Complaints and Grievances

This section sets out the standing under which this policy is issued, who owns it, who is bound by it, and how it is kept current. It is not itself a procedure. The obligations begin at Section 1.

This policy makes sure patients and families can raise any concern about their care without fear, that the Agency listens, fixes problems quickly, and learns from them, and that patients know they can also go to AHCA and other outside bodies.

This policy covers complaints and grievances about care or services furnished or not furnished, lack of respect for person or property, staff conduct, billing, scheduling, equipment and supplies, and contracted services, from any person and in any form. The complaint officer is Pat Sample, Administrator, (813) 555-0111, person1@example.com.

The following terms have the meanings given below when used in this policy.

Every patient has the right "To voice grievances regarding treatment or care that is (or fails to be) furnished and the lack of respect for property by anyone who is furnishing services on behalf of the hospice" and "To not be subjected to discrimination or reprisal for exercising his or her rights" (42 CFR §418.52(b)(1)(iii)-(iv)). Under Florida’s patient’s bill of rights, "A patient has the right to express grievances to a health care provider, a health care facility, or the appropriate state licensing agency regarding alleged violations of patients’ rights. A patient has the right to know the health care provider’s or health care facility’s procedures for expressing a grievance" (s. 381.026(4)(b)6., F.S.). On or before the first day services are provided, each patient and immediate family or representative is told of the right to report complaints with the statutory words: To report a complaint regarding the services you receive, please call toll-free 1-888-419-3456. (s. 408.810(5)(a)1., F.S.; Policy FL-HSP-PR-01). Florida law sets no time frame for a hospice to answer a complaint. The Agency’s own time frames are: acknowledgment within 5 and resolution within 30 of receipt, sooner wherever the complaint affects current care.

• At admission, staff give and explain Form FL-HSP-CMP-01-A, which names the complaint officer and lists the outside bodies in Section 7, and give the first-day notice under Policy FL-HSP-PR-01 (s. 408.810(5)(b), F.S.).
• Staff tell patients and families that complaining will never affect their care, and that they can complain to staff, to the complaint officer, to the Administrator or directly to AHCA.
• The complaint process is explained in the patient’s language, with an interpreter if needed (Policy FL-HSP-PR-04).

1. Anyone at the Agency who receives a complaint listens, thanks the person, and writes down what was said. If the complaint alleges abuse, neglect, exploitation, mistreatment, an injury of unknown source or missing property, the staff member follows Policy FL-HSP-ANE-01 at once.
2. If the complaint is urgent, the staff member tells the supervising nurse or on-call nurse at once, and the problem is addressed the same day.
3. The staff member passes every complaint to the complaint officer the same day. The complaint officer logs it on Form FL-HSP-CMP-01-B.
4. The complaint officer acknowledges the complaint to the person who made it within 5 of receipt, by phone or in writing, and says who will look into it.
5. The complaint officer, or a manager not involved in the matter, investigates: talks with the person, staff and contractors involved, reviews the record and schedules, and decides what happened.
6. The complaint officer resolves the complaint within 30 of receipt and tells the person what was found and done, in writing if the person asks or if the complaint was written. If more time is needed, the person is told why and when to expect an answer.
7. If the person is not satisfied, the Administrator reviews the complaint and responds. The person may also ask for the governing body to review it, and is reminded of the outside bodies in Section 7.
8. The complaint officer records the outcome and any corrective action, such as retraining, a schedule change, a change of staff, or a policy change, on Form FL-HSP-CMP-01-B.

Patients and families may contact any of these at any time, whether or not they have used the Agency’s process.

• Complaints by a nursing home, assisted living facility or inpatient facility about the Agency’s care go to the complaint officer and are handled under Section 6. The facility liaison takes part (Policy FL-HSP-FAC-01).
• Complaints about a facility’s or contractor’s care of a hospice patient are passed to that provider under the written agreement, followed up by the Agency, and reviewed in the QAUR/QAPI program as care in alternate settings and by contracted entities (Rule 59A-38.006(5)(a), F.A.C.; Policy FL-HSP-CON-01).

No patient, family member or staff member is subjected to discrimination or reprisal for making a complaint (42 CFR §418.52(b)(1)(iv)). Care is never reduced, delayed or ended because someone complained. Any report of reprisal goes to the Administrator, who investigates it.

The QAUR/QAPI committee reviews all complaints received from patients and their families each quarter (Rule 59A-38.006(5)(e), F.A.C.), looks for patterns, and recommends improvements to the Administrator and the governing body (Policy FL-HSP-QA-01).

Each role named below carries the duties shown.

Kept for at least six years (Agency standard):

• Form FL-HSP-CMP-01-B, with the date received, the date acknowledged, the findings, the date resolved and corrective actions.
• Written complaints and responses.
• Quarterly summaries for the QAUR/QAPI committee.
• The complaint officer checks each quarter that complaints were acknowledged and resolved within the Agency’s time frames, and reports the results.

All staff and volunteers learn in orientation and every year how to receive a complaint, when it is urgent, when it is really an abuse report, how to pass it on the same day, and that reprisal is forbidden (Policy FL-HSP-HR-01).

This policy implements the following authorities.

• s. 381.026(4)(b)6., F.S., Patient’s right to express grievances
• s. 408.810(5), F.S., Notice of the right to report complaints
• s. 408.811, F.S., AHCA inspections and investigations
• s. 415.1036, F.S., No reprisal for reports of abuse
• Rule 59A-38.006(5)(a), (e), F.A.C., QAUR review of contracted care and complaints
• 42 CFR §418.52(b)(1)(iii)-(iv), (b)(4), Patient’s rights
• 45 CFR §164.530(d), Privacy complaints

The following documents are read together with this policy.

This policy is adopted by the governing body of Sample Agency, LLC. The effective date, the person who approved it, and the date of approval are shown in the header block and recorded in the signature lines below.

Every version of this policy, the date it took effect, a summary of what changed, and who approved it is recorded below. Where a statute or rule cited in the References section is amended, the amendment is recorded in this table and a new version of this policy is issued.