Delaware Long-Term Care Ombudsman (LTCO) Complaint Form

In order to submit this online complaint, you must provide your name in the form below. If you want to file a complaint without providing your name, you can contact the LTCOP hotline at 1-855-773-1002 and speak anonymously with an Ombudsman representative.
If you are filing a complaint on behalf of an individual receiving Home and Community-Based Services, please contact the LTCOP hotline at 1-855-773-1002 and speak with an Ombudsman representative.

This form can be used to report complaints pertaining only to the facility types listed below, which are under the jurisdiction of the LTCO Program. If you are unsure of the facility type, please select Other.

Facility Information

Name of Facility
Street Address

City

Zip

Person Reporting

Do you wish to remain anonymous to the facility (Yes or No)?YesNo

First Name

Last Name

Email Address

Contact Number

Relationship to Resident

Resident Information

First Name

Last Name

Day

Month

Year

Contact Number

Room Number

Complaint

Describe the event: Provide a detailed description of the complaint.

Once your complaint is received, it will be reviewed by an Ombudsman representative. If you have provided a contact number, you may receive a call from the designated Ombudsman seeking additional information to resolve your complaint.