Solving Problems

Group photo of older people

Complaints can be an important means of identifying and solving problems that affect one individual resident/recipient or a whole group receiving long term care services. Thoughtful responses to complaints can be an important way to improve long term care overall.

Getting Started

Keep in mind that clear communication is important. Be clear about the specifics of the problem. What exactly happened or is happening? When did it happen or does it happen? Who is involved? Who else is aware of the problem? Be clear about what you think would help solve the problem. It may help to write it down.

Try to solve the problem by talking to a staff member. Determine which staff member would be the best with whom to discuss the problem. Often it can be most helpful to start with the staff person most directly involved in the care or situation in question. There may have been miscommunication or a misunderstanding about needs or expectations. The caregiver may be thankful for the opportunity to improve the situation. For some problems, or in cases where the direct caregiver is not responsive to suggestions, it may be the nursing supervisor or Director of Nursing, the facility administrator or service director with whom you need to talk. Depending on the type of concern and your rapport with particular individuals, it may be most helpful discuss the concern with the doctor in charge of the care, the social worker, the dietician or a therapist. Remember that in order to solve a problem, staff must first be aware that a problem exists.

When you talk with a staff person, state the problem and discuss possible solutions. Ask when and how you can expect the problem to be solved. Set a time when you will come back and discuss the progress of solving the problem.

Consider using care planning conferences to discuss issues with staff.

Facilities and service providers usually have a grievance procedure for handling complaints that you may choose to follow.

If you are afraid to complain or speak up out of fear that someone will take it out on you or your loved one, then remember that often, if you are experiencing a problem, chances are that other residents and families may also be experiencing the problem. It may be helpful to work with the family council or resident council to address problems as a group rather than as an individual.





Help with Solving Problems

If you want help solving a problem, contact your local Long-Term Care Ombudsman. The Ombudsmen provide counseling and information on the telephone or in person to help you solve the problem and if you wish, they can also become directly involved, meeting with family members, care recipients and provider staff to work to solve the problem(s). Ombudsmen may also involve other agencies as needed if the care recipient and family agree to this action. To reach a local Long-Term Care Ombudsman, you can call the statewide toll-free number at 1-800-552-3402 or dial (804) 565-1600.

If the problem you are seeing suggests possible abuse, neglect or exploitation of a resident/recipient who is 18 or older, it is important to report such concerns immediately to Adult Protective Services (APS). To reach APS, you can call toll-free 1-888-832-3858.




Where to File a Complaint

You have several options in having your complaint handled by other agencies:

Other Options for Handling Certain Complaints:

  • Department of Health Professions handles complaints against a specific licensed or certified health professional such as a facility administrator, doctor, nurse, pharmacist, social worker, certified nursing assistant (CNA), or other health professional that must be licensed. Telephone: 800-533-1560.
  • Senior Medicare Patrol handles reports of Medicare and Medicaid fraud, waste and abuse. Telephone: 800-938-8885.
  • Office of the Attorney General’s Medicaid Fraud Control Unit investigates reports of suspected fraud by a Medicaid Provider. Telephone: 800-371-0824.
  • The local Police handle reports of criminal activities including sexual abuse. See your telephone directory for the local number.
  • Virginia Department of Behavioral Health & Developmental Services (DBHDS) – Office of Human Rights handles complaints about treatment or services received at one of the facilities licensed by DBHDS. File a complaint with the Human Rights Advocate at the facility where the resident or patient is receiving treatment or contact the central office at 804-786-2008.
  • Virginia Health Quality Centeris Virginia’s Quality Improvement Organization (QIO) under contact with the Centers for Medicare and Medicaid Services. The Virginia Health Quality Center is staffed with professions who are trained to review medical care and help beneficiaries with complaints about the quality of care paid for by Medicare. Among other duties, this office addresses individual beneficiary complaints, and provider notice appeals. The Consumer Helpline is 800-545-3814; the Expedited Appeals Line is 1-866-263-840 or contact the main office number at 804-289-5320.
  • Virginia disAbility Law Center handles complaints about care provided to persons with disabilities. Telephone: 800-552-3962.

Confused? Contact your local Ombudsman for help!




Regulatory Agencies

Regulatory agencies are designated organizations responsible for the licensing of certain types of facilities and services. They also inspect these facilities and services to make sure there is compliance with all applicable laws and regulations. In addition, regulatory agencies receive and investigate complaints involving the facilities and services.

