2010 Annual Aging Forum: Forging the Future ARC Area Agency on Aging

1. 2010 Annual Aging Forum: Forging the Future ARC Area Agency on Aging

2. Overview What do you expect from organizations that provide you or your family with programs or services? Why are complaints and grievances important? What is the quality your agency�s or organization�s complaint process? What are complaint best practices?

3. Aging Network

4. Older Americans Act Participants in Older Americans Act and other federally and state-funded non-Medicaid home and community based services have the right to file grievances or complaints regarding specific actions or activities affecting their personal participation in the program or the conduct of the program as it relates to all participants at a given site or location without fear of reprisal.

5. Clients Rights/Grievances Older Americans Act: 42 U.S.C.A. �3026 (a)(10) (Area Plans shall�) provide a grievance procedure for older individuals who are dissatisfied with or denied services under this title; 42 U.S.C.A. �3027 (a)(1)(B) (State plans shall�) issue guidelines applicable to grievance procedures required by section 306(a)(10); and 42 U.S.C.A. 3030 (c-1) (In-home services for frail elderly�) The right to voice a grievance with respect to such service that is or fails to be so provided, without discrimination or reprisal as a result of voicing such grievance. HIPAA and LEP/SI complaint rights for clients Medicare Part D rights Contract requirements for providers/contractors O.C.G.A. �31-8-133. Residents' rights.

6. OIG Study Only 19 percent included most commonly used non-excluded drugs 19% included 151 or fewer Beneficiaries- Like the program Step Therapy, quantity limits, generics OIG Study Only 19 percent included most commonly used non-excluded drugs 19% included 151 or fewer Beneficiaries- Like the program Step Therapy, quantity limits, generics

7. Complaints and Grievances Participants may file in writing or orally. Participants may have a representative present, such as a caregiver- client must attend if representative option is chosen, unless too frail to do so. Grievance policies and procedures shall assure older adults and their families that their concerns will be considered in a fair and timely manner by the Area Agency, regardless of the ultimate legitimacy of the claim.

8. Complaints and Grievances Redress of grievances shall be available to applicants for and recipients of services provided through any and all non-Medicaid fund sources administered by the Area Agency.

9. Complaints and Grievances Due process entails the implementation of specific procedures designed to safeguard the legal rights of individuals and to assure maximum fairness in decision making. ARC AAA is responsible for its providers being required to have grievance policies.

10. Resolve at lowest level, if possible Resolution: Every effort shall be made to resolve grievances at the lowest level of authority to avoid the creation of burdensome documentation and ineffective use of staff time. Complaints shall be directed as appropriate to the situation to the following authorities in the order indicated:

11. Resolve at lowest level, if possible (1) site manager or director or case manager; (2) program or project director; subcontract agency director; area agency on aging director; the Director of the Regional Development Center (now Regional Commissions) or Board of Directors of a non-profit Area Agency; the Director of the Division of Aging Services or her/his designee.

12. DAS Compliment, Comment or Complaint (C3) Division of Aging Services' Compliment, Comment, or Complaint (C3) Consumer Feedback Form Cancel this survey >>� Compliments, Comments, or Complaints (C3) � The mission of the Division of Aging Services is to assist older individuals, at-risk adults, persons with disabilities, their families, and caregivers to achieve safe, healthy, independent, and self-reliant lives. Our goal is to continually improve and pursue quality service. You can play a role in that process by providing feedback.CONSUMER / CLIENT RIGHTS IN THE FEEDBACK PROCESS:� Anyone can submit feedback� Feedback may be submitted at any time � Feedback includes, but not limited to, compliments, comments, or complaints� Submitting feedback is easy and accessible� Anonymity is an optionWOULD YOU PREFER TO SUBMIT FEEDBACK BY PHONE?Call 1-866-55-AGING (24464).Note: Please note that this is a feedback tool. Please do not provide personal information such as social security numbers, medical health information, or any sensitive data. If personal information is needed, a Division of Aging Services representative will contact you.

