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 family caring for a dying person rarely has time or energy to complain, so when they do, it matters. This policy makes sure that Sample Hospice, LLC (the "Agency") listens, acts quickly, puts things right, and learns, and that patients know they can complain to the Agency or directly to HHSC without any effect on their care.

Complaints made by a patient, the patient’s family or guardian, or the patient’s health care provider (including a nursing facility) about treatment or care the Agency furnished, treatment or care it failed to furnish, or a lack of respect for the patient’s property by anyone furnishing services on the Agency’s behalf (26 TAC §558.250(c)(1)). As the Agency’s own standard, complaints from anyone else, such as a neighbor or referral source, are handled the same way.

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

The Agency has a grievance mechanism under which a patient can participate without fear of reprisal (26 TAC §558.282(a)). Every patient has the right to voice grievances regarding treatment or care that is, or fails to be, furnished, or regarding the lack of respect for property by anyone furnishing services on behalf of the Agency, and must not be subjected to discrimination or reprisal for doing so (26 TAC §558.282(f)(8); 42 CFR §418.52(b)(1)(iii)-(iv)). A patient 60 or older may complain about care or treatment, anonymously or through a person the patient designates, and the Agency must promptly respond to resolve the complaint and may not discriminate or take punitive action against the patient (Tex. Hum. Res. Code §102.003(f)).

The Agency documents receipt of each complaint and initiates an investigation within 10 days after receipt; documents all components of the investigation (26 TAC §558.250(c)(2)); and completes the investigation and documentation within 30 days after receipt, unless it has and documents reasonable cause for a delay (26 TAC §558.250(d)). Within those limits the Agency acknowledges each complaint within 5 and aims to resolve it within 30. The Agency does not retaliate against any person for filing a complaint, presenting a grievance, or providing information in good faith (26 TAC §558.250(e)).

At admission, the Agency gives each patient a written statement that a complaint against the Agency may be directed to HHSC Complaint and Incident Intake, P.O. Box 149030, Austin, Texas 78714-9030, toll free 1-800-458-9858 (26 TAC §558.282(d)). The statement also tells the patient that a complaint may be directed to the Agency’s administrator and, because it does, it states the time frame in which the Agency reviews and resolves a complaint (26 TAC §558.282(d)). This is Form TX-HSP-CMP-01-A. The clinical record documents that the patient was informed (26 TAC §558.301(a)(9)(L)). HHSC can also be contacted at HHSC Complaint and Incident Intake, P.O. Box 149030, Austin, Texas 78714-9030, toll free 1-800-458-9858.

1. Listen and record (any staff member, same day). Thank the person, listen without arguing, and fix anything you safely can at once (for example, call for a missed supply delivery). Record what was said, by whom, the date and time, and give it to the complaint officer the same working day. Never discourage a complaint or suggest it may affect care.
2. Check for abuse, neglect or exploitation. If the complaint suggests abuse, neglect, exploitation or an injury of unknown source, follow Policy TX-HSP-ANE-01 at once; the 24-hour outer limit runs from the moment the Agency has cause to believe.
3. Log and acknowledge (complaint officer). Enter the complaint on Form TX-HSP-CMP-01-B with the date of receipt, and acknowledge it to the complainant within 5, by telephone or in writing, giving the name of the person handling it.
4. Initiate the investigation (complaint officer, no later than 10 days after receipt). Record the date the investigation began (26 TAC §558.250(c)(2)(A)). For a complaint about a current patient’s care, the supervising nurse reviews the care within one working day (the Agency’s own standard).
5. Investigate. Talk to the complainant, the patient where able, and staff involved; review the record, schedules and visit data; and document every step (26 TAC §558.250(c)(2)(B)). If the complaint is about the complaint officer or the Administrator, the governing body assigns someone else.
6. Resolve and respond. Decide what happened and what will change. Tell the complainant the outcome, in writing if they wish, and that they may also contact HHSC. Aim to resolve within 30.
7. Close (no later than 30 days after receipt). Complete the investigation and documentation within 30 days, or document the reasonable cause for delay and the expected date before day 30 (26 TAC §558.250(d)).
8. Learn. Report every complaint and its outcome to the QAPI Committee (26 TAC §558.287(a)(1)(A)(ii)(V), (iv); Policy TX-HSP-QA-01).

Where a patient lives in a nursing facility or ICF/IID, a complaint by facility staff about hospice care, or by the hospice about facility care, is handled through the coordination arrangements in Policy TX-HSP-FAC-01. A complaint by the family about facility care is passed, with consent, to the facility and the family is told how to contact HHSC. Any concern of abuse, neglect or exploitation follows Policy TX-HSP-ANE-01.

Accountability under this policy is allocated as follows.

The complaint log (Form TX-HSP-CMP-01-B) and a file for each complaint, containing the record of receipt, acknowledgment, investigation steps, findings, response and corrective action, are kept for at least six years (the Agency’s own standard), confidential and available to HHSC on request. The complaint officer checks the log weekly for complaints approaching day 10 or day 30. The QAPI Committee reviews the number, type, timeliness and outcome of complaints and the appropriateness of the Agency’s responses at each meeting (26 TAC §558.287(a)(1)(A)(ii)(V)).

Every employee, contractor and volunteer is trained at orientation and annually (the Agency’s own standard) on receiving complaints, recording them, recognizing when a complaint is really an abuse, neglect or exploitation report, and the no-retaliation rule.

This policy implements the following authorities.

• 26 Texas Administrative Code §558.250(c)-(e), Agency Investigations
• 26 Texas Administrative Code §558.282(a), (d) and (f)(8), Client Conduct and Responsibility and Client Rights
• 26 Texas Administrative Code §558.301(a)(9)(L); §558.287(a)(1)(A)
• Texas Human Resources Code §102.003(f), complaints by elderly individuals
• 42 CFR §418.52(b)(1)(iii)-(iv), right to voice grievances without discrimination or reprisal
• 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 Hospice, 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 Section 11 is amended, the amendment is recorded in this table and a new version of this policy is issued.