be unavailable

• Childhelp also offers text support at the same number and live chat support on their website.

• Keep in mind that CyberTipline is meant to report online child abuse, not adult abuse. If someone has posted inappropriate content of an adult online, visit the Stop Non-Consensual Image Abuse website or the FBI’s Internet Crime Complaint Center .

Who can make an anonymous CPS report?

• Visit the Child Welfare Information Gateway's website for more information about mandatory reporters.

• The child is absent often.
• The child doesn’t dress appropriately for the weather.
• The child seems filthy and smells bad.
• The child requests food and/or steals money from others. [7] X Trustworthy Source Child Welfare Information Gateway Online portal managed by the U.S. Children's Bureau providing resources related to childcare and abuse prevention Go to source

• A child with visible injuries (e.g., bruises, burns, bites, etc.).
• A child who’s visibly afraid of their parent or guardian.
• A child who’s fearful of adults.
• A child with disappearing injuries after being away from school. [9] X Trustworthy Source Child Welfare Information Gateway Online portal managed by the U.S. Children's Bureau providing resources related to childcare and abuse prevention Go to source

• A child with polarizing types of behavior (e.g., being incredibly submissive then being incredibly aggressive).
• A child who’s behind their peers when it comes to emotional development and maturity.
• A child who acts extremely mature or extremely juvenile.
• A child who has tried to take their own life in the past. [11] X Trustworthy Source Child Welfare Information Gateway Online portal managed by the U.S. Children's Bureau providing resources related to childcare and abuse prevention Go to source

• The child has trouble sitting down or walking around.
• The child mentions wetting the bed or having bad dreams.
• The child is uncomfortable switching clothes for gym class or doing physical things.
• The child gets pregnant or tests positive for an STI/STD. [13] X Trustworthy Source Child Welfare Information Gateway Online portal managed by the U.S. Children's Bureau providing resources related to childcare and abuse prevention Go to source

Expert Q&A

• Check out resources like ChildWelfare , HHS , MayoClinic , and KidsHealth to learn more about child abuse. Thanks Helpful 3 Not Helpful 0
• If you’re ever confused about any part of the child abuse reporting process, call or text the Childhelp Hotline at 1-800-422-4453, or visit their website to chat with a professional. Thanks Helpful 2 Not Helpful 0

• If you suspect that a child’s life is in danger because of their abuse, call 911 rather than your state’s abuse hotline. Thanks Helpful 2 Not Helpful 0

You Might Also Like

• ↑ https://www.childwelfare.gov/topics/responding/reporting/how/
• ↑ https://www.childhelphotline.org/how-it-works/
• ↑ https://mayoclinic.org/diseases-conditions/child-abuse/symptoms-causes/syc-20370864
• ↑ https://www.childwelfare.gov/pubPDFs/signs.pdf
• ↑ https://www.mayoclinic.org/diseases-conditions/child-abuse/symptoms-causes/syc-20370864
• ↑ https://www.childwelfare.gov/topics/can/identifying/emotional-abuse/
• ↑ https://hside.org/child-abuse-signs-symptoms/#types

About This Article

To make an anonymous report to child protective services, start by collecting as much information as you can about the situation, such as the child’s name, their parent’s names, address, age, and a description of their abuse or neglect. Since there are many child protective services across the country, call ChildHelp on 1-800-422-4453, who will direct you to the relevant authority. Alternatively, search online for your state or region, followed by “Child abuse hotline” to find the right organization for your area. However, if you suspect that a child is in immediate danger, don’t hesitate to call 911. For more tips from our Legal co-author, including how to report child abuse or neglect in writing, read on! Did this summary help you? Yes No

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What Is Mandated Reporting?

Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

kali9/E+/Getty

Who Is a Mandated Reporter?

• Requirements
• Failure to Report
• What Information Is Disclosed?

What Other Things Might Be Reported?

Mandated reporting refers to the legal obligation to report abuse. Mandated reporters are individuals or agencies that are legally required to make these reports. In the United States, mandated reporting laws vary significantly.

The Rape, Abuse, and Incest National Network (RAINN) allows you to look up mandated reporting laws for your state.

