Posted by: Robert Markette
April 28, 2006

Today I want to pass along a thought on complaint resolution and complaint logs. All of you who are certified for Medicare and most of you who are subject to state licensure are required to have a means for resolving client complaints. I have had numerous agencies run into difficulty with this standard and it is almost always for one of two or three reasons.

The first is failure to follow up. You policies and procedures likely include a policy and procedures on receiving a complaint and following up on the complaint. If a complaint is logged, you had better have documentation following up on the complaint. Sometimes, this does not happen. This can be for any number of reasons up to and including the complainant has also called the state department of health, adult protective services, or law enforcement. In those cases, the law enforcement personnel may enter you agency to investigate the complaint before you finish your investigation. This does not eliminate your need to follow your procedures.

It may mean your follow up notes the APS or police investigation and, while that investigation is ongoing, the employee(s) involved may need to be suspended (consult your personnel policies.)

Regardless of what the follow up entails, you need to follow up and to document that follow up. In fact, the failure to clearly document your follow up is another common basis for citations for agencies. You need to have clear documentation that you investigated the complaint and how it was resolved. If it has not been resolved when you are surveyed, you should still be able to show which steps of your procedure have been completed. The record should also reflect that you are responding promptly. If the log shows a complaint, but your records do not show that you followed up for more than a month, you are most likely going to be cited in a survey.

Keep in mind, that the survey may not be your only problem. If you have an employee who is abusing a patient and you receive a complaint, but fail to properly follow up on the complaint, you may be open to charges for failing to report the abuse to the proper authorities as wall as being liable in a civil action for failing to fulfill you duty to your patients.

If after you perform your investigation, you determine the complaint is baseless, make a record of that. If you feel the complaint is unresolved, because you are unable to make the patient or the patient’s family happy, remember that resolution of the complaint does not hinge upon the complainant’s feelings. You may note that you have resolved the complaint, because you investigated it and took action that you deemed appropriate to prevent the issue in the future. The complaint log should note that the complaint has been resolved as well.

One final point, like everything else in home care, clear, concise documentation is a key to complaint resolution. The surveyor should be able to look at the record and see that the complaint was received, that there was prompt follow up, and that there was resolution to the complaint. The surveyor should not see a complaint, with little or no additional documentation.

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