Regulatory Information and Links

Type of Care Regulating Agency Applicable Regulations Check a Provider’s Record
Nursing Home Virginia Department of Health – Office of Licensure and Certification State Regulations:

Regulations for the Licensure of Nursing Facilities in Virginia

Federal Regulations:

Code of Federal Regulations Title 42—Public Health, Chapter IV Centers for Medicare & Medicaid Services, Department of Health and Human Services, Subchapter G – Standards and Certification, Part 483 – Requirements for States and Long Term Care Facilities
Find and Compare Nursing Homes
Assisted Living Facility Virginia Department of Social Services - Division of Licensing Programs State Regulations:

Standards for Licensed Assisted Living Facilities
Assisted Living Facilities information and inspection reports
Adult Day Care Center Virginia Department of Social Services - Division of Licensing Programs State Regulations:

Standards and Regulations for Licensed Adult Day Care Centers
Find an Adult Day Care Center and inspections reports
Home Health

Hospice
Virginia Department of Health – Office of Licensure and Certification State Regulations:

Rules and Regulations for the Licensure of Home Care Organizations

Rules and Regulations for the Licensure of Hospices
Find and Compare Home Health Agencies


Virginia Department of Social Services: Division of Licensing Programs

State/Home Office:

Virginia Department of Social Services
Division of Licensing Programs

7 North Eighth Street
Richmond, VA 23219-3301
(276) 676-5490


Regional Offices

Abingdon

190 Patton Street
Abingdon, VA 24210
(276) 676-5490

Counties served:
Bland, Buchanan, Carroll, Dickenson, Grayson, Lee, Patrick, Russell, Scott, Smyth, Tazewell, Washington, Wise, Wythe

Cities served:
Bristol, Galax, Norton

Henrico

1604 Santa Rosa Road
Wythe Building, Suite 130
Richmond, VA 23229-5008
(804) 662-9743

Counties served:
Amelia, Brunswick, Buckingham, Charles City, Charlotte, Chesterfield, Cumberland, Dinwiddie, Essex, Fluvanna, Goochland, Halifax, Hanover, Henrico, King and Queen, King George, King William, Lancaster, Louisa, Lunenburg, Mecklenburg, New Kent, Northumberland, Nottoway, Powhatan, Prince Edward, Prince George, Richmond, Westmoreland

Cities served:
Colonial Heights, Hopewell, Petersburg, Richmond, South Boston

Fairfax

11320 Random Hills Rd., Suite 200
Fairfax, VA 22030
(703) 934-1505

Counties served:
Arlington, Loudoun, Fairfax

Cities served:
Alexandria, Fairfax, Falls Church, Leesburg

Peninsula

2600 Washington Avenue, Suite 202
Newport News, VA 23607
(757) 247-8020

Counties served:
Gloucester, Isle of Wight, James City, Mathews, Middlesex, Surry, Sussex, York

Cities served:
Emporia, Franklin, Hampton, Newport News, Poquoson, Williamsburg

Piedmont

Commonwealth of Virginia Building
210 Church Avenue, Southwest, Suite 100
Roanoke, VA 24011-1779
(540) 857-7920

Counties served:
Alleghany, Amherst, Appomattox, Bath, Bedford, Botetourt, Campbell, Craig, Floyd, Franklin, Giles, Henry, Montgomery, Nelson, Pittsylvania, Pulaski, Roanoke, Rockbridge

Cities served:
Bedford, Buena Vista, Clifton Forge, Covington, Danville, Lexington, Lynchburg, Martinsville, Radford, Roanoke, Salem

Valley

Augusta Professional Park
57 Beam Lane, Suite 303
Fishersville, VA 22939
(540) 332-2330

Counties served:
Albemarle, Augusta, Clarke, Frederick, Greene, Highland, Madison, Orange, Page, Rockingham, Shenandoah, Warren

Cities served:
Charlottesville, Harrisonburg, Staunton, Waynesboro, Winchester

Virginia Beach

Pembroke Office Park
Pembroke IV Office Building, Suite 300
(Second Street at Virginia Beach Boulevard)
Virginia Beach, VA 23462-5496
(757) 491-3990

Counties served:
Accomack, Northampton, Southampton, Greensville

Cities served:
Chesapeake, Norfolk, Portsmouth, Suffolk, Virginia Beach




Warrenton

170 West Shirley Ave., Suite 200
Warrenton, VA 20186
(540) 347-6345

Counties served:
Caroline, Culpeper, Fauquier, Prince William, Rappahannock, Spotsylvania, Stafford

Cities served:
Fredericksburg, Manassas, Manassas Park, Woodbridge




Virginia Department of Health Office of Licensure & Certification

The Virginia Department of Health – Office of Licensure and Certification, also referred to as OLC, licenses and surveys nursing homes, home health agencies, hospice programs and hospitals to determine whether they are in compliance with all applicable laws and regulations. In addition, OLC receives and investigates complaints about the quality of care provided.

Office of Licensure and Certification

Virginia Department of Health
9960 Mayland Drive, Ste. 401
Richmond, Virginia 23233
Phone: 804-367-2100
Toll free complaint line: 1-800-955-1819

Virginia Department of Health logo