Experience Professional and Compassionate Care with the team at Devotion Hospice

Improvement Project

This form is intended to be used by participants and/or their designated representatives to provide feedback on how we can improve, award compliments or report dissatisfaction with Devotion Hospice, LLC services.

Any Devotion Hospice, LLC participant or his/her representative may file a grievance with any staff member at any time either in person, by calling 248-581-4000, Fax: 248-524-3922, or in writing to Devotion Hospice, LLC 153 N. Milford Rd, Ste 103 Highland Township, MI 48357

What to expect of the Improve Project process after you submit your
suggestion or complaint:

For suggestions/compliments:
Your suggestion will be reviewed within 30 days by our Executive Director.

For complaints/grievances:
Participants will be informed that their complaint has been received within ten business days of receipt.

Devotion Hospice, LLC will make all accommodations to resolve the issue and send a letter outlining a resolution within 30 calendar days of receipt.

All grievances will be kept confidential and shared with staff only to the extent necessary to investigate and resolve complaint(s).

Devotion Hospice, LLC will continue to provide the participant with all services at the frequency provided in the current plan of care.

Devotion Hospice, LLC will not discriminate against a participant on the grounds that a compliant has been filed.

Notice of Nondiscrimination/Filing a Grievance

Devotion Hospice, LLC complies with applicable federal civil rights laws and does not discriminate, exclude or treat people differently on the basis of race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, marital status, familial status, or any other characteristic protected by applicable federal, state, or local law and regulations in regards to admission, access to treatment, or employment.

Devotion Hospice, LLC provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters, written information in other formats (large print, audio, accessible electronic formats, other formats); and free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. If you need these services, contact the office.

If you believe that Devotion Hospice, LLC has failed to provide these services or discriminated in any other way, you may file a grievance in person or by mail, fax or email by using the contact information listed below. If you need help filing a grievance, contact our Executive Director: Phone:248-581-4000; Fax 248-524-3922; Email bethanysafadi@devotionhospicemi.com; 153 N. Milford Rd, Suite 103 Highland Twp, MI 48357

It is the law for Devotion Hospice, LLC not to retaliate against anyone who opposes discrimination, files a grievance or participates in the investigation of a grievance.

Grievances must be submitted to Devotion Hospice, LLC within 60 days of the date you become aware of the possible discriminatory action, and must state the problem and the solution sought. We will issue a written decision on the grievance based on a preponderance of evidence no later than 30 days after its filing, including a notice of your right to pursue further administrative or legal action. You may also file an appeal of our decision in writing to our President/CEO within 15 days. Once an appeal is received a written response will be issued within 30 days.

The availability and use of this grievance procedure does not prevent you from pursuing other legal or administrative remedies.

You may also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by using any of the following methods:
• Submit electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf.
Write to U.S. Department of Health and Human Services, 200 Independence Avenue, SW Room 509F. HHH Building Washington, D.C. 20201. Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html
Call 1-800-368-1019 (toll free) or 1-800-537-7697 (TDD).