Real People Real Problems An Evaluation of the Long-Term Care Ombudsman Programs of the Older Americans Act (1995) / Chapter Skim
Currently Skimming:
Expansion of the Long-Term Care Ombudsman Program
Expansion of the Long-Term Care Ombudsman Program
Pages 205-230
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From page 205... ...
The LTC ombudsman fills this advocacy role for older individuals in LTC residential facilities with varying degrees of effectiveness in all 50 states, the District of Columbia, and Puerto Rico. Many older consumers never enter such facilities; they may receive a broad array of health care and LTC services in such settings as their own homes, acute care hospitals, psychiatric hospitals, adult day care centers, and physicians' offices.
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From page 206... ...
206 REAL PEOPLE, REAL PROBLEMS a stronger ombudsman program than exists today and to bring more and better empirical evidence into the debate. NEED FOR OMBUDSMAN SERVICES BY CONSUMERS OF HEALTH CARE AND LONG-TERM CARE SERVICES An individual's need for advocacy assistance is likely to be related to two factors: (1)
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From page 207... ...
For example, an individual who has a broken hip and is trying to arrange for home-delivered meals for a few weeks is much less likely to need an advocate than is an individual with severe cognitive impairment who is Irving to anneal an involuntary transfer from nursing facility. - ~ C7 ~ Err- ~ ~~~ ~~~~~~~ ~~~~~~~~ -~~~~~ ~ When the LTC ombudsman program first began in the early 1970s, its efforts were targeted at nursing facility residents because they were viewed as among the most vulnerable consumers, that is, as persons who were relatively "disempowered" and living in very complex "total" institutions.
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From page 208... ...
Nearly 88 percent of nursing facility residents and 49 percent of home health consumers needed help dressing (Older Americans Report, 1994~. Compared to residents in nursing facilities, home health consumers receive care in a virtually "invisible" setting (U.S.
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From page 209... ...
In some areas of the country, particularly rural areas, consumers face the dilemma of having too few choices; sometimes they may be placed on waiting lists for services and sometimes needed services are simply not available. A typical scenario for an elderly person requiring comm~mitv-hn~1 services illustrates this"complexity." obtain medical monitoring from a visiting nurse, receive assistance with bathing from a home health aide, be placed on a waiting list for a chore aide, attend an adult day care center, be driven to appointments by a special transportation service, have some of these services coordinated by a case manager, and rely extensively on family members or friends for many other personal care needs, especially when the system's representatives are not available (e.g., on evenings and weekends)
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From page 210... ...
with problems in dealing with a wide array of paraprofessional personnel such as nursing aides, personal attendants, and homemakers. The current LTC ombudsman program has already given considerable effort to working with similar types of aides in nursing facilities.
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From page 211... ...
First of all, family and friends may live in another community or state and have little ability to observe or intervene first hand, regardless of their good intentions. Furthermore, for many individuals, this may be their first encounter with Medicare, a hospital social worker, a home health aide, or an area agency on aging (AAA)
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From page 212... ...
Publicly funded case management agencies, which may be public or private nonprofit, in many states have responsibility for allocating, coordinating, and purchasing LTC services for low-income clients receiving services under Medicaid waivers and state-funded programs. Publicly funded case managers are expected to be both advocates and resource allocators.
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From page 213... ...
This is particularly true in private case management programs when the "client" is the person who is paying. Third, limited access to case management programs prevent them from being considered a broad-based solution to meet advocacy needs.
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From page 214... ...
Other Oversight, Quality Assurance, Consumer Interest, and Advocacy Programs Yet other mechanisms are available to resolve consumers' complaints and assure the quality of the care they receive. These programs include the service
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From page 215... ...
To the extent that they are collectively deficient in these regards, arguments can be advanced for new responsibilities for one or more of these existing programs or for a new configuration along the lines of the present LTC ombudsman program in order to meet LTC advocacy needs more fully. The committee concludes that probably no one mechanism can be relied on to handle all the consumer advocacy issues that can and do arise in the area of home- and community-based health care and LTC services for the elderly.
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From page 216... ...
