To report a problem at a New York nursing home, use the NYS Nursing Home Complaint Form (DOH-5022) from the Department of Health. You can submit it online, by mail, fax, or email, or by calling the complaint hotline at 1-888-201-4563. Filing is free, you can stay anonymous, and every complaint is treated as confidential.1New York State Department of Health. Nursing Home Complaint Form One limit to know up front: the Department only accepts complaints about incidents that occurred within the past year.
Where to Get the Form
The form comes in two formats on the Department of Health’s nursing home complaint page. You can fill it out as an interactive web form and submit it from the site, or download the three-page PDF (DOH-5022) and complete it by hand or by typing into it before printing.1New York State Department of Health. Nursing Home Complaint Form2New York State Department of Health. New York State Department of Health Nursing Home Complaint Form Both versions ask for the same information.
What Each Section Asks For
The form has five sections. Gathering the details below before you start keeps the Department from returning your complaint for missing information.
Your Contact Information
The first question asks whether you want to remain anonymous. Check “yes” and the Department will still review your complaint, but it cannot send you status updates. Provide your name, address, phone, and email, and the Centralized Complaint Intake Unit will mail you an acknowledgment letter confirming receipt and explaining how the complaint will be handled.1New York State Department of Health. Nursing Home Complaint Form You’ll also note your relationship to the resident — family member, friend, current or former employee, or another resident.
Resident and Facility Information
Enter the resident’s first and last name and where the resident is now: still in the nursing home, in a hospital, or elsewhere. If the resident has been discharged, include the discharge date. For the facility, give the nursing home’s name, street address, city, and the room number where the resident stayed or is staying. Accurate facility details route your complaint to the correct regional office faster.2New York State Department of Health. New York State Department of Health Nursing Home Complaint Form
Complaint Details
A short set of yes-or-no questions helps investigators gauge severity and status:
- Date the concern occurred, as specific as possible, including the shift (day, evening, overnight) if you know it.
- Whether law enforcement is involved. Note here if you’ve already contacted police.
- Whether the resident’s care plan was followed. If the facility deviated from an individualized plan, checking “no” flags it for reviewers.
- Whether you’ve already raised the issue with facility staff or administration, and whether it was resolved.
- Whether other residents are affected. Problems that reach beyond one resident, like chronic understaffing or unsanitary conditions, signal a systemic issue.
Complaint Description
The description field is the heart of the form. Write a detailed narrative that includes the time, date, and shift of the incident, any staff involved, other residents who were present, and any witnesses.1New York State Department of Health. Nursing Home Complaint Form Lay events out in the order they happened. If you observed a pattern over days or weeks, describe each occurrence separately with its own date. Stick to what you personally saw, heard, or were told firsthand; investigators can tell the difference between direct observation and secondhand information, and the former carries more weight.
Supporting Documents
Attach copies of anything that backs up your account: photographs, medical bills, discharge paperwork, or written statements from witnesses. Send copies only. The form warns that documents may not be returned.2New York State Department of Health. New York State Department of Health Nursing Home Complaint Form
How to Submit It
The Department accepts complaints through five channels. Each one receives the same level of review, so pick what fits your situation.1New York State Department of Health. Nursing Home Complaint Form
- Online: complete the interactive form on the Department of Health’s nursing home complaint page and submit it from the site.
- Mail: send the completed form and any supporting documents to NYSDOH DRS/SNHCP, Mailstop: CA/LTC, Empire State Plaza, Albany, NY 12237.
- Fax: (518) 408-1157.
- Email: scan the form and send it to nhintake@health.ny.gov.
- Phone: Nursing Home Complaint Hotline, 1-888-201-4563.
The hotline is staffed from 8:30 a.m. to 4:45 p.m., Monday through Friday. Outside those hours, leave a voicemail and someone will follow up the next business day.3New York State Department of Health. Complaints About Nursing Home Care If a resident is in immediate physical danger, call 911 first and file the complaint afterward.
Anonymity and Confidentiality
The Department’s policy is to keep your identity confidential. In some cases, investigators may need to share the nature of the complaint or the resident’s name with the facility to conduct a meaningful investigation. If you file anonymously, the Department cannot share your name because it doesn’t have it, but you also won’t get the acknowledgment letter or any status updates.1New York State Department of Health. Nursing Home Complaint Form
What Happens After You File
The Centralized Complaint Intake Unit reviews every complaint and assigns a priority that sets how quickly investigators must begin. Federal law sets the start deadlines:4Office of the New York State Comptroller. Department of Health – Investigation of Nursing Home Complaints
- Priority A, immediate jeopardy: investigation starts within 2 days.
- Priority B, non-immediate jeopardy, high: within 10 days.
- Priority C, non-immediate jeopardy, medium: within 45 days.
- Priority D, non-immediate jeopardy, low: within 120 days.
Staff are required to complete investigations within 180 days, though complex cases involving multiple allegations or facilities can take longer.4Office of the New York State Comptroller. Department of Health – Investigation of Nursing Home Complaints Some complaints are resolved through records review and phone interviews; others trigger an unannounced onsite visit.5New York State Department of Health. About Nursing Home Inspections – Section: Inspections After the investigation closes, the Department determines whether the facility violated state or federal standards and may require a plan of correction or impose civil penalties.
If You’d Rather Talk to Someone First
The New York State Long-Term Care Ombudsman Program is a separate resource for residents and families dealing with nursing homes, assisted living, and other long-term care settings. Ombudsmen can investigate complaints on a resident’s behalf, mediate with facility staff, and explain your rights. The program operates independently of the Department of Health, so you can use it instead of or alongside Form DOH-5022. Reach the Ombudsman at 1-855-582-6769 or ombudsman@aging.ny.gov.6New York State Office for the Aging. Long Term Care Ombudsman Program In serious cases involving immediate harm, doing both is worth considering.