Clothing disappearing from the laundry, requested reminders or escort to activities not happening, and aid with "attitude," neglected hygiene or developing skin sores, there is always going to be something, and there's no perfect elder care provider. Sooner or later you will face the need to address a problem with your home care agency, your parent's assisted living residence, or a nursing home. Rather than blasting in ready for battle, here's how to get your complaints heard:

Unless the problem is one that is causig actual harm to your elder it's almost always best to start at the level of the problem. You can always work your way up the chain of command later if you must. In the case of abuse and/or neglect, of course you will want to go directly to your state enforcement agency.

Get Your Ducks in a Row

First, take a deep breath and organize your thoughts. It's always better to present in a calm and dignified manner. If you have to go outside and do some deep breathing, give yourself that extra few minutes to calm down. It will be worth it.

While you're deep breathing, organize your thoughts so you can be clear and direct about your complaint. Review the facts as you understand them: What is your concern? Who is involved? Where and when is it happening? Why is it happening?

When you're calm, talk it over with your senior. Is this problem as great a concern to your elder as it is to you? What would your elder like you to do about it? Your senior might be willing to overlook some things that don't feel so important in the interest of maintaining harmony. Or, your senior might rather deal first with another issue that feels more urgent.

If It's a Staff Issue, Start Where The Problem Lies

Small irritants may simply be a matter of letting the staff member know. Larger issues may be out of the staff member's control, but you won't know until you bring it up.

If you filled out pages and pages of information about your elder and the care staff doesn't seem to have read anything you wrote, don't be surprised. Many facilities do not permit their aids to look at patient charts. You may have to make an extra effort to educate direct caregivers about your parent.

Be sure to make a note of the caregiver's name and the date you spoke.

If you've spoken to the caregiver or worker involved and you've had no success in resolving the problem, then it's time to take a step up the line.

Speak to the Direct Supervisor or Department Manager

Direct care aids in nursing homes and assisted living residences usually report to the Director of Nursing or the Assistant DON. Physical Therapy, Food Service, Laundry, Housekeeping, etc. will each have a manager in charge. In the case of a home care agency, you should have received contact information for your worker's supervisor.

Let them know of your concern, and give them sufficient time to rectify the issue. "Sufficient" time will depend on the urgency of the issue, of course.

Again, make a note of who you spoke with and when, as well as their response to you.

Request a Care Plan Conference

If you have not seen improvement, you have the right to request an assisted living or nursing care planning conference at any time. Request that the individuals with the authority to resolve your issue be present, as well as any others you think would be helpful. Be prepared to discuss your concerns and how you would like to see the issue resolved.

If your concerns are with a home care worker, this is the time to request a face-to-face meeting with the employee's direct supervisor, as your previous contacts will probably have been via telephone.

You do not want this meeting to be confrontational if you can avoid it. You want to participate as an active member of the care "team" working together for the benefit of a resident or client.

Before the meeting concludes be sure to ask for a time when you can expect to see results, and the person you should follow up with if you don't see the results you anticipate.

Be sure to get a copy of the care plan before you leave.

If the problem is resolved, be sure to come back to the care team with praise and thanks.

Meet With the Administrator

If your problem is not resolved in a timely manner after your care plan meeting, make an appointment to meet with the administrator of the residence or the home care agency.

Again, be sure to make notes about what was said and what the administrator agreed to do.

If you want to be perceived as a very businesslike advocate for your senior, follow this meeting up with a written letter to the administrator (not an email) that summarizes your joint agreements.

Use Your Ombudsman

If you have not seen results within the time frame you agreed to, and if you have not heard back from the administrator about the cause of any delay, contact your Long Term Care Ombudsman.

The Ombudsman is empowered to investigate resident and advocate complaints. The Ombudsman will work with everyone to reach a fair resolution if possible.

If you don't have information about how to contact your Ombudsman, use the Ombudsman Locator.

The Top of the Food Chain

We always hope it won't come to this, but every so often we have to continue right up to the top of the administrative ladder. Every licensed home care agency, assisted living residence and nursing home must provide contact information for their owner, corporate or franchise headquarters, etc. If you did not receive this information in your original packet of information, contact your state licensing agency for this information.

Write a letter to the owner, regional manager, CEO, or the board of directors and send a copy to the administrator. Administrators hate to be contacted by their corporate overseers, and most will do whatever they can to resolve an issue before they have to report to their bosses that they can't effectively manage an issue.

When things get to this level do not use the telephone. You want to have a written record of your complaint. If you want to be doubly assured that your letter has been received, send it Registered, Return Receipt Requested.

Abuse, Neglect and the End of the Line

In the case of abuse or outright neglect you will want to make an immediate report to the licensing agency responsible for your provider or facility. You should have received information about how to make a report when your elder moved in or started receiving services. Most states also require that this information be displayed in a prominent location within their building. If you can't find the number to make a report, contact your Ombudsman and get this information. Reports can be made by telephone. Hotlines are usually answered 24-hours per day.