Although it is no longer in operation, New York City also had a home care ombudsman program for several years. In order to gather information the committee convened a technical panel that commissioned a paper to canvass states with expanded ombudsman programs (Lower, 1994)
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From page 217... ...
Occasionally a worker is assigned for a home visit. Unlike the current program, none of the expanded ombudsman programs currently uses volunteers, perhaps because of uncertainty about the appropriate role of volunteers in this new arena.
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From page 218... ...
Philosophical and operational considerations argue both for and against such an expansion. Conceptual Considerations Several policy-oriented, or conceptual, questions must be considered when assessing whether the current LTC ombudsman program should expand to serve other consumers of health care and LTC services, such as older persons who receive extensive home health care.
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From page 219... ...
Although the rights of nursing facility residents have been codified extensively in federal and state laws and regulations, the rights of consumers of health care and LTC services outside facilities are not explicitly enunciated in the same way. Ombudsmen are used to working within the highly regulatory framework that applies to nursing facilities.
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From page 220... ...
Perhaps the ombudsmen's time would be better spent on systemic advocacy aimed at giving consumers a stronger voice in care decisions or home care policy. Perhaps the greatest emphasis should be given to education or training of consumers and their surrogates about their rights.
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From page 221... ...
States with expanded ombudsman programs report that detailed agreements among relevant state agencies, state units on aging (SUAs) , and AAAs, are even more vital than in the current ombudsman program to facilitate a clear understanding of each agency's role in the delivery of health care and LTC services.
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From page 222... ...
In its various factfinding activities and through its own deliberations, the committee developed a keen appreciation of key reasons that proponents of an expanded ombudsman program hold the views they do. Indeed, expansion received significant but not unanimous support among committee members, but many expressed concern about the lack of information regarding how to resolve several major operational considerations.
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From page 223... ...
Current Program Capacity to Expand Although an ombudsman program to serve consumers outside of LTC residential facilities could fit conceptually within the same model used by the current LTC ombudsman program, the current program can ill endure another unfunded mandate. In many states, the program does not have adequate coverage of nursing facilities even when coverage means one visit per year and the coverage of B&C homes is far less developed than in nursing facilities.
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From page 224... ...
Those deciding on the appropriate organizational location of any expanded ombudsman program must take into consideration this new and evolving role of the aging network. (For a related discussion, see Chapter 4.)
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From page 225... ...
First,the potential magnitude of complaints and the types of complaints are not simple to predict based on the limited experiences reported by most states with expanded ombudsman programs. As argued earlier, those data are widely regarded as reflecting the absolute lower boundary on the likely number of complaints in a broader program, even one expanded to include only the elderly receiving home- and community-based health care and LTC services.
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From page 226... ...
CONCLUSIONS AND RECOMMENDATIONS In conclusion, various arguments are marshalled for and against expanding the current LTC ombudsman program to other settings, as a means of helping to fill deficits in the present system by which people receive health care and LTC services. Opponents raise other jurisdictional and operational points.
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From page 227... ...
Because of these design and methodological limitations, the collective experience of these projects cannot be used to argue conclusively for the need for and benefits of such an expanded ombudsman program. Evidence is also sparse concerning the effectiveness of the program with respect to home care or housing, both in terms of increased protective activities and enlarged advocacy efforts.
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From page 228... ...
These kinds of analyses should also consider the incentives and challenges of the evolving forms of LIC, including proposed voucher systems, client-directed home care, payment of family members, and capitation. Studies of case management programs that authorize and purchase health care and LTC services from multiple providers should examine the extent to which clients of these programs need an additional source of advocacy.
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From page 229... ...
Other activities are in place ostensibly to help address the needs and interests of vulnerable people receiving community-based health care and LTC services. These include: case management programs, the APS efforts available in most states; the home care complaint hotlines mandated by law in 1987, which have been variably implemented across the United States; and licensure,
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From page 230... ...
Home care complaint hotlines are for the most part poorly publicized and underutilized. Licensure and certification are only as good as the motivations of surveyors and certification programs and the strength of public requirements, regulations, and sanctions; these factors vary significantly across states.
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