At a Glance

Mandating reporting laws vary by state. In some cases, certain professionals and organizations are required to report suspected abuse, while some states and jurisdictions require all residents, even private citizens, to report suspected abuse. However, anyone can report abuse, neglect, or abandonment whether or not they are a mandated reporter.

Research suggests that mandatory reporting requires professionals to make accurate and informed decisions in children's best interest. Since laws vary by state, there are some jurisdictional differences about who is required to make these reports. Typically, this includes the following individuals:

• Babysitters
• Daycare providers
• Law enforcement
• Teacher's aids
• Other school employees
• Other medical professionals
• Psychologists
• Social workers
• Other therapists

In addition, certain organizations and agencies are required to report suspected abuse, which can include:

• Child advocacy organizations
• Domestic abuse organizations
• Medical clinics

You do not have to be a mandated reporter to report suspected abuse. Anyone can report suspected abuse, and in some states, non-mandated reporters can make these reports anonymously.

Mandated Reporting Requirements

Although states vary on the specifics, mandated reporters exist to ensure safety by reporting suspected abuse. The local department of human services (sometimes called Child Protective Services or Department of Social Services) investigates the report and determines whether intervention is necessary.

Mandated reporters may report suspected child abuse , elder abuse, or vulnerable adult abuse.

Abuse can include physical, sexual , or emotional abuse (though many states do not include emotional abuse under mandated reporting laws), neglect, and exposure to unsafe environments, such as drug use or domestic violence .

Mandated reporters typically do not investigate suspected abuse; rather, their obligation is to report their suspicions. For example, if a child discloses that a parent hit them, the mandated reporter does not reach out to the parent to confirm the report but instead reports the allegation.

Mandated reporters are only required to disclose allegations to the department of human services. They are not required to tell the parent or guardian about the report, and often a mandated reporter will not share the allegation if the guardian might be the perpetrator. The information is kept private for safety reasons and to prevent further abuse in retaliation for making the report.

What Happens If a Mandated Reporter Doesn't Report?

Mandated reporters are legally required to follow state laws about reporting abuse and neglect. Failing to make a report is a crime and is classed as a misdemeanor in most states, with specific penalties varying by jurisdiction.

They must report even if they are uncertain about whether or not the allegation is true. Mandated reporters might also be subject to civil litigation for failing to protect a vulnerable individual.

In some states, there is no statute of limitations on failing to make a report. As such, victims of abuse can pursue charges against the mandated reporter no matter how long ago they disclosed the abuse.

Because mandated reporters are required to make these reports, they cannot be penalized for making a report in good faith. In addition, if someone who is not a mandated reporter makes a report that turns out to be unfounded, they cannot be penalized. This is because safety is important, and people must not be penalized for trying to keep vulnerable populations safe.

What Information Is Disclosed in the Report?

Again, requirements vary by state; however, reports must include information about the victim, perpetrator, current location, and the allegation. Sometimes, limited information is available, and the report will only include the information that is available.

The mandated reporter can request a confirmation letter documenting that they made the report. The letter might include information about the outcome of the investigation.

Guardians can request information about the report; however, this might not include who made the report. Because a perpetrator might punish the victim for reporting abuse, information about who made the report is typically kept confidential.

How to Report Abuse

Check with your state Department of Health and Welfare or contact local law enforcement to learn where to report suspected abuse. The information included during mandated reporting will include:

• Names of the child, family, and their contact information
• Where the child is located
• Whether the child is in immediate danger
• Description of what you witness
• Why you are concerned
• Other information that might be helpful
• Your name, contact information, and relationship to the child
• Names of other people who might know the situation

Sometimes, information might not fall under mandated reporting, but an individual might still disclose it for safety or legal reasons.

Duty to Warn

Many therapists and other professionals will also report threats to harm self or others, known as duty to warn or duty to protect. In most states, this does not fall under mandated reporting. However, there is civil precedent indicating that a therapist can be held liable if a client discloses a plan to hurt themselves or someone else, and the therapist does not take steps to intervene.

This requirement is based on the legal case, Tarasoff vs Regents of the University of California, a 1976 case in which a client disclosed to his therapist that he intended to commit murder. The victim's family successfully sued the therapist for failing to protect the victim after the client carried out his plan.

Duty to warn can include contacting the potential victim if the information is available. It can also include contacting law enforcement about a threat.