13. DAS Compliment, Comment or Complaint (C3) http://www.surveymonkey.com/s.aspx?sm=w2NC0KVOCopYJ49Vld4CXQ_3d_3d

14. Common Disputes Affecting Older Persons Eldercare/family disputes Senior housing disputes Long-term care conflicts Neighborhood disputes Landlord-tenant Consumer disputes Senior Center Disputes ADA access challenges Health care quality disputes Bioethical disputes

15. Complaint Receivers Vary

16. Conflicts in Family Caregiving Relate to financial decisions Relate to healthcare decisions Relate to family conflict or dynamics Relate to perceived diminished capacity of care-receiver Relate to stress of caregivers and/or stress of conditions

17. Problem A 12-page letter lands on your desk for response You are asked to explain what happened Participant was terminated from the senior center for disruptive behavior from services as other participants sent management a petition Complaint comes to your agency that operates the senior center.

18. Complaint Best Practices A best practice environment must: Make it easy for customers to complain and customers will make it easy for you to improve. Respond to complaints quickly and courteously with common sense and you will improve customer loyalty.

19. Complaint Best Practices Resolve complaints on the first contact and save money by eliminating unnecessary additional contacts that escalate costs and build customer confidence. Technology is critical in complaint handling systems.

20. Complaint Best Practices Recruit and hire the best for customer service jobs.

21. Basic Steps for EffectiveComplaint Management 1 - Designate a Location to Receive Complaints Consumers need to know where and how to file complaints or make inquiries. Select a place to receive complaints that is visible and accessible to consumers. Publicize the complaint system to encourage consumers to voice their dissatisfaction and to make the good intentions of the company apparent. 2 - Develop a System for Record-keeping Prepare forms for recording, categorizing and filing complaint records. Design the system to perform functions such as the following: communicating complaint data to top management; permitting swift identification and response when complaints need to be reported to other departments or companies in the distribution network, or to law enforcement or regulatory agencies; providing market research through complaint trends; and enabling management to monitor the efficiency and effectiveness of the complaint- management system. 

22. Complaint Best Practices 3 - Process and Record Complaints Log in the complaint and any relevant data. Categorize it for resolution and record-keeping. Categories must be clearly defined and exclusive of one another. Assign the complaint to one person for handling. Forward the complaint to another level of authority, if appropriate. 4 - Acknowledge Complaint Consumers do not register complaints with only a casual interest in their disposition. Complaining involves some inconvenience and, possibly, expense. Loyal customers with strong feelings are often involved. Personalize the response. Talk to the customer, if possible, by phone or in person. Use letters when necessary, but avoid impersonal form letters. Take extra time, if needed, to help consumers with special needs, such as language barriers. 

23. Complaint Best Practices  5 - Investigate and Analyze the Complaint Be fair. Get both sides of the story. Keep records in the complaint file of all meetings, conversations or findings. 6 - Resolve the Problem in a Manner Consistent with Company Policy Forward the complaint to the appropriate level of authority for resolution. Keep the consumer informed through progress reports. Notify the consumer promptly of a proposed settlement. 

24. Complaint Best Practices 7 - Follow-Up Find out if the consumer is satisfied with the resolution. Was it carried out? Refer the complaint to a third-party dispute-resolution mechanism, if necessary. Cooperate with the third-party. 8 - Prepare and File a Report on the Disposition of the Complaint, and Periodically Analyze and Summarize Complaints Circulate complaint statistics and action proposals to appropriate departments. Develop an action plan for complaint prevention. Make sure the consumer viewpoint is given appropriate consideration in company decision making.

25. Tips Listen to the Voice of the Customer Know That Front-Line Complaint Resolution Saves Reputation, Time and Money and Improves Customer and Worker Satisfaction Focus on Improving Quality not Dealing with Symptoms

26. Consider Accommodations for individuals with mental and/or physical disabilities should be anticipated and addressed when requested. Wheelchair access Hearing devices Communications devices Interpretation, and other accommodations

27. Complaint Assessment What is the story? What is the backstory. Who are the people? Disabilities/Cognitive issues Health Communication styles What is important to them? Values Beyond positions What is the relationship?

