Let Hospital and Nursing Home Know Your Grievances – Learn the Ways of Complaining!

• Date: March 15, 2010
• Source: admin

Now your issue/complaint with the facility will 100% be taken care of. This assurance is coming Ralph Montano, spokesman for the California Department of Public Health, which regulates hospitals and long-term care facilities in the state.  

Your complaint may range from mixed-up lab results, medication errors, foreign objects left in a patient during surgery or a host of other topics and now you can expect help from facility staff, state regulators, insurers and other agencies.

However, though the facility of lodging compliant has solved the problem of patients’ to some extent but still problem lies with the process which hinders patients from showing their agitation. At times, the process of registering your problem is tedious or time consuming and at times your complaints get lost! Therefore, knowing the right method of lodging your complaint is a must if you want it to reach the ear of the right person.

Ways of Lodging Complaints 

In-house Services

Not happy with the hospital services? Let the providers know your issue so that they can resolve the matter within themselves.  In fact, many organizations like better to resolve problems at the point of care.

As suggested by Patti Harvey, vice president of quality and patient care services for Kaiser Permanente in Southern California, your problem with facility you should first share with your bedside nurse. When that talk does not resolve the matter, approach other people higher in the chain of command. You can even approach the hospital administrator to look into your matter.

If the problem still persists, bring your problem to the notice of members of service offices. According to Virgie Mosley, manager of patient affairs for the health system, all UCLA Health System hospitals have similar offices to resolve complaints or grievances. Therefore, once you or your family members notify the patient affairs office, the chair of the clinical team responsible for that unit reviews your records and you soon receive a written response from them.

Insurance Agencies

In case you want to avoid any confrontation with the hospital during your admission, you can wait till the time you’re out and then lodge a complaint with your insurance company. In California, the Department of Managed Health Care requires a written process from the insurer. 

One of the most renowned insurance agencies, Aetna, empowers its members with a membership number on their identification number to help them lodging their complaints against hospitals or nursing homes. 

According to Terri Schroeder, head of regional quality for Aetna Inc. "We are especially interested when they have a quality-of-care or service concern,". He continues "We want to do everything possible to make sure patients are getting the care they need and deserve."

When fault lies with the facility, Aetna not only can request a corrective action but can even terminate the institution's contract. Even though the details of the investigation are confidential, members can still inquire the status of problem.

The Joint Commission on Accreditation of Healthcare Organizations

Working from 1910, the Joint Commission on Accreditation of Healthcare Organizations is a not-for-profit agency that recognizes and certifies more than 17,000 healthcare organizations and institutions such as hospitals, nursing homes, behavioral health facilities and clinical laboratories nationwide. When your problem with the hospital facility is not being taken care of, let the commission's Office of Quality Monitoring know your matter. This non-profit organization works day in and day out to secure patients’ rights. It evaluates complaints filed against accredited organizations relating to care and safety issues.

File your complaint to the Joint Commission. Add a brief summary of the issue and provide name and address of the facility and then send it by mail, e-mail, or fax. Your compliant will surely be taken care of and if there is a serious threat to patient safety, a staff member will conduct a surprise visit to the organization to verify the complaint.  Verified complaints can result in actions from resolution of the problem to denial of accreditation.

Help of Ombudsman

The California State Long Term Care Ombudsman Program is also there to resolve the problems you faced at nursing homes. With 35 offices in the state, ombudsman representatives advocates for residents of the 1,200 nursing homes and almost 8,000 residential homes in California.

Upon the receipt of your compliant, the facility receives an ombudsman from a nearby office mentioning about an investigation within two to three days. When the facility takes action, ombudsman considers the case as resolved.

In case the facility does not take proper action or in case the patient files the problem of neglect or abuse, the ombudsman will bring it to the attention of the California Department of Public Health. However, for most of the time, ombudsman representatives have been able to resolve issues that came to them.

State regulators

As recommended Pat McGinnis, executive director of California Advocates for Nursing Home Reform, while filing your case with your local ombudsman, file one with the Department of Public Health for better result. 

Depending on the severity of the complaint, state regulators response within 24 hours to 10 business days. In case the facility proves to be at fault, the department can issue fines, deficiencies or revoke Medicare and Medi-Cal funding. Documentation of substantiated complaints is available at district offices.

For more detailed information, check the websites of Joint Commission, State regulators and ombudsman, and resolve your problem with the facility.

Source: 

http://www.latimes.com/features/health/la-he-practical-matters-20100315,0,4960231,full.story