If someone discloses that they are suicidal and have a plan or intent to end their life, the therapist might contact crisis or emergency services to ensure their safety.

Because duty to warn involves civil liability, it is separate from mandated reporting laws.

Court Orders

Professionals might be subject to a court order from a judge to disclose information. Refusing to comply with a court order is illegal, and defying a court order can lead to jail time. Judges might request information as part of criminal cases or child custody disputes. Court orders do not fall under mandated reporting laws.

What This Means For You

Mandated reporting aims to ensure the safety of vulnerable populations and prevent abuse. Check your government website to learn more about your state's mandated reporting laws. You can learn what circumstances require a report and which professionals and organizations are mandated reporters.

Tufford L, Lee B, Bogo M, et al. Decision-making and relationship competence when reporting suspected physical abuse and child neglect: An objective structured clinical evaluation .  Clin Soc Work J . 2021;49(2):256-270. doi:10.1007/s10615-020-00785-6

Idaho Department of Health and Welfare. Reporting neglect, abuse, or abandonment .

Tarasoff v. Regents of the University of California, 131 Cal. Rptr. 14 (Cal. 1976).

By Amy Marschall, PsyD Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.

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• Crime, justice and the law
• Reporting crimes

Report child abuse

If you’re worried that a child or young person is at risk or is being abused contact the children’s social care team at their local council .

You’ll be asked for your details, but you can choose not to share them.

Call 999 if the child is at immediate risk.

If it’s not an emergency, you can report the crime online or call 101.

Calls to 999 or 101 are free.

What to report

Child abuse includes physical, sexual and emotional abuse, and neglect. You can read more about the signs of child abuse .

You don’t need to be sure that a child or young person has been abused - it’s OK to report a suspicion.

What happens when you report it

The person who answers your call will decide what to do. For example, they might:

• gather more information
• ask a social worker to look into it
• contact the police, if they think the child is at immediate risk or a crime has been committed

The children’s social care team will tell you what happens next, but they will not be able to give you any confidential information.

Contact the NSPCC if you want to discuss your concerns and get advice.

NSPCC (for adults) Telephone: 0808 800 5000 Find out about call charges

ChildLine (for children and young people) Telephone: 0800 1111 (free)

The ChildLine number will not show up on your phone bill if you call from a landline or from most mobile networks.

Report child abuse in education

NSPCC (for children, young people and adults) Telephone: 0800 136 663 (free)

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Home » How Do I Call In a Report? » What Criteria Must Be Met?

What Criteria Must Be Met?

Five criteria cps needs to register a report:.

You do not need to be certain that child abuse or neglect has occurred before you call the Child Abuse Hotline . However, you do need to have a reasonable suspicion . When you call, Child Abuse Hotline staff member will ask you to explain the information and circumstances that caused your suspicion.

Child Abuse Hotline staff members must use the five criteria based on state law to assess each call. Hotline staff will ask you about the child, the child’s family or persons legally responsible for the child and the circumstances in which you believe abuse or neglect took place. CPS needs this information in order to register a report . “Registering” a report means that CPS has enough information to follow up with the family and begin an investigation .

If you have a reasonable suspicion that abuse or neglect has occurred, you should always call the Hotline. If all of the necessary information is not available when you call the Hotline, CPS cannot register the report and may make other recommendations.

Below are the five criteria CPS uses to assess each call to the Hotline.

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• About Child Abuse and Neglect
• Risk and Protective Factors
• Public Health Strategy
• Child abuse and neglect are serious public health problems.
• Child abuse and neglect can have long-term impacts on health, opportunity, and well-being.

What are child abuse and neglect?

Child abuse and neglect includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (e.g., a religious leader, a coach, or a teacher) that results in harm, the potential for harm, or threat of harm to a child.

