4. Complaints process

There are 5 sections to our Complaints Handling Policy:

4.1 How to make a complaint

Anyone can make a complaint about aged care services to the Complaints Commissioner.

We encourage people making complaints to give the Commission their contact details so we can:

involve them in the process
give them updates
check that the outcomes meet their needs.

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

There are 2 ways a person can make a complaint without sharing their identity with the provider:

Confidential complaint – we do not share with the provider:
the identity of any person making the complaint
the identity of a person identified in the complaint
any other details included in the complaint.
Anonymous complaint – we do not ask the person making the complaint for any information that can identify them.

Protections for people making complaints

Complaints made to the Complaints Commissioner may also qualify for whistleblower protections under the Aged Care Act. Further information is available in the Managing whistleblower disclosure policy.

Exceptions

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

the complaint suggests serious or immediate risk or harm to the older person or others
someone is at risk of self-harm
the person making the complaint threatens to harm someone.

We only do this when we need to, to protect the safety and health of people at risk. Where we can, we let the person making the complaint know before we share any information.

You can find out more about when and how you can contact us anonymously in our Privacy Policy.

Confidential and anonymous complaints

If we cannot share the details of the person making the complaint with the provider, this can change how we manage the complaint. It can also limit the outcomes we can achieve.

If we can share the identity of the person making the complaint with the provider, we can:

give the provider more detail about what happened
check the information we get from the provider, responsible person or worker with the person who made the complaint, to make sure it is consistent
work with the people involved in the complaint to get a wider range of outcomes, like an apology or conciliation. Conciliation is where a complaints officer helps the people involved to reach a mutually agreeable outcome to resolve the concerns of the complaint.

With anonymous complaints, we are limited in providing these outcomes. That is why we encourage people to give us their contact details.

Anonymous and confidential complaints are important. They give us vital information about issues that can affect 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.

Withdrawing a complaint

A person who makes a complaint with the Commission can withdraw it at any time, either orally or in writing.

If a complaint is withdrawn, we will take no further action in relation to the complaint and will end any resolution process underway. However, we may still:

continue to respond to risks or non-compliance identified in the withdrawn complaint (we will no longer engage with the person who withdrew the complaint)
use the information gathered from the withdrawn complaint to assess the risk of a provider, responsible person or worker.

4.2 Who is involved in a complaint

Early in the complaints process, we work out who needs to be involved, and their roles.

Person who makes the complaint

When things go wrong, older people can raise their concerns with their aged care provider and with the Complaints Commissioner.

Anyone can make a complaint, including:

older people
their supporters
their carers
their advocates
aged care workers
aged care professionals.

Throughout the complaints process, we communicate with the person who made the complaint in a timely way. This is to understand their needs, keep them up to date and discuss outcomes.

Older person

We will always contact and keep in regular communication with an older person who is directly affected by a complaint. We will also communicate with an older person’s carer, registered supporter or advocate if they have one. We engage with the older person to:

help them understand their rights
hear their experience
understand the outcomes they want
keep them informed, if they want
understand what support they need during the complaints process.

We do this when the older person made the complaint and when someone made the complaint for them. We will not talk about the older person to others unless we have their permission. Sometimes a complaint can affect many people receiving aged care, and it may not be practical to contact everyone. In these instances, we may seek to only contact older people if they are specifically identified and directly impacted.

Person who represents the older person

Registered supporters support older people to make and communicate their decisions. A registered supporter can be a trusted family member or friend that the older person chooses. An older person can have more than one registered supporter. Registered supporters do not have authority to make decisions for the older person. Their role is to support the older person to make their own decisions in line with the older person’s wishes and preferences.

Substitute decision-makers are appointed decision makers who have authority under state or territory law to make decisions for older people receiving care. A substitute decision-maker can only make decisions in line with their active, legal authority. Examples include people appointed under a power of attorney or an enduring guardianship. Each state and territory has information about substitute decision-makers.

Independent aged care advocates can play an important role in the complaints process. Independent aged care advocates provide free, independent, and confidential support for older people making complaints. This support includes assisting them to raise their concerns and understand their rights. All older people who receive or are seeking government-funded aged care have access to independent aged care advocates.

We welcome independent aged care advocate involvement in the complaints process. We will work with them to help people to make a complaint and understand their rights. We will communicate regularly with the independent aged care advocate about the progress of the complaint, where the older person has given us permission to do so.

Registered provider

Registered providers must manage complaints about their services. They must make sure:

they fix the issue, prevent it from happening again, and restore relationships
their complaints management system and practices are in line with the Statement of Rights.

Providers are important in the complaints process. We work with them to:

understand their point of view
give them information about our role
ask for the information we need
decide how we can work together to achieve good outcomes for older people
build their capability to develop and deliver:
best practice complaints handling (including open disclosure)
a culture of continuous improvement, learning and innovation.

