Where to Start
Complaints should first be presented to local management of a facility or Home Care office before using the provincial complaint mechanisms. It is very useful to know the relevant regulations so that these can be referenced when raising a concern.
At the local level, the publicly funded Home Care office, along with DSL and LTC facilities, must follow Section 18 of the Continuing Care Health Service Standards. This includes:
- Having a documented policy and procedure for responding to concerns.
- Providing documented information on “relevant external complaints and concerns resolution process”. This includes the non-local processes described below to address issues that have not been resolved satisfactorily at the local level.
The service provider must provide the above information upon the Client’s commencement of services or upon request. For AHS Home Care, the concern resolution process is governed by the AHS Patient Concerns Resolution Procedure.
Most health care issues encountered by caregivers can be addressed through informal discussions with facility LPNs, RNs or the Home Care Case Manager. For accommodation concerns, the facility administrative staff, including the managers, may be contacted. Ideally, more formal complaints should not be frequently required. Depending on the nature of the concern, these can be made directly by the caregiver to the facility General Manager and/or to Home Care management. One potentially productive approach for health care issues is to first call a meeting of the Interdisciplinary Team and management. Discussions should encourage everyone to understand each other’s concerns and to seek a mutually agreeable solution to the issue. It may also be useful, in some cases, for the caregiver to indicate if the complaint is the result of the facility or Home Care not following the regulations. This is why it is important for caregivers to understand their roles and rights as an important member of the Interdisciplinary Team and be aware of the Continuing Care Health Service Standards, for health care issues, and the Supportive Living or Long-term Care regulations for other issues. If concerns are not addressed to the caregiver’s satisfaction, a written complaint can be submitted to management with supporting documentation, timeline and possible facility and/or Home Care non-compliances with particular clauses in the regulations. If the concern still does not meet a satisfactory resolution, the complaint may then be submitted at the provincial level.
In some cases, the management itself may call for a meeting because of a particular concern the staff has with the resident. In this case, the caregiver should ask for the nature of the concern before the meeting takes place. This avoids surprises at the meeting and allows the caregiver time to research the problem, the regulations and any possible solutions to the problem.
According to the standards, concerns can also be addressed through a Council which is defined as:
“A group of Clients or family from the same continuing care setting that meets on a regular basis to improve the quality of life of Clients and to identify and address concerns.”
The formation of a Council for DSL and LTC facilities, and Home Care, offers a good vehicle for Clients to communicate with each other and to consolidate their concerns and document them in writing for submission to the service provider. It should also be noted that concerns and complaints are probably more likely to be addressed quickly if they involve failure to follow regulations. It is therefore worthwhile for at least one member of the Council to be familiar with the regulations governing a particular service and facility. In addition to dealing with concerns, Councils can also be very useful in fundraising for projects of particular interest to the residents. Many DSL and LTC facilities organize regular group meetings with their residents (or their caregivers) to discuss issues and to obtain feedback. These meetings tend to be chaired by the facility staff. In that case, they should not be considered Councils, which are run by the residents themselves. Residents have potentially more influence through a Council due to the clauses in Section 18 of the Continuing Care Health Service Standards.
With the rare exception of the refusal of a Home Care services application, discussed in Section 3.3.1 of the Where do we go from here? document, concerns not satisfactorily addressed at the local level are normally submitted at the provincial level rather than at the zonal level.
Submission of complaints at the provincial level vary depending on the nature of the complaint. Those related to subsidized and non-subsidized SL and LTC accommodations should be addressed using the Alberta Health Complaints Mechanism. On the other hand, concerns related to Home Care and to health services provided in subsidized DSL and LTC facilities are handled by the AHS Patient Relations Department. If in doubt, one of these two entities should be contacted to determine whether the concern is related to accommodations or to health service. If it is related to accommodations, the complaint must be submitted by a Client directly affected by the complaint. If it is related to the health services, the concern may be presented by the Client affected or by a representative, such as a member of a Council, on the part of one or more Clients. It is important to note that those who submit concerns at the provincial level will first be asked to try to resolve the issue at the local level. AHS, which is required to follow the Alberta Patient Concerns Resolution Process Regulation and the Patient Concerns Resolution Procedure, has published a brochure expressing its interest in obtaining feedback from Albertans.
Although they must still follow the appropriate accommodation standards, it should be noted that non-government-subsidized facilities do not directly fall under the Continuing Care Health Service Standards. This can limit the ability of Clients to file health care related complaints to the AHS Patient Relations Department, which only accepts complaints related to Home Care and to government-subsidized DSL and LTC facilities. For some SL1 and SL2 facilities, this is not a major concern since most health care service is provided by Home Care, which does fall under these standards. It can however become a concern for SL1 and SL2 facilities that provide some of their own health care services or for non-subsidized SL3 residents, where the care is mainly provided by the facility itself. That said, some facilities provide both DSL3 and SL3 units and may elect to follow the same policies and procedures for both types of units in spite of the fact that they are not required to do so for SL3. In this case, there still remains a concern if the procedures are not consistently followed since it may be difficult to raise a complaint with AHS. In this respect, a DSL3 resident is better protected by the regulations. Similar problems occur when filing complaints with the Alberta Ombudsman, which does not accept complaints involving companies. As previously noted, there are a few relatively infrequent exceptions such as where a resident is subsidized directly by AHS and is admitted into a non-designated SL facility. In that case, the resident would have access to the AHS complaint mechanism. Finally, any complaint involving a physician can be submitted to the College of Physicians and Surgeons of Alberta as well as to the AHS Patient Relations Department.
Complaints related to health care services can also be addressed to the Alberta Health Advocates. Because they are familiar with the various regulations, they can assist clients in preparing their complaints to a local facility or to AHS. The Office of the Seniors Advocate Alberta provides advocacy services for seniors issues that are not solely related to health care. Alberta Ombudsman will accept complaints related to both health care services and accommodations. These entities are discussed in Sections 220.127.116.11, 2.1.2 and 2.1.4 of the Where do we go from here? document. In practice, the Alberta Ombudsman will likely contact the previously-mentioned Alberta Health, the Office of the Seniors Advocate Alberta and/or AHS departments to investigate the issue. The Alberta Health Advocates, the Office of the Seniors Advocate Alberta and the Ombudsman may be the only viable complaint mechanisms when there are perceived fundamental deficiencies in the AHS complaints resolution process or in the Alberta Health Acts, Standards and Regulations. These include uncertainties and disputes in the interpretation of these documents. An example where this may occur is in any perceived inadequacy and interpretation of resident/staff ratio requirements in the Alberta Health Standards. There are no minimum ratios specified in the regulations for Supportive Living facilities. On the other hand, the Operations Regulations for Long-term Care facilities indicate that:
“An operator shall cause his nursing and personal services staff to provide an average of at least 1.90 paid hours of combined nursing and personal services per resident per resident day in his nursing home.”
Although the above suggest a resident/staff ratio of 12.6, the use of the word “average” can lead to uncertainties in the interpretation and to concerns as to the minimum staff ratio required at all times.
If the concern remains unresolved with the above mechanisms, the matter can be brought to the attention of the local MLA.