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.

A complaint is information the Agency needs. Families of dying patients often hesitate to complain, so staff make it easy and safe to do so. This policy makes sure that every patient of Sample Agency, LLC (the "Agency") receives education in the availability and use of the hospice’s grievance process, can communicate grievances, concerns or complaints for prompt resolution (Ga. Comp. R. & Regs. 111-8-37-.10(1)(f)-(g)), knows how to complain to the Department, and is never penalized for complaining.

Any expression of dissatisfaction, spoken or written, about the Agency’s care or services, staff, contractors, volunteers, billing, equipment or communication, made by a patient, family member, representative, facility, physician or anyone else, in any setting.

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

Every patient has the right to receive education in the availability and use of the hospice’s grievance process, and to communicate grievances, concerns or complaints to the hospice for prompt resolution (Rule 111-8-37-.10(1)(f)-(g)). At the time of admission, the Agency provides to the patient, the patient’s representative, and the patient’s legal guardian the contact information, including the website address of the Department, for reporting complaints about hospice care to the Department (Rule 111-8-37-.10(3)). The Agency posts in a public area at the facility a copy of the patient rights and the contact information, including the website address of the Department, for reporting complaints (Rule 111-8-37-.10(4)). Patient and family complaints and on-call logs are among the systematic reviews of the quality management program (Rule 111-8-37-.09(2)(g)).

If the Agency is Medicare-certified, the 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 not to be subjected to discrimination or reprisal for exercising his or her rights (42 CFR §418.52(b)(1)(iii)-(iv)). The Agency applies this to every patient.

Georgia 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 the nurse explains the grievance process orally and gives Form GA-HSP-CMP-01-A, which contains the Agency’s complaint officer and the Department’s contact information: Georgia Department of Community Health, Healthcare Facility Regulation Division, Complaint Intake, 2 Martin Luther King Jr. Drive SE, East Tower, 17th Floor, Atlanta, Georgia 30334. Toll-free 1-800-878-6442. Website: https://dch.georgia.gov/hfrd-file-complaint. Email: HFRDComplaintintake@dch.ga.gov (Rule 111-8-37-.10(1)(f), (3)). The patient’s or representative’s signed acknowledgment of the admission packet records receipt.
• The form is explained in a language and manner the patient understands, and a Spanish version is available. Where the Agency cannot communicate effectively with the patient, the attempts are documented in the record (Rule 111-8-37-.10(1)(s)).
• The same information, with the patient rights, is posted in a public area of each office (Rule 111-8-37-.10(4)).
• Staff remind families of the process at the first visit after any significant problem, and at the bereavement contact after a death.
• Patients may also ask to review copies of any inspection report completed by the Department within the two years preceding the request (Rule 111-8-37-.10(1)(p)). The office keeps those reports ready to show.

1. Receive. Any staff member, contractor or volunteer who receives a complaint listens, thanks the person, deals with any immediate risk, and does not argue or promise an outcome. If the complaint suggests abuse, neglect or exploitation, the staff member follows Policy GA-HSP-ANE-01 at once.
2. Pass on. The staff member tells the complaint officer the same day, with the patient’s name, the complainant, what was said and any action taken. After hours, a complaint about current care goes to the on-call nurse, who acts and tells the complaint officer the next business day.
3. Log. The complaint officer enters every complaint in the complaint log (Form GA-HSP-CMP-01-B) the same working day, including complaints resolved on the spot.
4. Acknowledge. The complaint officer acknowledges the complaint to the complainant within 5, by telephone or in writing, and gives a contact name.
5. Investigate. The complaint officer or a person not involved reviews the record, speaks to the staff concerned, the patient and family, and any facility or contractor, and decides what happened.
6. Resolve. The complaint officer gives the complainant the resolution within 30 of receipt, explains any changes made, and reminds the complainant of the right to complain to the Department and the other bodies in Section 7. If more time is truly needed, the complainant is told why and when to expect the answer.
7. Escalate. A complainant who is not satisfied may ask for review by the Administrator, and then by the governing body. The Administrator reviews every complaint about a physician with the medical director.
8. Close. The log records the dates of receipt, acknowledgment and resolution, the finding, the action taken and whether the complainant was satisfied.

Patients and families may complain to any of these bodies at any time, without first using the Agency’s process. No one is discouraged from doing so.

When the Department investigates a complaint, it provides the outcome of the investigation to the person who complained and to the facility on request after the investigation is completed, and the names and identifying information of complainants are classified as confidential (Ga. Comp. R. & Regs. 111-8-25-.06(5)). The Agency never tries to find out who complained to the Department.

Complaints from a nursing home, personal care home, assisted living community or inpatient facility about the Agency, and complaints by patients or families about a facility’s care, are logged and handled in the same way. The designated hospice care team member for the facility (Policy GA-HSP-FAC-01) takes part in resolving them, and a complaint about a facility’s care is also passed, with the patient’s agreement, to the facility’s administrator. A complaint that suggests abuse, neglect or exploitation of a resident is reported under Policy GA-HSP-ANE-01.

No patient’s care is reduced, changed or ended because a complaint was made, and no staff member may discourage a complaint or treat a complainant differently. A patient must never be asked to request a voluntary discharge because of a complaint (Rule 111-8-37-.14(6)(b)). Any reprisal is a disciplinary matter.

Each role named below carries the duties shown.

The complaint log, each complaint file (statements, findings, letters) and the annual summary are kept for at least six years (the Agency’s own standard). Patient and family complaints and on-call logs are reviewed systematically by the quality management committee against written criteria (Ga. Comp. R. & Regs. 111-8-37-.09(2)(g); Policy GA-HSP-QA-01) at each meeting, including the time taken to acknowledge and resolve each complaint against the Agency’s time frames and any patterns by team, discipline, facility or contractor. The Administrator checks the office postings each quarter.

Every employee, contractor and volunteer is trained at orientation and annually on receiving a complaint, Section 6 steps 1 and 2, and the outside bodies in Section 7, as part of patient rights training (Ga. Comp. R. & Regs. 111-8-37-.13(2)(b), (4)(c)). The complaint officer is also trained on investigation and written responses.

This policy implements the following authorities.

• Ga. Comp. R. & Regs. 111-8-37-.10(1)(f)-(g), (p), (s), (3)-(4), patient and family rights
• Ga. Comp. R. & Regs. 111-8-37-.09(2)(g), quality review of complaints and on-call logs
• Ga. Comp. R. & Regs. 111-8-37-.14(6)(b), no demand for voluntary discharge
• Ga. Comp. R. & Regs. 111-8-25-.06(5), outcome of Department investigations; confidentiality of complainants
• 42 CFR §418.52(b)(1)(iii)-(iv), right to voice grievances without reprisal (Medicare-certified hospices)
• 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 rule cited in the References section is amended, the amendment is recorded in this table and a new version of this policy is issued.