There are four common types of abuse and neglect:

• Physical abuse is the intentional use of physical force that can result in physical injury. Examples include hitting, kicking, shaking, or other shows of force against a child. 1
• Sexual abuse involves pressuring or forcing a child to engage in sexual acts. Examples include fondling, penetration, and exposing a child to other sexual activities. 1 Read more information about child sexual abuse .
• Emotional abuse refers to behaviors that harm a child's self-worth or emotional well-being. Examples include name-calling, shaming, rejecting, and withholding love. 1
• Neglect is the failure to meet a child's basic physical and emotional needs. These needs include housing, food, clothing, education, access to medical care, and having feelings validated and appropriately responded to. 1 2

Quick facts and stats

Child abuse and neglect are common. At least one in seven children experienced child abuse or neglect in the past year in the United States. 3 This is likely an underestimate because many cases are unreported. In 2021, 1,820 children died of abuse and neglect in the United States. 4

Children living in poverty experience more abuse and neglect. Experiencing poverty can place a lot of stress on families, which may increase the risk for child abuse and neglect. Rates of child abuse and neglect are five times higher for children in families with low socioeconomic status compared to families with a higher socioeconomic status. 1

Child maltreatment is costly. In the United States, the total lifetime economic burden associated with child abuse and neglect was about $592 billion in 2018. 5 This economic burden rivals the cost of other high-profile public health problems, such as heart disease and diabetes. 6

Children who are abused or neglected may suffer immediate physical injuries such as cuts, bruises, or broken bones. They may also have emotional and psychological problems, such as anxiety or posttraumatic stress. 1

Over the long term, children who are abused or neglected are also at increased risk for experiencing future violence victimization and perpetration, substance abuse, sexually transmitted infections, delayed brain development, lower educational attainment, and limited employment opportunities. 1

Abuse and neglect may result in toxic stress, which can change brain development and increase the risk for problems like posttraumatic stress disorder and learning, attention, and memory difficulties. 7

Child abuse and neglect can be prevented. Certain factors may increase or decrease the risk of perpetrating or experiencing child abuse and neglect.

Preventing child abuse and neglect requires understanding and addressing the factors that put people at risk for or protect them from violence. 8

Everyone benefits when children have safe, stable, nurturing relationships and environments. We all have role to play.

• Child Maltreatment Surveillance: Uniform Definitions for Public Health and Recommended Data Elements [4.12 MB, 148 Pages, 508] .
• Fortson, B. L., Klevens, J., Merrick, M. T., Gilbert, L. K., & Alexander, S. P. (2016). Child Abuse and Neglect Prevention Resource for Action: A Compilation of the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Note: The title of this document was changed in July 2023 to align with other Prevention Resources being developed by CDC's Injury Center. The document was previously cited as "Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities".
• Leeb RT, Paulozzi L, Melanson C, Simon T, Arias I. Child Maltreatment Surveillance: Uniform Definitions for Public Health and Recommended Data Elements, Version 1.0. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2008.
• Finkelhor D, Turner HA, Shattuck A, Hamby SL. Prevalence of Childhood Exposure to Violence, Crime, and Abuse: Results from the National Survey of Children's Exposure to Violence. JAMA Pediatr. 2015;169(8):746–754. doi:10.1001/jamapediatrics.2015.0676
• U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. (2023). Child Maltreatment 2021. Available from https://www.acf.hhs.gov/cb/data-research/child-maltreatment.
• Klika JB, Rosenzweig J, Merrick M. Economic burden of known cases of child maltreatment from 2018 in each state. Child and adolescent social work journal. 2020 Jun;37(3):227-34.
• Centers for Disease Control and Prevention.(2022). Health and Economic Costs of Chronic Diseases. Available from https://www.cdc.gov/chronicdisease/about/costs/index.htm
• Shonkoff J, Garner A, & Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, and Section on Developmental and Behavioral Pediatrics. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232-e246.
• Preventing Multiple Forms of Violence: A Strategic Vision for Connecting the Dots. (2016). Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

Child Abuse and Neglect Prevention

Child abuse and neglect can have long-term impact on health, opportunity, and well-being. CDC works to understand the problems of child abuse and neglect and prevent them.

For Everyone

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When to Report Child Abuse to CPS (and How to Do It)

April is Child Abuse Prevention Month: are you prepared to recognize and appropriately report an abusive or neglectful situation?

Being able to recognize child abuse or neglect is the first step toward stopping it. Some cases are more obvious than others, but understanding the law is critical to knowing when legal intervention is necessary and how best to contact the authorities.

Recognizing Abuse or Neglect

Child abuse and neglect are not limited to noticeable physical harm or abandonment, so make sure the full scope of both definitions are taken into account. Remember, “ reasonable suspicion ” is the only requirement for calling Child Protective Services (CPS).

