Rhode Island Nursing Home Resident Complaint (LTC Ombudsman / Department of Health)

RHODE ISLAND NURSING HOME RESIDENT COMPLAINT

TABLE OF CONTENTS

1. Routing — Who Receives This Complaint
2. Complainant Identification
3. Resident Identification
4. Facility Identification
5. Statement of Resident Rights at Issue
6. Detailed Complaint Narrative
7. Evidence and Witnesses
8. Internal Grievance and Facility Response
9. Relief Requested
10. Discharge / Transfer Appeal (if applicable)
11. Statutory Authority and Enforcement
12. Complainant Certification and Signature
13. Rhode Island Practice Notes
14. Sources and References

1. ROUTING — WHO RECEIVES THIS COMPLAINT

This complaint is being submitted simultaneously to:

☐ RI State Long-Term Care Ombudsman
Alliance for Better Long Term Care
422 Post Road, Suite 204, Warwick, RI 02888
Phone: 401-785-3340 / Toll-Free: 1-888-351-0808
Online intake: https://alliancebltc.org/ombudsman-program

☐ RI Department of Health — Center for Health Facilities Regulation
3 Capitol Hill, Room 306, Providence, RI 02908
Complaint line: 401-222-5960
Online complaint form: https://health.ri.gov

☐ RI Office of Healthy Aging — APS (if abuse/neglect/exploitation)
25 Howard Avenue, Building #57, Cranston, RI 02920
Hotline: 401-462-0555

☐ CMS Region I (New England) / 1-800-MEDICARE (Medicare/Medicaid-certified facility)

☐ RI Attorney General — Elder Abuse Unit: 401-274-4400

☐ Local police department: [________________________________]

☐ Facility administrator (internal grievance / required notice)

2. COMPLAINANT IDENTIFICATION

3. RESIDENT IDENTIFICATION

4. FACILITY IDENTIFICATION

5. STATEMENT OF RESIDENT RIGHTS AT ISSUE

Check each right alleged to have been violated. Each is grounded in the federal Nursing Home Reform Act (42 U.S.C. § 1395i-3 / § 1396r and 42 C.F.R. Part 483) and Rhode Island General Laws Chapter 23-17.5:

☐ Freedom from abuse, neglect, exploitation — 42 C.F.R. § 483.12; R.I. Gen. Laws § 23-17.5-9, § 23-17.8
☐ Freedom from unnecessary physical or chemical restraint — 42 C.F.R. § 483.10(e), § 483.12(a)(2); § 23-17.5-12
☐ Quality of care and quality of life — 42 C.F.R. § 483.24, § 483.25
☐ Adequate and appropriate nursing services / staffing — 42 C.F.R. § 483.35; R.I. Gen. Laws § 23-17.5-33 (RI minimum staffing — 3.81 hours of direct care per resident per day, as amended)
☐ Comprehensive person-centered care planning — 42 C.F.R. § 483.21
☐ Pharmacy services / freedom from unnecessary medications — 42 C.F.R. § 483.45
☐ Infection control — 42 C.F.R. § 483.80
☐ Right to self-determination, choose physician, refuse treatment — 42 C.F.R. § 483.10(c); § 23-17.5-3
☐ Right to participate in care planning and access medical records — 42 C.F.R. § 483.10(c), (g); § 23-17.5-2
☐ Right to privacy and confidentiality — 42 C.F.R. § 483.10(h); § 23-17.5-13
☐ Right to manage personal financial affairs / Personal Needs Funds — 42 C.F.R. § 483.10(f)(10); § 23-17.5-14; 210-RICR-50-05-2
☐ Right to file grievances without retaliation — 42 C.F.R. § 483.10(j); § 23-17.5-8
☐ Right to visitors / essential caregivers — 42 C.F.R. § 483.10(f)(4); R.I. Gen. Laws § 23-17.5-31 (essential caregiver during disaster declaration)
☐ Right to remain in facility / freedom from improper transfer or discharge — 42 C.F.R. § 483.15; R.I. Gen. Laws § 23-17.5-21, § 23-17.5-25 (bed-hold and readmission)
☐ Right to form / participate in a resident or family council — 42 C.F.R. § 483.10(f)(5)–(6); § 23-17.5-30
☐ Right to a smoke-free environment — § 23-17.5-26
☐ Right to dignified treatment of belongings and reimbursement at death — § 23-17.5-31

6. DETAILED COMPLAINT NARRATIVE

Date(s) of incident(s) or pattern observed: [__/__/____] to [__/__/____]

Location within facility: [________________________________]

Staff involved (names / titles / shifts): [________________________________]

Detailed factual account (chronological; quote statements verbatim where possible; describe injuries, condition, environment, omissions, financial transactions, or treatment):

