4. Complaints process

There are 5 sections to our Complaints Handling Policy:

Overview
Aim of the Commission’s complaints function
Guiding principles
Complaints process
Personal and protected information

4.1 How complaints can be made

Anyone can make a complaint about aged care services to the Commission. We encourage people raising complaints to provide their contact details to us because it allows us to:

involve them in the process
provide updates
check complaint outcomes meet their needs.

However, we understand that some people wish to remain anonymous or keep their information confidential. We want everyone making a complaint to feel safe and able to raise their concerns.

We offer 2 ways to make a complaint without sharing their identity with the provider:

Confidential complaint: we will not share details with the provider, including:
1. the identity of any person and/or
2. any specific information requested not to be shared.
Anonymous complaint: we do not ask for or retain identifying information. The complainant may also choose to complain using a pseudonym.

If anyone is worried about providing information due to fear of retribution, it is important they raise this with the Commission.

Exceptions

There are some very rare times when the Commission may have to share the identity of the person making a confidential complaint. For example, we might need to share information to police if someone is in immediate danger. This includes when:

the complaint suggests serious or immediate risk or harm to the older person
a complaint party is at risk of self-harm
the person making the complaint threatens to harm involved parties.

We do this only when necessary to ensure the safety and health of a person. Where practicable, we will let the person making the complaint know before we share any information.

Please see our Privacy Policy for more information about when and how you can interact with us anonymously.

Considerations for confidential and anonymous complaints

Not being able to share the details of the person making the complaint with the provider affects how we manage it and, sometimes, the outcomes we can achieve.

For example, if we can share the identity of the person making the complaint with the provider, we can:

give them more detail about what happened
check information we receive from the provider with the person who made the complaint, to make sure it is consistent
work with the complaints parties to achieve a wider range of outcomes, like an apology or conciliation approach.

With anonymous complaints, we can’t do that. This means we are sometimes more limited in what we can achieve with anonymous and confidential complaints. That’s why we encourage people to leave details on how we can contact them if they can.

However, anonymous and confidential complaints are still important to the Commission and give us vital information about issues that can be affecting the safety and wellbeing of older people. The most important thing is everyone can feel safe to raise their concerns in whatever way suits them.

Withdrawn complaints

There may be times where the parties do not want to continue with their complaint. Where this occurs, we may continue with the complaint, where needed, for example to manage risks to older people.

Own initiatives

An own initiative complaint is where a decision is made to initiate a complaints process based on information received which identifies concerns about a provider not meeting its responsibilities. When deciding to undertake an own initiative, we collect and record sufficient information on:

the name of the provider
the source of the information
when and how the concern was identified
the reason we created an own initiative case (what is the risk we are concerned about).

4.2 Who’s involved in a complaint

There are several different parties involved in the complaints process. Early in the process, we clearly establish who needs to be involved and their roles.

Person who makes the complaint

When things go wrong, older people should feel empowered to express their concerns with their aged care provider and with the Commission. Complaints can also be raised by anyone else. Often this might be:

their family, friends or representative
aged care workers
professionals in the sector.

We will communicate with the complainant in a timely manner throughout the process to understand their needs, keep them up to date on progress and discuss outcomes.

Older person

We will always contact the older person involved in the complaint or their representative. We will engage with them to:

hear their experience
understand the outcome they seek
keep them informed if that is their wish.

This is regardless of whether they made the complaint, or someone made the complaint on their behalf. We will not usually talk about the older person to others unless we have their permission.

Person who represents the older person

Sometimes older people have legal representatives or other people they give us permission to talk to on their behalf. We will ensure we clearly understand the representatives involved and work closely with them to gather information and provide updates.

Aged care provider

Aged care providers have the key responsibility for resolving the complaint about their service and ensuring they remedy the issue, restore relationships and prevent it from happening again. As such, they are a key stakeholder in the complaints process. We will work with providers to understand the issues from their perspective, provide information about our role, the information we need, and engage with them about how we can best work together to achieve the outcomes for older people.

