A Guide To Developing An Effective Complaint and Grievance

A Guide To Developing An Effective Complaint and Grievance Process

for Assisted Living and Other Long Term Care Facilities

The National Center For Assisted Living created this guide to aid assisted living and residential care facilities in the development

of a sound, effective process for handling complaints and grievances. A structured complaint and grievance policy is one of the

foundations of a resident-centered approach to care and a hallmark of the nation’s most revered service providers.

TURNING COMPLAINTS

INTO

COMPLIMENTS

:-(

:-)

NCAL Brochure 2/4/05 10:25 AM Page 1

The National Center For Assisted Living (NCAL) is

committed to quality and performance excellence in the

assisted living profession and actively supports Quality First, a

covenant for healthy, affordable, and ethical long term care,

and adherence to its principles and goals. NCAL represents

more than 2,400 non-profit and for-profit assisted living

residences through a federation of state affiliates that are

dedicated to professional and compassionate care for the

elderly and disabled.

NCAL actively represents the assisted living profession's

perspectives to policymakers who shape laws, regulations,

policies, and opinions that will influence the future of assisted

living. NCAL provides advocacy tools and educational

products designed for the assisted living profession to better

serve our nation's elderly and disabled.

For more information about NCAL, please visit our Web site at

www.ncal.org or call the national office at (202) 842-4444. For

consumer information about assisted living and the continuum

of long term care, please visit www.longtermcareliving.com.

National Center For Assisted Living

1201 L Street NW

Washington, DC 20005

(202) 842-4444

A special thanks goes to the members of NCAL’s 2004 Consumer

Relations Committee for their tremendous assistance with and support

for the creation of this brochure.

NCAL Brochure 8/18/05 7:50 AM Page 2

About This Guide

Assisted living facilities certainly receive their fair share of resident and family

complaints about many issues, including dining services, cleanliness, policies,

activities, missing clothes, and more serious concerns such as theft of resident

property or mistreatment of residents. Whatever the scope of complaints received

by your facility, it is important to have a clearly defined process by which

residents and families can register their concerns. In turn, those concerns should

be addressed sincerely and promptly, regardless of the type of the complaint. The

resident who shyly says that dinner was cold last night to a personal care aide

should be given the same attention as the one who aggressively approaches the

facility director about her housekeeping service.

The manner in which complaints are received and addressed demonstrates an

important measure of your facility’s commitment to quality care and resident

satisfaction. A structured complaint and grievance policy is one of the

foundations of a resident-centered approach to care and a hallmark of the

nation’s most revered service providers. When clearly communicated to staff,

residents, and families and strictly adhered to by all parties, the complaint process

can be a valuable asset among your resident relations and retention strategies, as

well as a sound risk management practice.

This guide to developing a structured complaint and grievance policy will give

you new insight on achieving higher levels of resident satisfaction and may

inspire a change of culture throughout the facility. For example, the process could

also be implemented for employees, who could make suggestions for improved

operations or express dissatisfaction with current policy. Seeing these

“complaints” as an opportunity to improve your facility’s quality of care will lead

to a more positive working environment for your staff and an enhanced living

environment for your residents.

Keeping Residents Satisfied Has Many Benefits

Providing quality care for your residents is the primary reason for working in the

assisted living profession. By maximizing resident and family satisfaction with

services, activities, or facility operations, you have a better chance at maintaining

occupancy rates and building a positive reputation in your community.

Research shows that dissatisfied customers (and their family members) tell on

average 15 other people about a negative experience. Without a structured

complaint process, residents and their family members may feel their only outlets

for venting their concerns are friends, relatives, doctors, home care aides, and

others. These negative impressions can seriously affect your facility’s standing in

the community and even the ability to attract new residents.

However, data also show that more than 85 percent of dissatisfied clients can be

brought back around with efficient and sincere efforts to address their concerns.

“When clearly

communicated to

staff, residents, and

families and strictly

adhered to by all

parties, the

complaint process

can be a valuable

asset among your

resident relations

and retention

strategies, as well

as a sound risk

management

practice.”

NCAL Brochure 2/4/05 10:25 AM Page 3

In turn, these newly “satisfied” customers can become your strongest supporters.

Dissatisfied customers report that when their concerns were handled with

attentiveness and empathy and in a timely, personal manner, they were more

likely to support how their complaints were resolved.