[___________________________________________________________________]
[___________________________________________________________________]
[___________________________________________________________________]
[___________________________________________________________________]
[___________________________________________________________________]
[___________________________________________________________________]
[___________________________________________________________________]
[___________________________________________________________________]
[___________________________________________________________________]

Harm or injury to resident:
☐ Physical injury (describe): [____________]
☐ Pressure injury / wound: stage [____]
☐ Falls (number, dates): [____________]
☐ Weight loss / dehydration / malnutrition
☐ Medication error or adverse drug event
☐ Psychological distress / fear / withdrawal
☐ Financial loss: $[________]
☐ Death (date and circumstances): [____________]
☐ Other: [________________________________]

7. EVIDENCE AND WITNESSES

8. INTERNAL GRIEVANCE AND FACILITY RESPONSE

42 C.F.R. § 483.10(j) and R.I. Gen. Laws § 23-17.5-8 require facilities to maintain a grievance process. Document attempts at internal resolution:

☐ Facility's Grievance Officer was contacted: [NAME] on [__/__/____]
☐ Written grievance response received within five business days as required: ☐ Yes ☐ No
☐ Care-plan meeting held: [__/__/____]

9. RELIEF REQUESTED

The complainant requests that the receiving agency:

☐ Conduct a prompt on-site investigation under 42 C.F.R. § 488.332 / RI DOH regulations.
☐ Cite the facility for federal F-tags and state deficiencies and impose remedies, including civil monetary penalties (42 C.F.R. § 488.408), denial of payment for new admissions, directed plan of correction, state monitoring, and termination if warranted.
☐ Refer suspected criminal conduct to the RI Attorney General's Elder Abuse Unit and local police.
☐ Coordinate with the State Long-Term Care Ombudsman to mediate resolution and ensure no retaliation against the resident.
☐ Refer to OHA Adult Protective Services for elder-abuse investigation under R.I. Gen. Laws § 42-66-8.
☐ Refer to RI Medicaid Fraud Control Unit if Medicaid funds were involved.
☐ Order specific corrective action, including: [________________________________]
☐ Stay involuntary discharge pending appeal (if applicable — see Section 10).
☐ Restore personal-needs funds and reimburse misappropriated funds.
☐ Provide written response to complainant within statutory timeframe.

10. DISCHARGE / TRANSFER APPEAL (if applicable)

Complete this section ONLY if challenging an involuntary transfer or discharge.

Bed-hold and readmission rights under R.I. Gen. Laws § 23-17.5-25 and 42 C.F.R. § 483.15(d): If the resident is hospitalized or takes therapeutic leave, the facility must hold the bed for the period covered by Medicaid (or as paid privately) and must readmit upon return. The facility must provide written notice of bed-hold policy at admission and at the time of transfer.

11. STATUTORY AUTHORITY AND ENFORCEMENT

Federal:

• Nursing Home Reform Act — 42 U.S.C. §§ 1395i-3, 1396r; 42 C.F.R. Part 483.
• Elder Justice Act — 42 U.S.C. § 1397j et seq.; covered-individual reporting under § 1320b-25 within 2 hours (serious bodily injury) or 24 hours (other) to State Survey Agency and law enforcement.
• Older Americans Act — 42 U.S.C. § 3058g (State LTC Ombudsman Program).

Rhode Island:

• R.I. Gen. Laws § 23-17.5-1 through § 23-17.5-34 — Rights of Nursing Home Patients (services, grievances, restraints, privacy, financial affairs, transfers, family councils, essential caregivers, minimum staffing, smoke-free environment, posting requirements).
• R.I. Gen. Laws § 23-17 — Licensing of Healthcare Facilities and DOH enforcement (license suspension/revocation, fines).
• R.I. Gen. Laws § 23-17.8 — Abuse in Healthcare Facilities (24-hour reporting to DOH, criminal and civil penalties).
• R.I. Gen. Laws § 42-66-8 — Mandatory reporting of elder abuse to OHA.
• 216-RICR-40-10-1 — RI DOH Licensing of Nursing Facilities regulation.
• 218-RICR-40-00-1 — Long-Term Care Ombudsperson Program regulation.

12. COMPLAINANT CERTIFICATION AND SIGNATURE

I certify under penalty of perjury under the laws of the State of Rhode Island that:

1. The information set forth in this complaint is true, correct, and complete to the best of my knowledge and belief.
2. I am authorized to file this complaint on behalf of the resident, or I am the resident.
3. I have made (or am simultaneously making) any required mandatory report under R.I. Gen. Laws § 42-66-8 and § 23-17.8 if the conduct described constitutes abuse, neglect, or exploitation.
4. I understand that retaliation against the resident or against me for filing this complaint is prohibited by 42 C.F.R. § 483.10(j)(4) and R.I. Gen. Laws § 23-17.5.