Other relevant parties

When handling a complaint, we may request information or documents from any other person with knowledge of the matter, for example aged care workers or other health professionals. If we identify a person with relevant information, we will contact them as needed.

Advocates can play an important part in the complaints process, supporting complainants and older people to understand their rights and raise complaints. We welcome the involvement of advocates in the complaints process and are committed to working with them to assist older people to get their issues resolved.

The Commission

The Commission owns the complaints process. We:

engage with all complaint parties and consider their perspectives, needs and preferences
consider relevant information and documents to understand the complaint
evaluate evidence we gather regarding what has happened and what has been done to address the issues
apply a risk-based and proportionate response.

In communicating with parties, we will:

treat everyone with respect
be transparent and clear on what each party can expect from us at each stage of the process
explain if there is any information or action, we need from each complaints party
listen to and acknowledge concerns
keep in mind the desired outcome the parties are seeking.

Our focus is on achieving meaningful, proportionate and sustainable outcomes aimed at safeguarding and protecting the rights of older Australians.

4.3 Phases in the complaints process

The complaints process is made up of several phases, including:

collect and triage information
assess
resolve
finalise
evaluate.

Collect and triage

When someone contacts us to make a complaint, we will listen and ask questions to collect relevant information and provide information needed to progress the complaint appropriately.

The information we collect includes:

complainant’s contact details (if appropriate)
provider’s details
older person’s details
complaint concerns
desired outcomes
details to understand if there is any immediate risk to the older person.

The information we provide includes:

an explanation of our role
what we can and can’t achieve
an explanation of the complaints process, and what parties can expect
how we are fair, impartial and use a risk-based proportionate approach to complaint handling
how we will keep parties updated.

Throughout the complaint process, we collect information on the risk or harm to the older person and use it to triage and prioritise the complaint. This allows us to take proportionate, risk-based action to ensure the safety, health and wellbeing of the older person.

Information can be provided to us through several avenues, including via phone, webform or email.

Assess

The assess phase is where our complaints officers analyse information gathered and understand the nature and the context of the complaint. We assess a complaint to understand how best to start resolving it and to determine if risks need to be escalated to other parts of the Commission. We assess information from various sources to inform our risk assessment. The priority, where required, is to work with the provider to immediately ensure the older person is safe from harm.

For all complaints we will then undertake the following activities:

Review information about the provider.
Engage with the complaint parties.
Conduct a risk assessment on available information, including what we have collected from complaint parties.
Escalate risk to appropriate areas of the Commission as required to ensure the safety of older people.
Confirm the issues we need to examine to resolve the complaint.
Seek specialist advice within the Commission if required.
Determine the best way to resolve the complaint.

The assess phase will take all relevant information into consideration to determine the most appropriate way to resolve the complaint. We will engage with the older person, the person raising the complaint and the provider during this phase to get their views and advise on the resolution strategy to be implemented.

We will also consider if risks need to be escalated to other areas of the Commission to ensure older people are kept safe. The Commission supervises providers using a case management model to coordinate the Commission’s regulatory responses. Throughout the complaint process, including in the assess phase, we will consider if risks detected should be escalated for further consideration by the Commission. Appropriate and timely risk escalation ensures all parts of the Commission work together as required to manage provider risk.

Resolve

The resolve phase is where we work with the complainant/older person and provider to resolve the complaint. Communication with complaint parties is of key importance throughout the complaint process. The resolution process should support the provider to remedy the issue(s), restore relationships, and prevent the issue(s) from happening again. We have several resolution approaches available to us, including:

Service Provider Assisted Early Resolution
- This is where we ask the provider to try to resolve the complaint directly with the older person.
Provider resolution
- This is where we ask the provider to undertake a resolution process. We outline the issues in the complaint and advise them of what we expect from them. We also provide a template to report back to us within a specified time.
Investigation
- This is where we take a deeper look at the complaint. We seek a response from the provider to understand the issues and review information from all parties. We assess the information to ensure the provider is meetings its responsibilities, that risk has been addressed and a meaningful outcome has been achieved for the older person where possible.
Mediation
- Mediation involves the person making the complaint and/or the older person and the provider meeting with an independent meditator to discuss the concerns and attempt to achieve a mutually acceptable resolution.
Conciliation
- Conciliation involves us assisting the complaint parties to work together to discuss the issues and come to an agreement on actions to resolve the complaint.