Another statistic to keep in mind is that as many as 33 percent of people won’t

pursue a complaint even though the issue is serious enough for them to

remember a year later. This suggests that many dissatisfied residents may simply

move out of your facility without ever discussing their concerns or giving you the

opportunity to address them. In addition, not only might they take their business

elsewhere, they’ll most likely talk about the reason for their departure. Or, a

resident or family may silently harbor a complaint and then build a laundry list of

little complaints that finally reaches a point where trust in the facility is lost.

The results of various customer surveys suggest that an effective complaint

process clearly outlines three matters: how to complain, where to complain, and

how seriously it will be handled. From the customer’s viewpoint, a business can

demonstrate its commitment to the complaint process by making it visible,

accessible, and fair.

Seeing Complaints as Opportunities for Improvement

Ideally, all staff and management would anticipate every resident’s current and

future concerns and act on them to prevent a complaint from ever being voiced

in the first place. Caregiving staff may observe issues that can be dealt with before

they reach the status of a complaint. For example, a caregiver who notices that a

resident’s unit is not up to general housekeeping standards should bring the

matter to the attention of the appropriate manager before the resident or a family

member finds it necessary to raise a concern.

Another way to mitigate future complaints is to carefully manage the

expectations of residents and family members. For example, if a resident who

moves into a facility has a history of falls, it is unrealistic to believe that those

falls will cease because of the change in residence. The falls may be reduced by

the facility’s more appropriate surroundings and increased supervision, but the

resident’s condition of susceptibility to falls still exists. By helping the resident

and family members embrace realistic expectations of care, staff and management

can avoid many complaints based on unrealistic expectations.

Despite any facility’s best efforts, however, complaints will occur. How they are

received will affect the success of their resolution. Seeing a resident’s or family

member’s complaint as an opportunity for improvement is the first step in

developing an effective complaint process. An administrator or director must

seek to uncover root causes of a complaint and develop solutions that satisfy all

parties, including staff. Trying to determine which employee to blame neither

encourages staff to record complaints nor enhances the resolution process. This

change from “seek to blame” to “seek to improve” can make a substantial

difference throughout your facility.

A STRUCTURED PROCESS

RESOLVES FUTURE DISPUTES

At a 60-unit assisted living

facility in North Dakota,

management and staff used

the facility’s grievance

procedures to solve a

medication management

complaint from a resident with

dementia. Although the

resident didn’t want staff

members administering his

medication, the staff knew his

condition prevented him from

safely administering it himself.

By outlining the issues on the

facility’s complaint form and

getting input from appropriate

staff and a family member, the

staff developed a win-win

solution for all involved.

Another family member,

however, disagreed with the

solution and called the state’s

ombudsman, who then

launched an investigation.

When the ombudsman visited

with the staff and reviewed

the complaint forms, she

found the facility had done

everything with the resident’s

best interest in mind. The

ombudsman praised the

facility for having a well-

organized process!

Having a procedure used

consistently by staff helped

resolve this issue and kept

pertinent information close at

hand. Even with a visit from

the ombudsman, the staff was

confident that their process

served both the resident and

the facility well.

NCAL Brochure 2/4/05 10:25 AM Page 4

Try this viewpoint: Complaints offer you the chance to enrich your facility’s

services and show responsiveness to resident concerns. They allow you to review

facility procedures through the eyes of your residents and determine if changes

can be made that would benefit residents and staff while staying within safety

guidelines. Remember that every complaint does not require a change in policy,

but a full review may reveal new ways to deliver services that delight your

residents and family members.

Complaints also offer staff an opportunity to contribute to the resolution. The

saying that two heads are better than one works well in complaint resolution.

Your frontline staff may have several viable solutions based on their knowledge

and experience. And what better way to gain buy-in on the resolution than to

have it come from the employees who will implement it?

One tough question that consistently arises during the development of such a

process is whether the resident/family member is “always right.” Although many

people will answer that question differently, it is important that all staff respect

the resident/family member’s opinion. When residents or family members share a

concern with staff, the employee should always listen attentively, record pertinent

information carefully and objectively, and share it with appropriate managers.

Creating a Culture of Continuous Improvement

For assisted living facilities committed to providing top-quality care and services,

the complaint process will be an important part of their approach to quality.

