Home Health & Hospice

A Patient's Complaint Can Lead to a Surveyor's Visit

Homecare Insider, October 5, 2009

An agency administrator writes:  Our agency faces a complaint survey.  A patient fell while our nurse was in the home, but it wasn’t the nurse’s fault.  The patient said he had only mild pain in one leg, and did not want us to call 911.  After our supervisor’s call, the family took the patient to a clinic and there was a fracture.  The county caseworker reported us to the state for not sending the patient to the emergency room.  While they are difficult, we know this patient and family well and have always accommodated them.  Where can I learn more about the complaint survey process?

In some cases, there is no obvious good choice at the moment of decision-making.  For that reason, it is important to have clear policies and ensure that staff understand their application.  Hindsight and second-guessing may indicate that another course of action would have been better, but if clinicians follow a well-developed policy, the agency will be on firm ground during a subsequent complaint survey.

The concern here is with the delay in the patient obtaining emergency care.  Consider one word the director used, “accommodated.”  Whenever it seems necessary to accommodate, step back and determine whether it is appropriate to do so.  Do policies and standards of practice support the accommodation?  In this case, the agency chose to accommodate the patient.  However, had the nurse acted on instinct and called 911, the patient would have received immediate emergency assistance.  The patient could have refused transport, but the agency would have done what it believed was appropriate and protected itself from second-guessing.  

The director should start by reviewing current policies and ensuring that staff are aware of expectations in such situations.  The director may even decide to revise policies and re-educate staff.  The clinical record should include a full description of the problem and resulting actions.

It is important to always be prepared for a complaint survey, since one can occur when least expected.  CMS Publication 100-7, the State Operations Manual, describes the complaint survey process, and §5240 addresses the home health agency hotline.  This section indicates that a surveyor may review an agency’s complaints and related records.  Agencies must ensure that all staff follow policies correctly, address and document complaints properly, and respond to nonroutine situations accurately.

Click here, if you need a copy of the state operations manual.