Health: filing a complaint about a nursing home

You’re a resident in a nursing home and something comes up that annoys you – your food is often cold, the call bell in your room isn’t answered quickly enough or some money has disappeared from your wardrobe, perhaps.

Maybe there has been an incident with a staff member or another resident that has upset you or perhaps something much more serious has happened – so what can you do?

The 2023 Ombudsman’s Report shows that nursing home complaints to his office represented 2% of complaints overall that year, and totalled 96 complaints, a 43% increase on 2022.

A total of 34 of those complaints related to care and treatment and eight to the level of fees charged.

The result of this was that 22% of complaints were upheld or partly upheld, 29% were not upheld and in 49% of complaints, assistance was provided to the complainant.

Tadgh Daly is Chief Executive Officer of Nursing Homes Ireland (NHI) representing nursing home owners.

“Given that there are over 30,000 people living in residential care in Ireland, issues will arise from time to time,” he says, “but the sector has an open culture in terms of raising areas of concern and aims to deal with the whole gamut of concerns effectively.”

The ideal is for issues to be dealt with at an early stage, at management level, and prompt action taken.

“We would encourage all residents and families to raise the issue at the earliest opportunity, with the carer, the nurse or the person-in-charge and try to get it sorted as soon as possible.

“Thankfully, most of the issues are dealt with at that point and the issue is either addressed or resolved swiftly so that confidence is restored for the person. An apology is given, if necessary, and confirmation that systems are put in place to address any such concerns and prevent any reoccurrence.”

By law, each nursing home is obliged to have a published complaints procedure, he states.

“It has to be easily accessible and there is also a review process,” says Tadgh. He points out that all nursing homes are expected to maintain a log of issues, including verbal complaints.

“This log of verbal and written complaints is checked by the Health Information and Quality Authority (HIQA) during their regular inspections where they talk to residents and staff.”

Don't let it fester

The issue with any concern or complaint is how it is dealt with, he believes.

“NHI members are keen to ensure that a) the concern is taken seriously, big or small, b) that it is dealt with responsibly and c) that the person gets an answer to it.”

If a formal complaint is made, in writing, the nursing home is expected to acknowledge receipt of the complaint in writing.

“They also have to outline how they are going to deal with it. If it’s a case where the resident might need assistance to make a complaint, there should be a patient advocate available to help in the nursing home or a referral to the national Patient Advocacy Service.”

There is a more formal and open procedure for complaints, too, for people who feel their complaint wasn’t dealt with properly.

“If they wish it to go further,” says Tadgh, “they can go to the Office of the Ombudsman. Nursing homes provide an information sheet related to the Ombudsman’s services.”

Minor to major

Complaints can vary from minor to major with what’s minor to one person being more serious to another.

“My minor could be your major,” he says. “If I can’t watch Clare play on television on Sunday, it’s serious for me because that’s what I did when I was at home.”

Major complaints can involve the crimes of physical or sexual assault.

“Assaults are crimes, whether on the street or in a residential setting,” he says.

“Sometimes it’s resident-to-resident aggression and there have also been cases of family member to resident aggression. It could be staff to resident also and sometimes staff are assaulted as well.

“Ultimately, if there is assault or alleged abuse or neglect, the relevant authorities will be notified – the Gardaí and Safeguarding Ireland. In these situations, the authorities take over and it is dealt with appropriately.

"The nursing home would make all their documentation available to both authorities, as required. All these occurrences have to be investigated – they are crimes.”

Tadgh also points out that the nursing home sector is highly regulated and that HIQA inspections occur regularly and their reports published.

On a final note, compliments are always much appreciated, he says.

“People working in the sector are very committed and compassionate and they take pride in their work, so when they get a thank you from a resident and their family, that’s hugely important as well.”

Age Action Ireland

Mary Murphy is policy analyst with the advocacy organisation Age Action Ireland and is aware of care industry concerns.

“Issues related to this come across our desk very often,” she says.

“We often get contact from older people themselves raising concerns or from family members who want advice on how to sort out a difficulty they might be encountering.”

One of the nursing home related concerns that Age Action is often contacted about is financing.

“The Nursing Home Support Scheme (Fair Deal), what it covers and what it doesn’t cover comes up frequently,” she says.

“Often people are caught by surprise that a lot of services you get within nursing homes aren’t covered by the scheme. It could be activities costs, or haircuts or newspaper costs.

"People can feel that those things should be covered given the amount of money they are paying towards residing within the nursing home.”

However, all these charges are set out in the person’s contract, Tadgh Daly responds.

“This is required by law and signed before the person is admitted. Yes, the charges can be a bone of contention but people would be aware of them from the start.

"Often people think everything is covered by the Fair Deal, but it is bed and board and basic aids and appliances and doesn’t include a whole realm of services that would be deemed appropriate to the care of the person.”

Many calls also come into Age Action Ireland from residents or family members concerned about being relocated when a nursing home is closing.

“You’d have cases where someone was happy in a nursing home that was within their community and don’t want to move away from family and friends and have to get a new GP, for example. That can be really difficult for people.”

The most extreme end of concern is around abuse, neglect or mistreatment.

“This is where there is a fear that someone is being taken advantage of, is not having needs met or is being treated unfairly.”

In this regard, Age Action is striving constantly to improve safeguarding legislation and procedures in Ireland, Mary says.

“We work to improve the protections and rights that older persons have and are entitled to within the care system. We are also aware of things like mistreatment of older persons – that incidents can occur if staff are overworked.

“If the conditions of work aren’t great, if there aren’t enough staff or if the turnover of staff is high, it may be very easy for corners to be cut. There can be dehumanisation and desensitisation and people can lose sight of the human who is there to receive care. This is very concerning.”

When people ring the Age Action helpline, they get some guidance about what to do.

“We find that by the time someone reaches out to us, they have often exhausted options and the issue hasn’t really been resolved to their satisfaction.

“If it is a Fair Deal issue, you can go to the HSE for clarification but there isn’t a one-size-fits all point of contact. Where we would direct a person to seek help would depend on the specific issue that’s been raised.”

Mary finds that many people are telephoning to ask if their complaint is one that they should take to the Ombudsman.

“They might want reassurance that their kind of situation is the kind that gets directed to the Ombudsman’s Office. We find that people are generally aware of the Ombudsman, which is good.”

Four-step advice:

1. Make a complaint to the private nursing home as soon as you can after the incident occurs/problem arises. Explain why you’re unhappy and how you want them to put things right.

2. Give the private nursing home a chance to resolve your complaint (six weeks) and give you their final response. Make sure to keep notes and copies of all letters about your complaint.

3. If you are unhappy with how the private nursing home has dealt with your complaint, contact the Ombudsman. The service is free. You can make a complaint using the online complaint form or get a factsheet related to this topic at ombudsman.gov.ie or you can call 01 639 5600 between 9.15am and 5pm, Monday to Friday.

4. When a complaint is upheld by the Ombudsman’s Office against a private nursing home, management is asked to learn from the experience and take action such as change their procedures or practices, upskill staff, offer a remedy and acknowledge what happened. An apology may also be required. The Ombudsman’s Office then checks that these commitments have been carried out.

HIQA

The Health Information and Quality Authority (HIQA) provides an information booklet on its website to explain what to do if you want to give feedback or make a complaint about care or treatment in a nursing home. HIQA is unable to investigate individual complaints but does listen to feedback. See hiqa.ie

Patient Advocacy Service

This service provides information on how to make a complaint to hospitals and to nursing homes. See patientadvocacyservice.ie/how-to-complain-faqs-nursing-homes or call 0818 293003. You can also check out ageaction.ie or call (01) 475 6989.