Effective quality management also includes developing a customer-focused

mission statement; surveying and responding to the customers’ needs and

expectations; empowering employees to continuously improve and surveying their

satisfaction with their work processes and environment; and gathering and

analyzing key performance indicators to improve organizational and process

results. For more information on developing these quality indicators, please see

the “Guidelines for Developing a Quality Management System For Long Term

Care Providers,” which is available online at

http://ahcaweb.org/quality/qf_index.htm under “Strategies for Implementation.”

Your facility’s procedure for handling complaints and grievances should be

regularly communicated to residents, families, employees, and other stakeholders.

The information reported by residents, family members, and employees should be

recorded, studied, and responded to in a timely and confidential manner. The

procedure should include:

➤ A clearly defined process for documenting resident and family concerns that

is communicated to and supported by all staff.

➤ A detailed description of the process that tells all residents and family

members how to pursue resolution of a concern and a time frame as to when

they can expect a response.

“For assisted living

facilities committed

to providing

top-quality care

and services, the

complaint process

will be an important

part of their

approach to

quality.”

NCAL Brochure 2/4/05 10:25 AM Page 5

➤ A process for assisting residents who need help preparing a written complaint.

➤ The names, job titles, and telephone numbers of the employees responsible for

implementing the process to resolve concerns.

➤ The address and toll-free telephone numbers of the ombudsman and the state

agency for reporting unresolved issues and concerns.

➤ A follow-up process that verifies that the concern has been resolved to the

resident’s and family’s satisfaction.

➤ A means to periodically aggregate and analyze data to identify common issues

and areas of concern.

➤ Maintenance of complaint records for quality assurance purposes.

➤ Regular reporting to the facility’s Quality Committee of data on registered

complaints, including the total number handled, types, and final dispositions.

A Model Complaint Process

Whatever process you eventually adopt should have as its centerpiece policies

and procedures that demonstrate the facility’s commitment to resident

satisfaction. What follows is a model procedure that can be customized to fit the

needs of your facility.

Step 1: Encourage Residents/Family Members to Share Concerns

Ensure that all facility staff and management encourage residents and family

members to share their concerns/complaints. It is far better to have issues

addressed early on than to wait for unexpressed complaints to balloon into

unwanted calls from an attorney, family physician, or ombudsman.

It is important to recognize that many families and residents do not take their

complaints to facility staff for fear of retaliation against the resident. Not only

does this situation leave staff helpless in addressing the concerns, it can lead to

an unnecessarily tense atmosphere.

You can prevent such an atmosphere by consistently asking residents and family

members for feedback, encouraging them often to let you and their caregivers

know about any concern they may have. You can extend on-the-spot invitations

(in the hallway during a visit) or more formal requests (such as a letter to

residents/family members or a newsletter article) for their opinions. These

approaches reassure residents and family members of your sincere interest in

feedback and help build trusting relationships.

When a resident or family member approaches an employee to discuss a concern,

the staff member’s attentiveness and empathy will play an important role during

the interaction. Staff should stop what they are doing and give the resident or

family member their full attention. They should also maintain eye contact and

avoid negative body language, such as crossed arms or shifting weight.

“The manner in

which complaints

are received and

addressed

demonstrates an

important measure

of your facility’s

commitment to

quality care and

resident

satisfaction.”

NCAL Brochure 2/4/05 10:25 AM Page 6

Step 2: Apologize and Take Information at Initial Contact

In general, the employee should apologize for the discomfort or inconvenience

caused by the incident. An apology does not mean an acceptance of blame.

Rather, it is a way to show the resident or family that the staff member recognizes

their concern and distress. Staff will have an opportunity later to explain the

situation, in a nondefensive way, if such an explanation is necessary. However, at

the initial contact, staff’s response should be that of understanding, recognition,

and consolation.

If the employee can competently address and resolve the complaint at the time it

is made, he or she should do so, preferably in the resident/family member’s

presence. If, after the employee takes action, the resident continues to complain

or indicates that the problem is ongoing, the employee should initiate the

facility’s complaint procedure.

If unable to resolve the problem, the employee should personally take the

resident/family member to a staff member who can address the concern. All staff

members should have the names and positions of people to whom they can take

both resident and family concerns.

Step 3: Document the Problem

All complaints should be systematically documented (see sample form on page

13). The forms should be readily available to residents and family members. A

copy should be included in the resident’s handbook and available throughout the

facility, including with the receptionist, at a central location on each floor, or

near the dining room or another area where residents often gather. Also, each

staff member should have ready access to the form.

