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Resident Concerns & Facility Grievance Policy

Tip Sheet

In Phase I of the Federal Nursing Home Revisions, effective November 2016, nursing homes are required to establish a
policy regarding receipt of resident grievances. Facilities will now be held accountable for their response to resident
grievances (See section 483.10). As part of the survey process, facilities will have to share their policy and provide
documented proof that they are adhering to same. Facilities must designate a staff person who will serve as the point of
contact for resident grievances. So, it is quite possible that, when an ombudsman approaches a facility staff member
regarding a resident concern, the facility may seek to invoke their Resident Grievance Policy. The following are some
simple guidelines and reminders about how an ombudsman should approach this situation.

I. When a resident brings the ombudsman a concern, this is opened as a case; however, we encourage self-
resolution as the possible first step. Therefore, it would be important that you- and your representatives – are
familiar with the facility’s grievance process and the residents’ rights in this area. With this increased level of
accountability for responding to resident concerns, the facility’s policy is clearly an additional resource for the
resident.
II. If a resident chooses to self-resolve by invoking the facility grievance policy, the ombudsman should certainly
follow-up with the resident – confidentially – to monitor the facility’s response to the grievance and to ascertain
the resident’s satisfaction with the outcome.
III. We remain resident directed. A resident can choose not to self-resolve. They obviously can choose not to file a
grievance.
IV. If, with resident consent, we approach a facility with a resident concern, and the facility wants to apply the facility
grievance policy, it is perfectly fine for the ombudsman to share needed information with the facility WITH THE
KNOWLEDGE AND CONSENT OF THE RESIDENT. The best approach would be to have the resident present to
provide the information and/or complete any required grievance form as per facility policy.
V. If the resident opts to invoke the facility grievance policy on their own – or via the ombudsman – the resident
should always request a copy of the completed grievance form and details regarding when a response could be
expected.
VI. If a resident refuses to provide the ombudsman with permission to share details of their concern with the
facility/use the facility grievance process, then the ombudsman should provide alternative approaches to
achieving resolution for the resident.
VII. The facility’s investigation does not replace the ombudsman investigation. If the resident authorizes us to
investigate, using their direction, we would investigate the resident complaint as per our protocol outlined in
certification training. Remember: Our verification standard may be very different from the facility’s verification
standard.
VIII. If a resident invokes the facility grievance process and the facility fails to follow the process, that, in and of itself,
is a complaint and the ombudsman should be advocating for the facility to respond to the residents as per their
policy.
IX. Be alert to facility efforts to educate the residents regarding their grievance policy – is it in the admission packet?
Are established residents in receipt of the information? Has it been discussed in resident council?

Office of the LTC Ombudsman
Version 1.0 September 2020
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