Aged care workers and responsible persons

Workers and responsible persons must comply with their obligations under the Aged Care Act. This includes obligations relating to complaints made about them. We work with responsible persons and workers to:

understand their point of view
give them information about our role
ask for the information we need
decide how we can work together to achieve good outcomes for older people
engage with and educate them about the Statement of Rights.

Other people

When we handle complaints, we can ask for information or documents from any other person with knowledge about the issue raised in the complaint. For example, health professionals may have information that will help us resolve a complaint. If we identify a person with information that can help us, we will contact them.

In addition to independent aged care advocates, other people can advocate on behalf of an older person, including their family, their carers, or their supporters.

The Commission

The Commission manages the complaints process. We:

work with everyone involved in the complaint and consider their points of view, needs and preferences
consider older people’s rights, and provider and worker obligations under the Aged Care Act
consider relevant information and documents to understand the complaint
use information we gather to understand what happened and what the provider, worker or responsible person has done to respond to the concerns
decide on a risk-based and fit-for-purpose response. This can include a regulatory response if a provider is unable or does not want to improve.

When we communicate, we will:

treat everyone with respect
be open and clear about what everyone can expect from us at each stage of the process
explain any information we need, or any action we need someone to take
listen to and acknowledge concerns
keep in mind the outcomes people want.

We focus on achieving meaningful, suitable and sustainable outcomes that safeguard the rights of older people.

4.3 Phases in the complaints process

The complaints process is made up of the following phases and generally occurs across the following timeframes:

Complaint phase	Expected timeframe
Collect and triage	Within 3 business days
Assess	Within 10 business days
Resolve	Within 90 days
Finalise	Within 90 days
Evaluate	After the complaint has ended

Collect and triage

A person can make a complaint to the Commission:

by phone
by letter
by webform
by email
in person, through an outreach request.

Our complaints handling system is easy to access. We help people make a complaint and we support everyone involved in a complaint. For example, we provide access to advocates, interpreter services and the National Relay Service. You can find out more in the Make a complaint section on our website.

When we receive a complaint, we collect and clarify information to understand:

the older person’s experience
the risks of harm to older people
the outcomes that the person making the complaint, and any older people identified in the complaint, want
the details of the complaint.

This helps us assess the risk and decide on the priority of the complaint.

Assess

In this phase, our complaints officers gather more information to understand the complaint and the risk of harm to the older person. This helps us to work out:

what went wrong
how the older person wants the complaint resolved
the outcome needed to fix it
how to restore the older person’s trust and confidence in their care
how to prevent the issue from happening again.

We use our risk-based monitoring tools and, where needed, ask for specialist clinical or legal advice to understand the complaint and the risks.

When we understand what needs to be fixed and prevented from happening again, our complaints officers will decide if further action is required, and if needed, the best way to resolve the complaint.

Resolve

In this phase, we plan and take action to respond to the complaint.

We work with the older person and the provider, responsible person or worker to address any remaining concerns and risks of harm to the older person.

The resolve phase is guided by the wishes of the older person. It supports and builds providers’ capability to:

fix the problem
restore the older person’s trust in care and repair the relationship with those providing their care
prevent the issue from happening again.

We assess current and relevant information all the time. It helps us decide how to approach resolving the issue. We update our approach as needed to make sure the actions we take in response to complaints are always:

appropriate
risk-based
proportionate to the risk of harm to older people.

Our actions can include:

provider led resolution– requires the provider to try to resolve the complaint and report back to the Complaints Commissioner within a specified timeframe
requesting specified actions – requires the provider, worker or responsible person to take specified action within a specified timeframe. For example, a specified action can include requiring a provider to fix an issue that may have been identified as an outcome being sought by the older person
investigating what caused the complaint, including:
requiring the provider, worker or responsible person to provide information or documents about the complaint
visiting a residential care home or a home or community setting to gather further information about the complaint
reviewing information and documents to inform the resolution process
discussing the complaint with the person who made the complaint, the provider, worker or responsible person the complaint is about, or any other relevant person
supporting a conciliation process, including asking any of the people involved with the complaint to take part in a process to reach a resolution
conducting a restorative engagement process that satisfies the needs of the older person receiving care
responding to escalating risk or non-compliance, where matters need further intervention by the Commission we do this using our Supervision Model. We can take regulatory actions in line with our Compliance and Enforcement Policy.

In our resolution process, we will work with all parties to make sure we are unbiased and fair. We will keep the person making the complaint and the older person informed of what is happening to address the complaint.