The form may be filed in one central location for the entire facility, or in a log

book designated for each floor of a facility. It is important to encourage staff to

report all complaints. Although direct caregivers may become accustomed to

hearing what they categorize as “gripes,” they shouldn’t turn a deaf ear to

complaints. They must keep in mind that for every family member or resident

they don’t listen to, there might be an attorney waiting for the chance to listen.

Communication books are another way to document complaints. These books are

for internal use and serve as a resource between shifts. That is, staff on each shift

can report issues that arose with particular residents or family members so the

staff on the next shift will understand the history of a situation. Managers can

also use the books to look for patterns in complaints and determine if a change in

policy or a resident’s service plan is needed.

Step 4: Designate a Staff Contact

In the event that a complaint is not resolved immediately, further review and

discussion may be needed. In this case, the facility should designate a single staff

person as the family’s contact during the resolution process and should introduce

this staff person to the family. If the family understands that this staff person will

follow up with them, they may not feel the need to constantly check on the

status of the resolution.

A STRUCTURED PROCESS

SHOWS COMMITMENT TO

RESIDENT SATISFACTION

At a 54-unit assisted living

facility in Indiana, staff finds

their complaint form is an

excellent method for tracking

a resolution and for keeping

the family informed. When a

complaint is first raised, social

services staff records the

information on the facility’s

compliant form. All

subsequent actions by each

department are also recorded.

That way, if a family member

calls about a registered

concern, any member of the

staff can let the person know

the status of the complaint.

The administrator notes that

the form also provides an

effective means for holding

accountable the different

departments that are needed

to address the issue. For

example, if a resident

complains about lost clothing,

the laundry department

records the dates of when all

methods were used to retrieve

the missing article. The

administrator can review the

form to ensure all means were

used to find the lost item. If it

can’t be found, the item is

replaced.

The facility’s process and form

increases resident and family

satisfaction. With a structured

complaint process, the

resident and family have

tangible assurances that their

concerns are taken seriously.

They recognize the facility’s

commitment to resolving

issues is an extension of its

commitment to their

satisfaction.

NCAL Brochure 2/4/05 10:25 AM Page 7

For more serious concerns, a letter (see sample on page 12) should also be sent to

the family to acknowledge the facility’s receipt of the complaint. The letter

should include the staff contact’s name, phone number, and hours available. The

letter should also give the resident/family an estimate of how long it will take to

resolve the issue.

Step 5: Gather the Facts

When a complaint has been logged and the staff member was unable to resolve it

during the initial contact, an interview process should be initiated to fully

understand the scope of the problem. It is important to hear from all parties

involved in the situation. These fact-gathering sessions are not intended to be

inquisitions; they are to uncover the root issues that led to the complaint. You

should encourage honesty from your staff in relating the events and avoid the

stigma of punitive actions during such an interview.

For complaints that deal directly with a policy (such as wake up time, service

delivery, or housekeeping), collaborating with staff on the nature of the complaint

and gathering their suggestions for addressing the issue helps build unity among

staff. Obtaining staff “buy-in” to the solution is important to achieving resident

satisfaction.

For more serious issues, such as theft or alleged mistreatment of residents, a more

investigatory approach is necessary. In those cases, all staff involved should be

interviewed as quickly as possible and appropriate authorities notified.

Step 6: Formulate a Solution

At the end of the initial contact, the resident or family member should feel that

something was done to resolve the issue. The tangible indication of a resolution

can be something as simple as an alternate meal, fresh bed linens, or more detail

about an action plan (e.g., a specific date on which the facility will follow up on

the problem).

For some policy-related issues that can’t be resolved at initial contact,

collaboration with staff on the resolution enhances staff unity and buy-in on the

outcome. The resident or family member may also be consulted for input on the

solution. For more serious concerns such as theft or alleged mistreatment of

residents, contact the proper authorities.

After a resolution has been determined, inform the resident/family as soon as

possible. Remember that any communication (verbal or written) must respect the

confidentiality of your employees. For example, if a staff member was dismissed

over an incident, relaying specific information to a family member may violate

the employee’s right to privacy. You can let the resident or family member know

that the person no longer is employed at the facility, but it is best to refrain from

sharing any details about such personnel decisions. In addition to discussing the

resolution, your communication with the family or resident is also an opportunity

to reaffirm your commitment to resident satisfaction. If a policy has been changed

for the benefit of all residents, include that in the note or phone conversation.