Signature: [________________________________]
Print name: [________________________________]
Date: [__/__/____]

13. RHODE ISLAND PRACTICE NOTES

1. Concurrent filings. File simultaneously with the LTC Ombudsman (advocacy/mediation), DOH Facilities Regulation (regulatory enforcement), and OHA APS (if elder abuse). The three tracks complement rather than duplicate one another. The Ombudsman cannot impose sanctions; DOH can.

2. DOH investigation timelines. RI DOH categorizes complaints by severity. Immediate Jeopardy complaints are investigated within 2 working days; high-priority within 10 working days; others routinely. The complainant should request notification of investigation outcome and a copy of the CMS-2567 statement of deficiencies if the complaint resulted in citations.

3. Minimum staffing. R.I. Gen. Laws § 23-17.5-33 establishes nurse-staffing minimums (currently set at a statutorily-defined hours-per-resident-per-day standard, with civil penalties for non-compliance). Facilities must post daily staffing per § 23-17.5-34. Non-compliance is a citable deficiency.

4. Personal Needs Fund. Each Title XIX resident is entitled to a separate, interest-bearing account (or facility-managed pooled account with sub-accounts) under 210-RICR-50-05-2. Misappropriation is a serious deficiency and may be criminal.

5. Involuntary discharge. Most disputed discharges fail because the facility's notice does not meet 42 C.F.R. § 483.15(c) requirements (proper basis, full discharge plan, ombudsman contact, appeal rights). Always obtain the notice and timeline before responding.

6. Bed-hold disputes. Common in Rhode Island when a resident is hospitalized for psychiatric or behavioral reasons. The facility must readmit upon return per § 23-17.5-25; refusal is appealable.

7. Civil litigation. R.I. Gen. Laws § 23-17.5 creates statutory rights enforceable in part through DOH; private rights of action for nursing-home negligence proceed under common-law tort, breach of contract, the consumer-protection statute (R.I. Gen. Laws § 6-13.1), and the elder-abuse criminal/civil framework. Pre-suit consultation with an elder-law attorney is strongly recommended before pursuing civil remedies.

8. Mandatory facility reports. Under § 23-17.8 and federal § 1320b-25, facilities themselves must report serious incidents to DOH and law enforcement within tight timeframes (2 or 24 hours). Failure of the facility to self-report is itself a deficiency and a basis for sanctions.

9. Retaliation. Any action against a resident or family that follows a complaint is a separate violation. Document timeline carefully.

14. SOURCES AND REFERENCES

• RI State Long-Term Care Ombudsman (Alliance for Better Long Term Care): https://alliancebltc.org/ombudsman-program
• RI Department of Health — Health Facilities Regulation: https://health.ri.gov
• RI Office of Healthy Aging — Ombudsman page: https://oha.ri.gov/resources/fraud-and-abuse/ombudsman-program
• RI Gen. Laws Title 23, Chapter 23-17.5: https://webserver.rilegislature.gov/Statutes/TITLE23/23-17.5/INDEX.htm
• RI Gen. Laws § 23-17.5-8 (Grievances): https://webserver.rilegislature.gov/Statutes/TITLE23/23-17.5/23-17.5-8.htm
• RI Gen. Laws § 23-17.5-25 (Bed-hold): https://webserver.rilegislature.gov/Statutes/TITLE23/23-17.5/23-17.5-25.htm
• RI Gen. Laws § 23-17.5-33 (Staffing): https://webserver.rilegislature.gov/Statutes/TITLE23/23-17.5/23-17.5-33.htm
• RI Gen. Laws § 23-17.8 (Abuse in Healthcare Facilities): https://webserver.rilegislature.gov/Statutes/TITLE23/23-17.8/INDEX.htm
• 216-RICR-40-10-1 (RI Licensing of Nursing Facilities): https://rules.sos.ri.gov/regulations/part/216-40-10-1
• 218-RICR-40-00-1 (LTC Ombudsperson Program): https://dhs.ri.gov/sites/g/files/xkgbur426/files/Regulations/218-RICR-40-00-1GoverningTheLongTermCareOmbudspersonProgram.pdf
• 42 C.F.R. Part 483: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483
• 42 U.S.C. § 1396r (NHRA — Medicaid): https://www.law.cornell.edu/uscode/text/42/1396r
• 42 U.S.C. § 1395i-3 (NHRA — Medicare): https://www.law.cornell.edu/uscode/text/42/1395i-3
• CMS Nursing Home Resident Rights: https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-certification-compliance/nursing-homes
• Medicare.gov Nursing Home Compare: https://www.medicare.gov/care-compare