Nursing Home Complaints Tennessee — How to File with the Health Facilities Commission

When to File a Complaint

Not every concern about your parent's care warrants a formal regulatory complaint. A cold meal or a slightly delayed medication administration is a conversation with the facility's director of nursing. But certain situations cross the line into reportable territory:

• Physical signs of abuse — unexplained bruises, cuts, or fractures
• Neglect — dehydration, untreated bedsores, soiled clothing left unchanged for hours
• Medication errors — wrong medication, wrong dosage, missed doses that cause observable harm
• Unsafe staffing — units left without a direct-care attendant, especially in secured memory care areas where Tennessee requires 24/7 awake staffing
• Financial exploitation — unauthorized charges on the resident's accounts, missing personal property, pressure to change beneficiary designations
• Involuntary discharge threats — particularly when a facility tries to discharge a resident for converting from private-pay to Medicaid, which is prohibited under federal and state law

If your parent lives in a secured memory care unit and you observe any of these conditions, the situation is especially urgent because the residents cannot advocate for themselves or leave the facility on their own.

Filing with the Health Facilities Commission (HFC)

The Tennessee Health Facilities Commission is the regulatory body that licenses and inspects nursing homes, assisted-care living facilities (ACLFs), and residential homes for the aged. They are the primary agency for investigating complaints about licensed facilities.

HFC Complaint Intake Hotline: 1-877-287-0010

Online: The HFC accepts complaints through a fillable PDF form available on their website at tn.gov/hfc. The form asks for the facility name and location, the name of the resident affected, the nature of the complaint, when the incident occurred, and whether the complaint has been raised with the facility first.

By mail: Download and complete the complaint form, then mail it to the Health Facilities Commission at the address listed on the form.

When filing, include as much specific detail as possible: dates, times, names of staff involved, photographs of injuries or conditions, and any written documentation you have (admission agreements, discharge notices, billing statements). Vague complaints ("the care isn't good") are harder to investigate than specific ones ("on August 15, my mother was found with a stage II pressure ulcer on her sacrum that was not documented in her chart or reported to the family").

What Happens After You File

The HFC triages complaints by severity. Allegations involving immediate jeopardy — situations where a resident faces an imminent threat of death or serious harm — are supposed to be investigated first. Standard complaints are investigated in the order received.

However, families should know that the HFC has been dealing with significant investigation backlogs. A legislative audit found that the commission failed to investigate more than 5,500 of the 13,000 complaints it received within federally mandated timelines. Investigations averaged three months even in cases where resident safety was at immediate risk.

This doesn't mean you shouldn't file. The complaint creates a formal record that can affect the facility's licensing status and is reviewed during future surveys. But it does mean you shouldn't rely solely on the HFC to resolve an urgent safety concern in real time.

The Long-Term Care Ombudsman

The state Long-Term Care Ombudsman program provides an independent advocacy channel that operates separately from the HFC's regulatory function. Ombudsmen are trained advocates who investigate complaints, mediate disputes between residents and facilities, and can intervene in real time.

State Long-Term Care Ombudsman: 1-877-236-0013

Regional ombudsmen are housed within the local Area Agencies on Aging and Disability (AAADs) across Tennessee. They frequently have real-time insight into facility conditions — staffing shortages, food quality complaints, patterns of neglect — that may not have resulted in formal HFC citations yet.

The ombudsman is particularly valuable in two situations:

Involuntary discharge disputes. If a facility issues a discharge notice (which often happens when a private-pay resident's funds run out and they convert to Medicaid), the ombudsman can intervene to halt the transfer and represent the resident in a formal appeal. Federal law prohibits facilities from discharging residents solely because they've converted to Medicaid.

Ongoing quality-of-care concerns. If the facility's problems aren't acute enough for an HFC investigation but are persistent enough to affect your parent's quality of life — consistently poor food, frequent staff turnover, lack of therapeutic activities in the memory care unit — the ombudsman can engage the facility's administration directly and push for improvements.

Adult Protective Services

If the situation involves suspected abuse, neglect, or exploitation of a vulnerable adult, you should also report to the Tennessee Department of Human Services' Adult Protective Services (APS).

APS Hotline: 1-888-277-8366

APS investigates allegations of abuse, neglect, and exploitation of adults who are unable to protect themselves. Their authority extends beyond licensed facilities — they also investigate situations in private homes and community settings. An APS report can trigger an independent investigation that runs parallel to any HFC inquiry.

What to Do While the Investigation is Pending

Filing a complaint starts the regulatory process, but protecting your parent can't wait for the investigation to conclude.

Document everything. Keep a written log of every visit: date, time, what you observed, who was on duty, and any conversations with staff. Photograph concerning conditions. Save any written communications from the facility.

Request the facility's records. Under Tennessee law, residents (or their legal representatives) have the right to review their medical records, incident reports, and the facility's most recent CMS Statement of Deficiencies. If the facility delays or refuses, note the refusal in your complaint.

Attend care conferences. If your parent is in a secured memory care unit, quarterly interdisciplinary team evaluations are required by state regulation. Attend these meetings and bring your documentation. Use them to formally raise concerns and create a written record that the facility was notified.

Consider an independent medical evaluation. If you suspect your parent has injuries or conditions that aren't being properly documented or treated, request that their primary care physician (not the facility's staff) conduct an independent examination.

When the Situation Requires Immediate Action

If your parent is in immediate physical danger — evidence of serious abuse, a medical emergency being ignored, or conditions that threaten life or limb — call 911 first. Then file the HFC complaint and the APS report.

In cases where the care situation has deteriorated to the point that you need to move your parent out of the facility, the ombudsman can help coordinate a safe transfer while ensuring the facility doesn't retaliate or refuse to release medical records.

For a comprehensive understanding of Tennessee facility licensing standards, resident rights, and the full complaint and advocacy landscape, our Tennessee Dementia & Memory Care Guide includes a facility evaluation framework and a complaint-filing reference designed for families in exactly this situation.

See more Tennessee guides →