Here are seven offenses a parent, guardian or caretaker can commit that would be considered abuse or neglect of a child, as per the Code of Virginia , section 63.2-100:

• Causes or threatens to cause a nonaccidental physical or mental injury.
• Has a child present during the manufacture or attempted manufacture of a controlled substance or during the unlawful sale of such substance where such activity would constitute a felony violation.
• Commits or allows to be committed any illegal sexual act upon a child, including incest, rape, indecent exposure, and prostitution, or allows a child to be used in any sexually explicit visual material.
• Neglects or refuses to provide adequate food, clothing, shelter, emotional nurturing, or health care.
• Abandons the child.
• Neglects or refuses to provide adequate supervision in relation to a child’s age and level of development.
• Knowingly leaves a child alone in the same dwelling with a person, not related by blood or marriage, who has been convicted of an offense against a minor for which registration is required as a violent sexual offender.

Exact definitions vary from state-to-state , but the above guidelines constitute an informative starting point. For a comprehensive list of indicators in both parent/guardian/caretaker and child behavior, review “ A Guide For Mandated Reporters In Recognizing And Reporting Child Abuse And Neglect. ”

Report Criteria

Naturally, if signs of the aforementioned offenses are present for a child, the average person may feel an obligation to report the abuse or neglect and should do so within the definition of reasonable suspicion. However, in the State of California, for example, an individual is legally mandated to report reasonable suspicion of abuse or neglect of a child if any of the following job titles apply : “Health practitioner, child visitation monitors, fire fighter, animal control officer, humane society officer, district attorney, school employees, film processors, clergy, social workers, daycare workers, police department employees, administrators or employees of public or private youth organizations or day camps.” Failure to report abuse or neglect of a child if you hold one of the above positions could result in a fine or even jail time .

Once the decision to report potential child abuse or neglect has been made, ensure that your statement is grounded by the following five criteria that allow CPS to register an official, actionable report :

• Identity and Location Before CPS can take action, the identities of the abused and the abuser(s), as well as their locations, must be confirmed. Full names, phone numbers, and home or business addresses (or just the city and state) will be invaluable information.
• Age of the Child From a legal perspective, the age of the abused party is extremely important. If the abused is under 18, always make the call to report. However, if the abused person is over the age of 18 or not under professional care due to long-term health concerns, such as physical or mental impairment (even then, states often cap the application of “child” at 21), then child abuse or neglect is not likely to apply in a legal sense. Of course, cases of assault should still be reported to your local police.
• Jurisdiction Where did the alleged abuse take place and where are the parties involved now? Not only is this information vital for location, it also establishes guidelines of legal responsibility for the investigation, if this is deemed appropriate.
• Persons Legally Responsible Who perpetrated the abuse or neglect? Any adult who was responsible for the child’s care or wellbeing during the relevant timeframe of the suspected abuse or neglect can be investigated. This includes any adult who regularly spent time in the child’s home.
• Allegation of Abuse or Neglect If the report claims a child is being abused: Is the alleged abuse physical, sexual or emotional? Did the abuser(s) carry out the alleged abused directly or by creating a situation where the abuse/danger was imminent? If the report claims a child is being neglected: Is the child in immediate danger? Has the legally responsible adult allowed a dangerous environment to flourish actively or inactively? Has the child been harmed by the neglectful situation? Once the above questions can be answered as thoroughly as possible, an official report can be made and acted upon quickly to help the child.
• When and Who to Call Keep in mind, “ you do not need to be certain that child abuse or neglect has occurred before you call the Child Abuse Hotline. ” Reasonable suspicion and the information listed above is enough for the CPS to register a report. To lodge a report call the Childhelp National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453). You can also find your specific state organization’s contact information here .

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How do I report elder abuse or abuse of an older person or senior?

Call the police or 9-1-1 immediately if someone you know is in immediate, life-threatening danger.

If the danger is not immediate, but you suspect that abuse has occurred or is occurring, please tell someone. Relay your concerns to the local adult protective services , long-term care ombudsman , or the police.

If you have been the victim of abuse, exploitation, or neglect, you are not alone. Many people care and can help. Please tell your doctor, a friend, or a family member you trust, or call the Eldercare Locator help line immediately.

