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OPTIONS FOR CHALLENGING

"COMPLAINT INVESTIGATION DECISIONS"

OF THE

One option for addressing concerns about nursing home care is filing a formal complaint with the Michigan Department Bureau of Health Systems (MDBHS). MDBHS is the state agency that licenses nursing homes and determines if they meet state and federal standards. If you file a complaint with MDBHS, it must investigate your concerns and report to you and the nursing home its findings. This Fact Sheet explains your options if you are concerned about the quality of a complaint investigation or if you disagree with MDBHS’s findings. If you need information about how to file a complaint with MDBHS, please ask us for a copy of our Fact Sheet "A GUIDE TO FILING FORMAL COMPLAINTS WITH THE MICHIGAN DEPARTMENT BUREAU OF HEALTH SYSTEMS."

If you have filed a complaint with MDBHS, you probably hope that it will confirm your concerns and see that they are corrected. Unfortunately, many citizens’ complaints are not confirmed by MDBHS. If MDBHS does not confirm your complaint, the nursing home will not be required to take any corrective actions.

Sometimes there may be a good reason why MDBHS cannot confirm your complaint. For example, the nursing home may have fixed the problem long before the complaint is filed or the investigator arrives. Other times MDBHS does not confirm complaints because a poor investigation was conducted. An investigation is inadequate if:

• MDBHS gives the nursing home advance notice of the investigation.
• It doesn’t take place soon enough to evaluate current evidence of the problem. Investigations

• It doesn’t take place at the appropriate time. For example, investigating complaints about the

• It accepts the nursing home’s claims, but ignores yours without evaluating the facts.
• It relies exclusively on nursing home documentation.
• Evidence of the problem is ignored or discounted without proper evaluation.
• The conclusions don’t match the facts.
• It confirms the problem existed but the problem is allowed to continue without appropriate citations, corrective action by the nursing home or monitoring by MDBHS.

If you believe a poor investigation has been conducted, you may want to complain again noting the lack of quality in the investigation itself. This may be frustrating and irritating, but we urge you not to give up. Your efforts will help focus officials on the need to improve nursing homes and complaint investigations.

Your copy of MDBHS’s investigative report should include a cover letter explaining your right to appeal the findings. Many complainants do not find the appeal process satisfactory, so we have identified other options for raising concerns about poor investigations. These options and the formal appeals procedures include:

1. Reinvestigation: If MDBHS did not investigate all of your concerns or failed to

evaluate relevant evidence, you can ask for a reinvestigation. If you ask MDBHS

for a reinvestigation, it is important to specifically identify the concerns or evidence

that were overlooked.

2. Informal Conference: If you want to appeal MDBHS’s findings but do not want a

Formal hearing, you may request and informal conference. This is a meeting held at

the nursing home and is run by a supervisor of the MDBHS Complaint Division.

Nursing home staff is allowed to attend this conference. You are given an opportunity

to discuss your concerns about the investigation and your complaints about the facility.

You may bring others to help present information. We can help you present your

concerns if you wish. The Complaint Unit Supervisor may amend the original determination

or order a reinvestigation. Usually, the initial findings are upheld. If you are still dissatisfied,

you may request a formal hearing if your initial appeal was filed within 30 days after you

received MDBHS’s initial complaint report. Informal conferences are a convenient and

inexpensive way to voice your concerns about the nursing home and MDBHS’s investigation.

3. Formal Hearing: You have 30 days from receipt of MDBHS’s findings to request a formal

hearing. Hearings are conducted by administrative law judges. The nursing home and its

attorney can and usually do participate. Although you are not required to have a lawyer, it

is best to have a legal representation since legal rules of evidence apply at formal hearings.

The hearings are usually held in Lansing. Formal hearings are a good option if MDBHS

Misapplied the law or ignored strong evidence of your concerns. Few complainants request

hearings because of possible expenses, delays, legal barriers, and uncertain outcomes.

4. Complaint Appeal Process: When filing an appeal of a complaint that has been investigated

by MDBHS, make sure you indicate whether you want and informal conference or a formal

hearing.

5. Other Complaint Resources: If you want to file a complaint with someone else regarding a

MDBHS investigation, you can make your concerns known by writing key officials and

complain about the quality of the investigation itself. Officials you may contact are the Director

of MDBHS, the Governor, your state senator and state representative, or the Health Care

Financing Administration (HCFA). (The HCF helps fund the investigations and makes Medicare

and Medicaid payments to nursing homes.) Writing these officials is a good way to let them

know that the complaint system needs improvement and may result in review of your complaints.

Please send a copy of your letters when writing to one of the above officials to your local ombudsman.

You may address your complaint to one or more of the following officials:

Thomas Lindsay, Director Associate Regional Administrator

Michigan Department Bureau of Health Systems Health Care Financing Administration

P.O. Box 30664 Division of Health Standards & Quality

Lansing, MI 48909 105 West Adams, 15^th Floor

Chicago, IL 60603

Governor Jennifer M. Granholm State Senator/Representative (name)

State Capitol State Capitol

Lansing, MI 48913 Lansing, MI 48913

6. Media Outreach: The media may be interested if MDBHS does not respond appropriately

to serious problems you have identified. Media stories can bring substantial attention to a

problem. However, you should be cautious since you cannot control what the media reports

or the reactions of others to their stories.

7. Creative Complaining: If you don’t like any of these approaches, try something else but

Rev: 03/97, 09/97, 04/98, 10/00, 04/04