28. Why Complaints and Grievances? How to handle complaints What to say & how to say it Use tracking and trending techniques of complaints for continuous improvement activity. Understand how handling complaints can deliver benefits to the organization at large.

29. Written or Oral Whose Complaint Is It? Unrealistic Desired Outcomes Whose Fault Is It? Power of Apology or Explanation Power of Due Process Anonymous Complaints

30. Complaints and Grievances Methods for prioritizing complaints and grievances Strategies for analyzing the information documented by client claims Tips for working with diverse populations, as well as difficult individuals

31. Complaints and Grievances Call Centers present opportunities All of the Aging Network is involved Identify all complaint sources? (e.g. Your agency or organization, CCSP, senior centers, grievances, appeals)

32. Trending Complaints and Grievances Can learn additional information than with customer satisfaction survey alone; Big picture that does not concentrate on �problem� can emerge; Analysis of data can yield information that is otherwise hidden from view; and Quality improvement can be quantified.

33. What Would Trending Look Like? cash deficit reached in 2017; at that point drain on system options cash deficit reached in 2017; at that point drain on system options

34. Fears and Myths A high number of complaints and grievances is bad An increased number of complaints and grievances is bad An absence of complaints and grievances is good Complaints are my fault Counting the number of complaints and resolve rate is enough

35. How Do You Rate? http://www.shawresources.com/form1.htm

36. HEALTH CARE FRAUDCOMPLIANCE PROGRAMS  �An effective compliance program, showing that the company has done its best to act responsibly to prevent wrongful activity and to root it out when it occurs, is perhaps the best way for a corporation to protect itself from the dire consequences of indictment and conviction.� U.S. Attorney General Janet Reno, February 2, 1998, AHA

37. EFFECTIVE CORPORATECOMPLIANCE PROGRAM (1) Written Policies and Procedures and Risk Areas (2) Designation of a Compliance Officer and Compliance Committee (3) Effective Training (4) Effective Communication (5) Enforcing standards through well-publicized (5) (cont�d) Disciplinary Guidelines (6) Auditing and Monitoring (7)Violations, Investigations, Reporting, Corrective Actions, and Sanctions

38. ACCOUNTABILITY, QUALITY AND RESULTS PICTUREPICTURE

39. Conflict Resolution Techniques Determine Who will conduct process Set the Tone Explain your Role Set Ground Rules that are respectful that maintain order Establish Time to Meet and be willing to meet in client�s home, if that is best for the client and they give permission Listen to Complainant. Give time for their story to be told. Listen to others who are involved and review documents, if any. Manage Information Manage Feelings Problem-Solve/Negotiate If rights or policy violated, state it in the resolution.

40. Leadership Strategies Support Front-Line Employees with Integrated Online Databases Capture Information About Customer Problems and Questions Use Information to Fix Problems Fast Address Underlying Causes of Problems Track Performance

41. Leadership Strategies Recruit and Hire the Best for Customer Services See Training as a Critical Investment, Not an Expense Use Teams and Teamwork Give Employees Authority and Responsibility to Resolve Complaints

42. Next Steps Review complaint and grievance policies within your agency or organization DAS will review its complaint and grievance policy Determine trends Determine what clients and applicants want Discuss what is working Determine how to support staff who must respond to complaints

43. Complaint Systems �Seeing the Upside Customer-focused Quality Improvement Early Warning System Federal Compliance oriented Ability to conduct trend analysis Best practice Ability to change program to meet client or customer needs-customer satisfaction

44. Complaints and Grievances Thank you for your efforts to review complaints and grievances on behalf of older and/or vulnerable Georgians in the Aging Network.

45. Division of Aging ServicesVision Living Longer Living Safely Living Well