In our resolution process, we will work with all parties to ensure we are unbiased and fair. We will work with the older person to make sure they understand what is happening to resolve the complaint. Part of our resolution approach may include conducting a site visit to the aged care service, an investigation of the issue(s), or directing the provider to take certain actions. Our priorities during this phase are:

to reduce any potential risk or harm to the older person to a manageable level
to balance the communicated needs and preferences of the older person
resolve the complaint where possible and achieve meaningful and proportionate outcomes for the older person
achieve the objectives of prevention, remediation and restoration.

Finalise

The finalise phase is where our complaints officers work with the parties to finalise a complaint. Engagement with the parties must occur before we decide to finalise a complaint.

We first need to decide if the complaint is ready to be finalised. In doing this we need to:

decide if the risk or harm to the older person has been mitigated
decide if we are satisfied the provider is meeting their responsibilities
communicate with the complaint parties.

Before we decide to finalise a complaint, we will check with the complainant if their desired outcome has been achieved. Where it has, we will progress to finalisation. Where it has not, we will consider if there needs to be further action taken by the provider that is proportionate and reasonable to address the concerns in order to remedy the issue, restore relationships and prevent the issue from recurring.

Once a complaint is ready to be finalised, complaints officers will contact parties to:

explain their decision
provide a written copy of their decision
explain their review rights.

Evaluate

The evaluate phase is where we look at how our resolution approach has achieved its objectives. This supports continuous improvement of our complaints handling processes. This lets us understand if we are using the right tools at the right time and that we are performing our complaints functions in line with:

legislation
our policies and procedures
industry best practices.

We evaluate our management of complaints through a variety of mechanisms including detailed analysis of customer feedback and monitoring of Key Performance Indicators. See Quality assurance below for more information on our evaluation mechanisms.

4.4 Review rights and complaints about us

For most decisions we make about a complaint, the complainant (and in some circumstances, the provider) has the right to ask for the decision to be reviewed if they don’t agree with that decision. Decisions that can be reviewed and who can seek a review are set out in the Rules, and include:

decisions to take no further action in relation to the issue raised in their complaint
decisions under Section 17 of the Aged Care Act to end a resolution process in relation to the issue raised in their complaint.

Some decisions are not reviewable, including those where:

the complainant has agreed to close the complaint because they were happy with the outcome. A new complaint would need to be lodged if the matter of concern has changed
the complainant has chosen to remain anonymous
the complainant has withdrawn their complaint
we have already reviewed the decision.

The Commission has a standardised process for handling review requests, which is outlined on our website. The review process is undertaken by one of the Commission’s designated review managers, who are independent to the complaints process.

Complainants can also make a complaint about us if they are not happy with our service or the way we dealt with their complaint. Further information on making a complaint about us can be found on our website here.

If the complainant is not satisfied with an outcome offered by the Commission, they can ask the Commonwealth Ombudsman to review our actions.

4.5 Quality assurance

We have strong systems in place to review our performance, identify continuous improvement opportunities and make changes to the way we handle complaints based on learnings. We do this through a range of activities, including:

monitoring Key Performance Indicators
routine surveying of customer (complainant and provider) satisfaction
quality assurance processes such as audits and targeted assurance activities
analysis and reporting on complaints trends
identifying and implementing lessons from:
- independent reviews of our complaint decisions
- complaints about us
- feedback from older people, their representatives, providers and other government agencies.