Filing Complaints & Resolving Serious Issues With Oversight Agencies

For egregious problems and when serious issues are not resolved through other efforts, you may want to consider filing formal complaints with oversight agencies.

General Guidance for Filing Complaints

  1. File a complaint first with the Massachusetts Department of Public Health (“DPH”), Division of Health Care Facility Licensure and Certification, the state agency that enforces nursing home regulations through regular inspections and complaint investigations.
  1. If the problem involves care provided under Medicare, also file a complaint with Livanta (in addition to DPH). (Livanta is the agency that handles Medicare complaints as described below.)
  1. If the problem concerns an emergency, or a serious healthcare or financial issue, also file a complaint with the MA Attorney General, Health Care Division. While the Division does not take action on individual complaints, it maintains statistics to establish patterns of serious nursing home infractions to bring suit, sponsor legislation, etc., to improve care throughout all Massachusetts nursing homes.
  1. Copy (i.e. “cc”) all correspondence to all parties you contacted regarding the complaint including the agencies listed here and your local LTC Ombudsman.
  1. Also, copy the LTC Ombudsman main office and MANHR for further support and information.

Executive Office of Elder Affairs Ombudsman Office
1 Ashburton Place, 5th Floor
Boston, MA  02108
Phone:  617-727-7750

MANHR
PO Box 560224
Medford, MA  02156
Phone: 800-988-4450

See below: “A Note About Influencing Those Agencies” for some additional ideas.

Massachusetts Department of Public Health

24-hour complaint hotline: 800-462-5540

The Massachusetts Department of Public Health (“DPH”), Division of Health Care Facility Licensure and Certification, is the state agency that enforces nursing home laws and regulations through regular inspections and complaint investigations.  This is the primary agency handling serious complaints that cannot be resolved through standard channels.  Here is the DPH link for Complaints Regarding Nursing Homes and Other Health Care Facilities.

The division 1) investigates allegations of abuse, neglect, misappropriation, and mistreatment; 2) reviews allegations related to poor quality care and resident/patient rights in health care facilities in Massachusetts.

It is MANHR’s experience that unless there is an immediate life-threatening problem, it could take a couple of months for a resolution from DPH.  If the resolution is unsatisfactory, you should contact DPH and follow-up with a stronger letter to further be “on the record” with your concerns.

Medicare

(Livanta handles Medicare healthcare delivery issues: 866-815-5440)

Contact Livanta if your loved one has Medicare coverage, and you are concerned about the healthcare your loved one has been receiving. Livanta is the agency contracted with Medicare to handle medical case reviews to support the rights of people on Medicare. These rights include healthcare delivery protections and making sure the healthcare services the law says recipients are entitled to are delivered, including rehabilitation and maintenance therapies (e.g. physical or speech therapies).

For example, if your loved one has Medicare coverage, and you want to file a complaint or an appeal, Livanta will help you to:

  • Appeal a notice that the hospital intends to send your loved one back to the nursing home when you believe he/she should continue to stay in the hospital.
  • Appeal a notice that states a course of treatment (e.g., rehabilitation) is going to end when you believe your loved one still needs those services.
  • Address other medical concerns, e.g. received wrong treatment, did not receive care instructions upon discharge, received infection while recuperating in the nursing home, etc.

Contacts for Livanta assistance:

  • Immediate Advocacy (IA) is an informal, voluntary process used by Livanta to resolve your complaint quickly.

Massachusetts Attorney General’s Office

Attorney General, Health Care Division
Health Care hotline at 888-830-6277

You also may file a complaint directly with the MA Attorney General Office (AG) about an emergency, or a serious healthcare or financial issue in a nursing home.  Please note: the AG’s office does not take action on individual complaints.  However, your filing of a complaint is ultimately a way to alert the AG’s office to nursing home issues, so the AG can maintain statistics to establish patterns of serious nursing home infractions.  Your input will help hold nursing homes accountable  and could spur the office to investigate harmful practices, sponsor legislation to change those practices, etc.

→ A Note About Influencing Those Agencies

While not for everyone and depending on each individual case, there are some other actions you can take to try and influence the speed with which your complaint is acted upon by an agency and, possibly, the outcome of your complaint.

Hiring a Lawyer – There are attorneys who are skilled in representing nursing home residents and their authorized representatives (and loved ones) in situations where the nursing home may be violating the rights of the resident.  At times, a letter from an attorney “does the trick” while other times, court cases are filed.  If you feel the need, it is useful to contact an attorney and, at least, have an initial conversation about your concerns.  See Hiring a Lawyer – Some Options.

Contacting your US and State Legislators – Elected officials recognize part of their jobs is to respond to constituent concerns and requests for help.  This applies to any issues you might be having with an agency who you have spoken to about your loved one’s quality of life and care in a nursing home. It is easy to call and ask for help from your elected officials US Congressperson and US Senator if it is a Medicare-related issue, or to Massachusetts legislators (both representatives and senators) if it is related to DPH or the nursing home. At a minimum, they are usually willing to contact the agency or facility involved and let them know he/she has an “interest” in the quick disposition of your complaint.

See “Contacting Your Elected Officials” for contact information for your particular federal and state legislators.

Going Public to the Media – In rare cases, you may want to consider calling local media (e.g. newspapers, television, radio, online news sites) to share your story.  If it is compelling enough (as decided by the editors/producers at the media outlet) they will conduct their own fact-finding and may decide to run a story.  Even if a story does not run, an agency getting a media inquiry about a complaint may feel the “pressure” to act quickly.

→ Next: Some Notes about Medication