Foundation for the Future of Aging

10 Questions to Answer...

When You Are Not Happy with Your Long-Term Care

1.      Have you clearly defined your goals for the service(s) that you or your loved one is receiving?

Fact: For information on how to define your goals, see Heinz "10 Questions on Planning for LTC."  Record your goals in a personal health record, and share these goals verbally and in writing with your providers.  

Web resource: www.tenquestionstoanswer.org

Web resource: http://www.medicare.gov/PHR/Overview.asp

2.      Have you examined what you can control or influence?

Fact: If you are unhappy with your care, examine what you can or cannot control or influence, and who can help you make changes.  Then make a plan and proceed with it.

3.      Do you know where to turn for help if you continue to be dissatisfied with your care? 

Fact: Every state has a long-term care ombudsman program to respond to complaints about care in nursing homes and assisted living homes. Your Area Agency on Aging (AAA) can tell you where to turn for help with concerns about other forms of long-term care such as in-home care. To reach your Long-Term Care Ombudsman, contact the National Ombudsman Resource Center. Your local AAA can be found by contacting the National Eldercare Locator.

Web resource: http://www.ltcombudsman.org/

Web resource: http://www.eldercare.gov/Eldercare.NET/Public/Home.aspx

4.      Have you started asking for improvement at the lowest level?

Fact: In a long-term care situation, it is important to build a foundation of mutual respect with the person providing direct service.  Recognizing their hard work and what they do right is one way for you to feel free to be specific about what is not satisfactory.

5.      If your long-term care services are not satisfactory, did you first communicate with your direct provider?

Fact: If you are unhappy with your in-home care or other community-based services such as transportation, home-delivered meals, adult day care, etc. your first call should be to your direct provider.  If that does not result in satisfactory change, you should then call the agency responsible and ask to speak with a supervisor or manager.  It is often easier to solve the problem with your current care before making the decision to change providers. 

6.      Are you satisfied with the services you are receiving in a nursing home or other residential care setting such as assisted living? 

Fact: If you are not satisfied with the service you are receiving, you should first try to resolve the issue by speaking with the Director of Nursing, the Administrator, and then the Long-Term Care Ombudsman. If those calls do not result in satisfactory change, you can call the state agency responsible for licensing or regulating the facility.  This number must be posted in a public place at the home or facility.

7.      Are you satisfied with the service or the discharge plan you or a loved one received from a hospital?

Fact: You have the right to speak with the "patient representative," the "utilization manager," and/or the Administrator for the hospital if you are not satisfied with the service you are receiving, including discharge plans.  If your issue is not resolved, you can file a complaint with the Joint Commission. 

Web resource: http://www.jointcommission.org/GeneralPublic/Complaint/

8.      Are you satisfied with your physician visits?

Fact: You can prepare for physician visits by taking your current medication list, having a list of questions/issues, and following your treatment plan.  Try to engage your doctor in a discussion about how to improve outcomes.  If you are still unsatisfied with the care you are receiving, you can contact your health plan or County Medical Society for referral to a new physician.

9.      Are you happy with the benefits or services you receive through your long-term care insurance plan, if you have one?

Fact: If you are not happy with your benefits, you can call your local Senior Health Insurance Assistance Program.  Your local AAA can give you the number.  If that does not resolve the issue, you can contact your state's department that licenses and/or regulates insurance policies and agencies.

Web resource: http://www.medicare.gov/Contacts/static/allstatecontacts.asp

Web resource: http://www.insurance.naic.org/state_web_map.htm

10.  Do you feel as if you have exhausted all available avenues to get satisfactory care?

Fact: If you feel you have tried every option available to you to resolve your issues, you can contact your State or Federal elected officials and ask them to help resolve the problem.