“When a resident

or family member

approaches an

employee to

discuss a concern,

the staff member’s

attentiveness

and empathy will

play an important

role during the

interaction.”

NCAL Brochure 2/4/05 10:25 AM Page 8

Step 7: Follow Up

It is essential to follow up on any complaints after you believe they have been

resolved. The staff contact should call the resident/family member to verify that

the resolution was satisfactory.

It is important to also recognize that for some issues a mutually agreed upon

resolution cannot be reached. For those unresolved issues, the parties may need

to respectfully disagree.

Staff Training Enhances Your Process

Staff training is one of your best strategies for managing resident complaints.

Ensuring that your staff fully understand and implement the complaint process is

critical to the program’s success. Begin with formal training on your complaint-

handling procedures during employee orientation. Have each department keep a

copy of the facility’s policies and procedures in a conspicuous place for reference.

In employee break rooms, signs that illustrate the facility’s commitment to

effective complaint resolutions serve as extra reminders. At times throughout the

year, stage role-playing skits that highlight the issue at individual department or

all-staff meetings. Repetition of the key elements of your program will help staff

stay mindful of the procedures and recognize its importance to the facility.

In addition to educating staff about complaint-handling procedures, ongoing

training should cover human reactions and the ways in which different types of

people complain. Just as there are many types of human personalities,

complainers, too, have different styles. Understanding some common approaches

used by dissatisfied clients will help staff resolve an issue by also addressing their

deeper motivations.

For example, the quiet resident may not complain at all, so staff should be sure to

regularly ask for comments about services and conduct regular satisfaction

surveys about the facility. With a more aggressive complainer, staff should listen

completely to the complaint, acknowledge the complaint, and log it accordingly.

This type of complainer often needs a time frame for resolution but does not

respond well to explanations or excuses. A chronic complainer requires extra

patience on the part of the staff. While the simple expression of the complaint is

helpful for this type of resident, the clear expectation is for a sincere apology and

an honest effort to resolve the issue.

Staff should also remember to listen to the problem, not the delivery.

Distinguishing the personality from the problem will help staff deal more directly

with the facts.

Your training program can also include a discussion of different cultural

approaches to personal interactions. As you encounter staff and residents of

varied backgrounds and heritages, it becomes important to raise the

consciousness of staff about how cultural differences can affect personal behavior.

“Staff training is

one of your best

strategies for

managing resident

complaints.”

NCAL Brochure 2/4/05 10:25 AM Page 9

For example, some cultures shun the idea of making eye contact during

caregiving. Take this opportunity to have staff members share their heritage and

knowledge of other cultures. Such exchanges could go a long way toward

avoiding misunderstandings and improving customer relations.

Guidelines for Good Listening Skills

Another important topic to cover during the complaint-handling training session

is the development of effective listening skills. This is a critical skill that must be

learned.

Listening is a large part of customer service. To effectively listen, staff must listen

for not only the concern, but also for the solution that the resident or family is

expecting. The resolution should meet that expectation.

✔ Stop what you are doing and make eye contact when someone addresses you,

even if you are in the middle of a task. If your task is time-sensitive, explain

this to the resident or family member and tell them when you will be available

to listen to the concern. Be sure to be available at the appointed time.

✔ Sit down with the person, if possible. The act of sitting down together feels

less rushed and more personal. Try to be on the same eye level.

✔ Limit distractions.

✔ Use positive body language. Keep body language open and friendly. Lean

slightly toward the person talking and keep your hands at your side.

✔ Mirror the other person’s concern. For example, say “If I am hearing you

correctly...” to reinforce your acknowledgment that you have heard

their point.

✔ Say what you can do and do it. For example, if a family member says, “Her

bed is always wet,” you must change the perception that the bed is always

wet. The words “always” and “again” indicate concerns that have not been

expressed or complaints that have not been addressed.

✔ Write the concern down, using the same words as the resident or

family member.

✔ Do not try to gain a “win” for the facility. Go for a win-win solution that

serves both parties.

✔ Create a climate for collaboration and negotiation. Do not get defensive.

Remember that you have a common goal: quality resident care. Become a

partner with the resident and family.

“It is essential to

follow up on any

complaints after

you believe they

have been

resolved.

The staff contact

should call the

resident/family

member to verify

that the resolution

was satisfactory.”

