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Complaints about aged care providers: the process, possible outcomes and being prepared

Newsletter 18 August 2017

The Aged Care Complaints Commissioner (‘Complaints Commissioner’), currently Ms Rae Lamb, has been responsible for managing all complaints about approved providers of aged care since 1 January 2016.  The following programmes fall within the scope of the Complaints Commissioner’s jurisdiction:

  • residential aged care services, including permanent care and respite care;
  • Home Care Packages delivered on a Consumer Directed Care basis;
  • flexible care where a person is receiving ‘residential care’ or ‘home care’; this includes services provided through transition care, innovative care or multi-purpose services (MPS);
  • Commonwealth Home Support Programme (CHSP); and
  • National Aboriginal and Torres Strait Islander Flexible Aged Care Programme (NATSIFACP).

Programmes that are outside the Complaints Commissioner’s jurisdiction include:

  • Veterans’ Home Care Program;
  • Partners in Culturally Appropriate Care; and
  • Home and Community Care delivered in Victoria and Western Australia.

The Complaints Commissioner recently shared at the Implementing Increased choice in Aged Care conference that almost 23% of complaints received relate to home and community-care services, an increase from 8% since 2015.  Approximately 4,500 complaints received by the Commissioner remain primarily concerned with residential care and there is a steadily growing portion of complaints in relation to home care and support.

The top five issues in home and community-care services relate to:

  1. Financial matters;
  2. Communication and consultation;
  3. Social and domestic assistance;
  4. Client assessment and service implementation; and
  5. Communication about fees and charges.

The Complaints Commissioner informed the recent Sydney conference that a common area of concern for aged care recipients is poor consultation over the inclusion of exit fees in home care agreements.

Functions of the Complaints Commissioner

The primary functions of the Complaints Commission are set out in the Aged Care Act 1997 (Cth) (‘the Act’) and the Complaints Principles 2015 (‘Complaints Principles’) and are as follows:

  • To resolve complaints about aged care services;
  • To ensure recipients of aged care services are well cared for and protected;
  • To educate people and aged care providers about the best ways to handle complaints and the issues they raise; and
  • To provide information to the Minister in relation to any of the Complaints Commissioner’s functions if so requested.

The complaints management process

The complaints management process comprises four phases, being the intake phase, detailed assessment phase, resolution phase and outcome phase.

During the intake phase the complaints officer will seek to clarify the issues, gather information, confirm whether the complaint is within the Complaints Commissioner’s scope and escalate the complaint where necessary. For more minor complaints, the complaints officer may seek to facilitate early resolution of the complaint at this stage through the provision of information or informal assistance to the parties.

If a complaint cannot be resolved during the intake phase using early resolution, it will proceed to a detailed assessment.  Additional information about the complaint is gathered, a risk assessment is performed and a plan for resolution is developed.

During the resolution phase, complaints officers work with all parties involved to try and resolve the concerns raised in the most timely and proportionate manner, while seeking to ensure a positive resolution of the complaint for the consumer.  Resolution may involve conciliation or mediation between the parties, or investigation into the provider.

One of the following outcomes is decided upon by the Complaints Commission during the outcome phase:

  1. That there be no further action in relation to the complaint.
  2. That the issues raised in the complaint have been resolved between the provider and the complainant.
  3. That the Commissioner is satisfied that the provider has addressed the issues raised in the complaint.
  4. That the Department initiate compliance action against the provider pursuant to Part 4.4 of the Act.

During the recent Sydney conference the Complaints Commissioner emphasised the importance of service providers attempting to resolve complaints early and to recognise complaints as an opportunity to better an organisation, to learn, and to improve. Moreover, the Complaints Commissioner encouraged service providers to understand and comprehend their rights and responsibilities, including their obligations under the Australian Consumer law especially in the current climate where there is increased consumer choice and control.

Rights of review

Both the complainant and the aged care provider have the right to request a review of the outcome reached by the Complaints Commissioner within 42 days of receiving the decision letter.  A review delegate will determine whether a new resolution process should be undertaken to assess whether a different outcome should be reached.

Other Government areas contributing to quality aged care services

The Australian Aged Care Quality Agency (‘the Agency’) is an independent body that grants accreditation to providers of residential aged care and conducts quality monitoring to assess the quality of residential care and home care against service standards.

The Department of Health (‘the Department’) regulates the corporate and financial responsibilities of providers, monitors provider compliance and may take appropriate compliance action against providers.

If in the course of dealing with a complaint, the Complaints Commissioner identifies matters that could indicate an issue of a systemic nature (that may affect some or all people receiving care at a service), these matters can be referred to the Quality Agency for consideration and action.  In these instances the Complaints Commissioner will continue to deal with aspects of the complaint that relate to individual people receiving care, while the Quality Agency may examine the provider’s performance against the relevant standards.

Being prepared for complaints

An integral way of mitigating the risk of complaints is to ensure that consumers receive the right information in a way that can be easily understood, particularly with respect to applicable exit fees.  Aged care providers should also ensure that they are familiar with their obligations under the Australian Consumer law.

Under the Act and the User Rights Principles made under the Act, every approved provider of residential, home, community and flexible care must establish an internal complaints resolution mechanism for their care service, and must use it to deal with any complaints that are made by or on behalf of a care recipient.

It is recommended that care providers who may not be approved also have an internal complaints mechanism.  Having a comprehensive complaints policy can assist with reducing complaints, including to external bodies such as the Complaints Commissioner, and with ensuring an appropriate response is provided should a complaint be made.


Zoe Hamilton, Senior Associate
Sydney

Angela Pale, Solicitor
Sydney

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Newsletter 18 August 2017
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