Complaints in long-term care facilities for older persons: Why residents do not give 'free advice'

In health care policies, the right to complain is presented as a key patient right. Complaints are also seen as a potential vehicle for quality improvement. However, in long-term care facilities for older persons in the Netherlands, relatively few complaints are registered. An explorative qualitative study was performed at three long-term care facilities to examine the ways in which different relevant actors define and relate to complaints. We conducted observations and semi-structured interviews with 76 persons: residents, their family members, nurses, volunteers, middle (facility) and upper (institutional) managers and complaint handling personnel. Long-term care facilities are social contexts obeying complex social and cultural norms. There are great differences in how complaining and complaints are perceived. For most residents, 'complaining' had strong negative connotations: they expected it would lead to undesirable social consequences that could not outweigh possible advantages. To nurses it was important to hear of residents' dissatisfactions but communicative aspects were challenging. Institutional managers saw complaints as 'free advice' they wished to use to enhance the quality of the care provision. Complaint managers underlined the procedural aspects to complaints. A more appropriate and productive policy on complaints in this health care sector should take these differences into account.