NCAL Brochure 2/4/05 10:25 AM Page 10

✔ Agree whenever possible. Focus on the issues on which you both agree.

✔ Say “yes” whenever possible. “Yes” is a powerful tool in moving toward

common ground. “Yes, I agree.” “Yes, he looks forward to breakfast.”

✔ Project confidence and competence. Sit up straight, make eye contact, use

the person’s name often, and do not shy away from stressful encounters.

Using Conflict Resolution Techniques

For Difficult Situations

There will be times when residents or family members become agitated because of

a perceived problem. That agitation may lead to further frustration and,

potentially, a loud, public display.

Often, the force of the anger or frustration directed at a staff member has nothing

to do with the individual personally. In fact, the staff member may have no

control over the problem. However, the staff member must listen, wait, and

respond in a manner that will diffuse the situation rather than escalate it.

The most important step a staff member can take is to listen actively, which

means conveying nonverbal messages through eye contact and occasional nods so

that the frustrated or angry resident or family member feels that the staff member

is listening and interested. Next, staff should treat any complaints or concerns as

valid: For the moment, they are valid simply because they are the perceptions of

the resident or family member. Later investigation may show that other factors

came into play and the situation was not as the resident or family member

perceived. But, at that initial moment, the concern should be validated.

Statements such as “I see how this would concern you” help diffuse the situation

by letting the resident or family member know that the concern has been heard

and the point made. As with any complaint, staff should refer the matter to the

appropriate manager, who will initiate an inquiry. It is important to objectively

document all steps taken.

Guidelines for Diffusing Difficult Behaviors

✔ If a family member’s complaint indicates that a resident may be in imminent

danger, go immediately to the resident to assess the situation.

✔ If an outburst occurs in a public area, break in at an opportune moment and

suggest moving the discussion to a private area. An effective statement may

be “I do want to fully understand your concern. Let’s move to [a more private

area] as I’d like to hear more.”

✔ Avoid standing over a resident or family member who is angry or frustrated.

Both parties should be at the same eye level, whether seated or standing.

A STRUCTURED PROCESS LETS

RESIDENTS BE HEARD

At a 34-unit assisted living

facility in Iowa, the

administrator began

receiving an unusually large

number of complaints about

food quality, even

though nothing had recently

changed. Though the

complaints were mostly minor

in scope, the volume

concerned her. So, instead of

addressing them

individually, she called a

meeting with the dietary

manager and invited the

residents.

The residents, she says, were

happy to attend and

appreciated the chance to

speak. As a result of the

meeting, relatively minor

changes were made:

Vegetables were cut smaller;

salmon patties were covered

to prevent them

from drying out.

On a follow-up survey,

resident satisfaction with the

food soared. Without

significant changes to the

menu, the facility netted

significant changes in

satisfaction among residents.

The more important

achievements, the

administrator says, were

allowing the residents' voices

to be heard and

acting on their

recommendations.

NCAL Brochure 2/4/05 10:25 AM Page 11

✔ When the anger or frustration begins to subside, validate the concern and

express gratitude to the resident or family member for bringing the complaint

to staff’s attention.

✔ Begin to ask questions to gain a greater understanding of the complaint or

concern when the resident or family member is calmer. As you ask questions

to clarify and define the issue, it may be helpful to take notes. Taking notes

not only shows interest, but also helps to list the “facts” perceived by the

resident or family.

✔ When you feel that you understand the concern, restate it to the resident or

family for confirmation.

✔ When concluding the conversation, tell the resident or family member what

will be done. Follow up with the resident or family in the time frame given.

✔ Besides telling the family member or resident that an investigation will occur,

take the time to provide additional customer service. “Will that be

satisfactory?” “Is there anything that we can do in the interim to make this

situation better?”

The Role of Resident and Family Councils

A resident council is an organized group of residents who live within an assisted

living community. The residents meet regularly to provide feedback to facility

management, address concerns, develop suggestions, and plan activities for the

facility at large. This forum can also be used to inform the residents of new

policies and procedures.

Each facility is encouraged to have a resident council to address concerns or

desires related to facility operation and services. The meetings provide a forum

for addressing concerns raised by individual residents and developing solutions.

The resident council that empowers residents to work together on agreeable

compromises can manage some concerns. Facility management should always be

open to hearing concerns, comments, and suggestions from the council.

It is ideal to have minimal interference from staff at the council meetings.