You can reach the Eldercare Locator by telephone at  1-800-677-1116 . Specially trained operators will refer you to a local agency that can help. The Eldercare Locator is open Monday through Friday, 9 a.m. to 8 p.m. Eastern Time.

The laws in most states require helping professions in the front lines -- such as doctors and home health providers -- to report suspected abuse or neglect. These professionals are called mandated reporters.

Important Links

• National Adult Protective Services Association (NAPA) Get Help In Your Area
• National Center on Elder Abuse (NCEA) Resources
• Eldercare Locator: community assistance for older adults

Search HHS FAQs by questions or keywords:

Why aren't nursing home residents reporting abuse? Fear of retaliation, study finds.

Fear of retaliation from staff is a major barrier to nursing home residents asking for their needs or complaining of abuse or neglect, a new survey found.

The survey by the Long Term Care Community Coalition, a nonprofit organization that advocates for residents in nursing homes and assisted living facilities, examined 100 complaints by nursing home residents across the country.

The report published this week sheds light on systemic issues in U.S. long-term care that can exacerbate neglect and poor facility conditions, including underpaid and overworked staff − factors that worsened during the pandemic, experts say.

Lead researcher, Eilon Caspi, an assistant professor at the University of Connecticut Institute for Collaboration on Health, Intervention and Policy, examined the surveys and complaint investigations by the Centers for Medicare and Medicaid Services. The report, titled " 'They Make You Pay’: How Fear of Retaliation Silences Residents in America’s Nursing Homes," details complaints investigated between 2017 and last year.

Fear of retaliation can be a major barrier to “reporting, detecting, and investigating abuse and neglect,” Caspi and his team wrote.

“While exploratory in nature, we believe that this review represents the most in-depth examination of this phenomenon to date and hope that it will contribute significantly to our understanding of this harmful yet largely invisible source of resident suffering in America’s nursing homes,” they wrote.

While the quality of care issues are well-known in U.S. nursing homes, residents’ fears could be a factor leading to underreporting and underestimating neglect or abuse, said aging and long-term care expert David Grabowski, a professor of health care policy at Harvard Medical School.

“There are real fears here that, at the end of the day, there's going to be retaliation,” he said. “I do think the vast majority of staff members are good people working hard, and many of them are underpaid and undervalued. But I think these issues come up, and when they do, they should be addressed.”

Where are the inspectors? How a lack of nursing home oversight is endangering residents.

Terry Fulmer, president of the John A. Hartford Foundation and leading expert in elder abuse and geriatrics, said educating staff on the harms of retributive statements should be key in fighting the problem.

"What we already knew but learned again in horrific detail during COVID was that care in nursing homes is unacceptable," she said. "Let's understand the phenomenon. Let's name it, let's teach, how to prevent it, how to anticipate the way it feels to families and older people and the staff."

In one of the complaints in the report, stemming from a resident in a northern California facility, residents told investigators they were afraid to voice concerns “because it backfires on you,” as “staff became aggressive.”

Other complaints detail sexual abuse allegations against staff, residents sitting in soiled conditions, and staff threatening family members of residents if they reported issues to the state or ombudsman association.

"You are dependent on staff members to provide you with basic care, continence, using the bathroom, the toilet, taking a shower," Caspi told USA TODAY. "So you can feel very small, and there's an inherent asymmetrical power... a power imbalance between residents and staff members."

John Rowe, professor of health policy and aging at Columbia University Mailman School of Public Health and the Butler Aging Center, said examining the conditions of staff is key to improving nursing home conditions and preventing neglect and abuse. He said the self-reported complaints reflect an understaffed workforce “dealing with the toughest patients.”

“This sector of the American health care system is underfunded. It's understaffed. It's undertrained,” he said, adding “one of the reflections of that is some level of elder abuse and neglect by an anxious, depressed, overworked, undertrained workforce.”

“We need to fix that,” he said.

Richard Mollot, executive director of the coalition, said he hopes the report sheds light on how fear compounds residents' vulnerability.

“It’s abuse of people who are very vulnerable, who don't have the ability to get out,” he said. “You can't just walk out of your nursing home when you're fearful.”

Reach Nada Hassanein at  [email protected]  or on Twitter  @nhassanein .