Our priorities in the resolve phase are to:

reduce risk of harm to the older person to an acceptable level
balance the needs and preferences of the older person
check if the outcome meets what the person making the complaint wanted. If not, we will consider if the provider needs to take further action
resolve the complaint where possible and achieve meaningful outcomes for the older person
remedy, restore and prevent – including making sure the provider, responsible person or worker has met their obligations under the Aged Care Act and is meeting their obligations under the Statement of Rights
build the capability of providers to develop and use effective and best practice complaints handling practices, including open disclosure
inform the person making the complaint (and any affected older person) about the proposed outcome. This will include discussing what actions we have taken and the reason for finalising the complaint. We do this to get their views and consider them before we finalise the complaint in the Finalise phase.

Finalise

Before finalising a complaint, the complaints officer will:

reach an evidence-based decision
tell everyone involved in the complaint what the outcome is
seek commitment for actions on any outstanding issues or promises to ensure a restorative outcome is reached
ensure the outcome meets our requirements under the Aged Care Act and Aged Care Rules
prepare a written statement, called a complaints determination, that:
explains the action the Complaints Commissioner took to deal with and resolve the complaint
explains what action, if any, another person needs to take to deal with and resolve the complaint
provides information about reviewing or reconsidering the determination
give a proposed complaints determination to the older person to seek their views
give a copy of the complaints determination to the older person and their carers, supporters and advocates (if they have consent to receive a copy), and the provider, worker or responsible person the complaint is about.

To verify if a complaint is ready to be finalised, we check:

if the older person’s desired outcomes have been achieved
the provider is meeting their obligations
if there are legislative grounds to finalise the complaint.

If we are not ready to finalise, we will do more work to resolve the complaint or risk of harm to the older person.

When a complaint is ready to be finalised, our complaints officers will contact people involved in the complaint to:

explain the complaint outcome, which includes:
explaining the actions to address the complaint
explaining the laws under which each issue was finalised
giving the reasons why the complaint was finalised
any other appropriate information
tell them that they will receive a copy of the complaint determination. The determination provides details about the complaint and outcomes
explain their rights to a review, if this applies.

We will provide the information above when we can. We will not communicate this information to finalise a complaint if:

we cannot contact the person who made the complaint because they asked to be anonymous
the person who made the complaint has withdrawn the complaint
the person who made the complaint, or an older person directly affected by the complaint, has asked not to be notified or receive further communication about the complaint
regular communication with the person who made the complaint, or providing a complaint determination, would go against our information management requirements.

Evaluate

In this phase we assess how effective our complaints handling approach was in achieving the outcomes we wanted. This informs our future complaints-handling approaches and supports continuous improvement. It helps us understand how well we are:

performing in line with our legislated responsibilities, policies and procedures and industry best practice
using the right tools at the right time to respond to risks of harm to older people
achieving the volume and quality of outcomes expected for older people.

We evaluate the way we manage individual complaints and complaints more broadly. We do this in various ways, including by analysing and monitoring our key performance indicators. You can find out more about how we evaluate our performance in section 4.4, Quality Assurance.

We also ask for feedback about how we addressed and resolved complaints from:

the person who made the complaint
each person the Complaints Commissioner communicated with, including anyone who made a complaint on someone’s behalf, such as a supporter or an advocate
the provider, worker or responsible person the complaint is about.

4.4 Quality Assurance

We have strong systems to review our performance, identify continuous improvement opportunities and change the way we handle complaints based on what we learn.

We do this through:

monitoring key performance indicators
surveying people who made complaints and providers to understand how satisfied they are with the complaints process
Quality Assurance processes, such as audits and targeted activities
analysing and reporting on complaints trends
identifying and applying lessons from:
independent reviews of our complaint decisions
complaints about us
seeking feedback from older people, their supporters, providers and other government agencies.

4.5 Review Rights

The following entities can request the Complaints Commissioner reconsiders the decision to take no further action in relation to the complaint or to end the resolution process in relation to the complaint:

the person who made the complaint (unless the complaint was withdrawn before the decision was made, frivolous, vexatious or not raised in good faith)
the provider, worker or responsible person who was subject to the complaint.

They can also ask for more information from us if they do not understand the decision.

The Aged Care Rules explain which decisions can be reviewed and who can ask for a review. Decisions that can be reviewed include those to:

take no further action on the issue raised in the complaint
end a resolution process for the issue raised in the complaint.

Some decisions cannot be reviewed. These include decisions where:

the person who made the complaint withdraws their complaint
the complaint was frivolous, vexatious or not raised in good faith.

The Complaints Commissioner has a consistent process for handling review requests. The review process provides for procedural fairness. The Commission’s review managers or review officers, who are independent of the complaints process, conduct the review.

4.6 Complaints about us

Anyone can make a complaint about the Commission if they are not happy with how we dealt with a complaint.

They also have the right to make a complaint to the Commonwealth Ombudsman. Their role is to make sure we are fair and follow proper processes.

The Commonwealth Ombudsman does not have the power to change our decision, but they can make recommendations. These can be about how we should have acted or what we can do to improve our processes.

Find out more about submitting a complaint about us.