Occasionally, the council may request a department head be present when

individual departments are discussed. This creates immediate answers and can

reduce some frustration with the residents. However, it is important that staff

avoid false promises and quick reactions.

Once a meeting is completed, the resident council representative generally meets

with the administrator and department head staff to address all concerns

presented at the meeting. Department heads should then investigate the issues

and respond to the council regarding the concerns and corrections. The

resolutions should be documented and followed up on as soon as possible.

“Resident and

family councils can

help issues get

resolved and help

improve quality of

life for residents.”

NCAL Brochure 2/4/05 10:25 AM Page 12

Family Councils

A family council is an organized group of relatives or friends of assisted living

residents that meets regularly to discuss issues and concerns about the facility.

While the primary purpose of a family council is for families, as a group, to

influence the quality of care for residents, it also offers a forum to enhance

communications with facility staff and offer peer support for the relatives and

friends of residents.

In the area of complaints, family councils present a unified voice to resolve

mutual concerns. This group is especially helpful for residents who cannot

verbalize their concerns, such as residents with memory impairment. For optimal

use, it is important that family council members recognize the whole assisted

living community and not just those residents of the family members in

attendance. An effective family council may submit concerns in writing to the

administrator.

If an administrator is attuned to the families’ concerns and makes every effort to

resolve them efficiently, then family councils can be very effective and beneficial.

Issues get resolved and improve not only the quality of care, but also the quality

of life. When family members understand what goes into making the community

work, and the “why” behind the procedures, it makes them feel a part of the

community and assists them in understanding the complexity of running a quality

community.

Turning Complaints Into Compliments

Turning complaints into compliments can be achieved with a strong commitment

by management and staff to continuously improve the quality of service delivered

to residents and families. It takes training, patience, and a mature attitude toward

accepting criticisms. Customer satisfaction can be maximized with an effective

complaint process. When staff consistently addresses resident and family

concerns, the facility can attain the highest levels of customer service. The

rewards can be significant for both residents and the facility staff.

NOTE: This brochure

should be used solely

as a reference tool. Its

contents are not to be

construed as legal

advice. Any questions

concerning the matters

set forth herein should

be directed to your

legal advisor. The

National Center For

Assisted Living

disclaims any and all

liability related to or

arising from the

information contained in

this brochure.

The material in this

brochure is subject to

Permission for

reproduction by other

parties must be

obtained from the

National Center For

Assisted Living.

Photocopying of these

materials is an

infringement of

NCAL Brochure 2/4/05 10:25 AM Page 13

Date

Dear [Resident or Family Member’s Name],

This is to acknowledge your [letter, phone call or conversation] [dated or on] [date] regarding [resident’s

name]. We at [facility name] strive to deliver quality care each day to all of our residents. Your [letter,

phone call or conversation] has been referred to my management team for review and appropriate action.

We value your comments and consider it an opportunity to work together to continue to meet the needs

of [resident’s name].

If you have any questions about this issue, please contact [staff contact name and title] at [phone

number]. You can generally reach [staff contact name] from [hours of availability].

We appreciate your pointing out areas of concern and hope we can continue to work together. To this

end, we would be happy to schedule a meeting with the team at [facility name] to review your concerns.

Your satisfaction is very important to us.

Sincerely,

Assisted Living Administrator

Sample Follow-Up Letter From An Assisted Living Facility

(Reprinted from “The Facility-Based Risk Management Program”)

NCAL Brochure 2/4/05 10:25 AM Page 14

Person Voicing Concern Date

Resident’s Name Unit #

How to Contact:

Address

Day Phone Evening Phone

Describe the complaint/concern:

Expectations of person voicing concern:

Referred to: Dept. Date of Referral

Findings:

Actions Taken:

Reportable to an outside agency? Yes No

If yes, was this reported? Yes No

To whom: Date

Investigation findings reported to person voicing concern? Yes No

How? In-person In writing Telephone

Notes:

Person voicing concern satisfied with findings and action? Yes No

Person Completing Inquiry Date

Sample Form For Recording Resident Family Complaints/Concerns

(Reprinted from “The Facility-Based Risk Management Program”)

NCAL Brochure 2/4/05 10:25 AM Page 15

National Center For Assisted Living

1201 L Street NW

Washington, DC 20005

(202) 842-4444

www.ncal.org

NCAL Brochure 2/4/05 10:25 AM Page 16