Problem Resolution

 

Background

First communicate issues with facility staff – do whatever you can to resolve the problem directly with staff.  If this is not successful, bring the issue to the next level in the nursing home.  Each facility has a defined protocol for handling issues that cannot be resolved at the direct care level.  If a Family-Run Council exists, inform the Council of your concerns as an additional resource.  You should also consider joining the Council.  Others in the facility may be experiencing the same problems, and the primary purpose of a Family Council is to address facility issues with administration.  Another option is contacting the regional or local Long-Term Care Ombudsman for assistance.

 

If you are unable to resolve problems directly with the nursing home, the following information provides other avenues to report and resolve grievances.  File a complaint when problems are serious and/or other steps to resolve your concerns have not been effective.  Although you are not required to try other dispute remedies first, it is usually best to do so.

 

Any person (not just residents or their family members) or organization can file a complaint with the Massachusetts Department of Public Health (“DPH”), Division of Health Care Quality (“DHCQ”).  DHCQ is the state agency that enforces nursing home laws and regulations through regular inspections and complaint investigations.  You can file a complaint about abuse, neglect and any other matter protected by law.

 

See Where To File Complaints for a full listing of agencies and organizations which investigate complaints and provide support.

 

Contact MANHR for questions and additional resources.

 

 

Helpful Hints

If the problem is experienced by other residents represented by a Family-Run Council, the Council can file a complaint with any of the agencies mentioned in this section.  Since a Family-Run Council complaint represents multiple residents, attention to the complaint may be expedited.

 

For support and to corroborate proceedings, it is prudent to have at least one other person present when you have meetings/discussions with the nursing home or oversight agency.  This could be a Long-Term Care Ombudsman, a friend, etc.  Also, if you receive permission from all parties, you can tape record the discussion.

 

To clarify the scope of confidentiality for your complaint, you should discuss any confidentiality concerns you may have directly with the agency investigator/representative.

 

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Documentation

It is important to have as much documentation as possible to support your claims – your written log (including date/time, staff involved, follow-up, etc.), and if possible, facility or physician records.

 

In addition, document the complaint process.  Keep a journal of your conversations (including who you spoke to, when, and what was said) for all parties that you speak with regarding the complaint. This information may be important if you do not receive a satisfactory or timely response.

 

There are no specific forms for filing a complaint, and the following information is provided as a general guide.  When writing a complaint, be brief but complete.  No investigator wants to read a long letter to figure out the issues. Provide the facts, and avoid stating the issues in generalities (such as "the facility is guilty of elder abuse").  Your complaint should include:

  1. Name and address of the facility;
  2. Your name, address, phone number, and relation to the resident (unless you choose to file anonymously);
  3. Name of the resident on whose behalf the complaint is made;
  4. Date(s) and time(s) of incidents;
  5. Specific complaints;
  6. Names of witnesses (including other health care providers, e.g.  hospital personnel);
  7. Names of staff, if relevant to the complaint;
  8. Records that should be examined;
  9. Include on-copy all parties you contacted.  Your complaint may receive better attention if the agencies know you have alerted other authorities. See Where to File Complaints for further information.

Where to File Complaints

In your complaint, include on-copy all parties you contacted (see Documentation).

 

The Massachusetts Department of Public Health (“DPH”), Division of Health Care Quality (“DHCQ”)  is the state agency that enforces nursing home laws and regulations through regular inspections and complaint investigations.  This is the primary agency handling serious complaints which cannot be resolved through standard channels.

 

The following entities also have the authority to investigate your complaint.  You should also ask for their assistance.
Medicare Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO)

Massachusetts Attorney General’s Office

 

Send a copy of your complaint to the local Long-Term Care Ombudsman Office and MANHR for further support and information.

 


Your state legislators make laws governing long-term care facilities and the DHCQ.  If you are not satisfied with the response from the DHCQ or other agencies, tell your state legislators about your experience and urge them to take action.  See Laws and Regulations – Contact Your Legislator to identify your legislators and pertinent legislative committees.

 

Other Options

You have the option of engaging an attorney to help resolve serious issues.

 

Depending on the issues, documentation, and your willingness to “go public”, you also could contact the media in your community.
 

 

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Department of Public Health, Division of Health Care Quality (“DHCQ”)



Complaint Unit
Department of Public Health
Division of Health Care Quality
99 Chauncy Street, 2nd Floor
Boston, MA  02111
General:  617-753-8000 (Toll Free: 800-462-5540)
Facsimile:  617-753-8095

 

Incident Reports
Telephone:  617-753-8036      

 

Patti Depew, Complaint Unit Manager

 

The DHCQ investigates complaints against health care facilities and all complaints of patient abuse and neglect in long-term care facilities.  The DHCQ also provides the mechanism by which criminal action may be taken by the Attorney General.

 

You may file a complaint as follows, and anonymous complaints are allowed:

 

It is our understanding that unless there is an immediate life-threatening problem, it could take up to a couple of months for a response.  Then, if the response is unsatisfactory, you should follow-up with a stronger letter.  For serious issues that are not being addressed through these avenues, consider contacting the DHCQ Director to hopefully achieve an investigation into the problem.  If the complaint results in an investigation, the survey will be unannounced to the facility.

 

If there was a specific incident, the nursing home should have generated an incident report which is filed with the DHCQ.  If the nursing home does not have a copy of the report or denies that there is such a report, you can contact the DHCQ incident report department.  If you have authority to access resident information, this department will tell you if a report was filed; and if the home refuses to give you a copy, you can obtain a copy from this department.

 

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Medicare Beneficiary and Family Centered Care Quality Improvement Organization

(BFCC-QIO)


BFCC-QIO Program
9090 Junction Dr., Suite 10
Annapolis Junction, MD  20701

FAX:  1-844-420-6671

 

Mon-Fri: 9AM-5PM

Sat-Sun: 11AM-3PM

Telephone:  1- 866-815-5440  


Livanta is the federally-designated Medicare Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for Massachusetts. The mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries.  If you have Medicare coverage, contact Livanta to:

 

While you can file a complaint or appeal by calling Livanta and speaking to an investigator, it is best to follow-up in writing. (See Documentation).  You should receive a written response to the complaint.

 


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Massachusetts Attorney General’s Office

Consumer Protection Division   

Attorney General’s Office
One Ashburton Place
Boston, MA  02114
Telephone:  617-727-2200


You can file a complaint directly with the Attorney General’s Office about an emergency situation in a nursing home.  An example of an emergency includes an immediate threat to the health of the nursing home resident.  Other examples of emergencies include when a resident is either discharged inappropriately and the nursing home refuses to take the resident back, or the resident will be discharged imminently into an unsafe situation before the hearing process at the Department of Medical Assistance Board of Hearings occurs. The nursing home resident or his/her family should always request a hearing to challenge the discharge, even when contacting the Attorney General’s Office.  (See Documentation).

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