Real People Real Problems An Evaluation of the Long-Term Care Ombudsman Programs of the Older Americans Act (1995) / Chapter Skim
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Advocating for Quality of Care and Quality of Life for Residents of Long-Term Care Facilities
Advocating for Quality of Care and Quality of Life for Residents of Long-Term Care Facilities
Pages 25-40
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From page 25... ...
addresses important aspects of these issues specifically the LTC ombudsmen's ability to deal with problems concerning care provided to and quality of life achieved by elderly residents of LTC facilities. Improving the quality of life for residents of LTC facilities requires a basic understanding of the overall LTC system in the United States.
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From page 26... ...
Such services may include health care, housing, transportation, and other social and supportive services. In a 1991 report, the IOM defined disability as "the expression of a physical or mental limitation in a social context the gap between a person's capabilities and the demands of the environment"; thus, disabilities may include physical, mental, and cognitive impairments (IOM, l991a)
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From page 27... ...
Too often, nursing facility residents have not chosen to enter a particular nursing facility or any facility at all (Coulton et al., 1989; Reinardy, 1992; Thuras and Kane, in press)
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From page 28... ...
found that people surviving to age 65 had a 42 percent probability of an admission to a nursing facility, an 11 percent probability of staying in a nursing facility for more than a year, and a 5 percent probability of staying in a nursing facility for five years or more. Within the short-stay group of nursing facility residents, some people receive short-term rehabilitation for conditions such as hip fracture and stroke, and some people receive terminal care or hospice services.
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From page 29... ...
are known to have particular problems achieving a satisfactory lifestyle in nursing facilities. Residents of Board and Care Homes and Other Residential Settings Between 600,000 and one million elderly and disabled persons are estimated to reside in B&C homes, also known as domiciliary care homes, personal care homes, residential care facilities, homes for the aging, rest homes, adult congregate living facilities, assisted living facilities, and adult foster care homes.
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From page 30... ...
Compared with nursing facility residents, B&C residents are more likely to be younger and more functionally independent. However, studies have found significant levels of disability among residents, and both anecdotal reports and more recent studies suggest a population that is aging and that experiences significant levels of chronic disease, functional impairment, cognitive impairment, and chronic mental illness (Hawes et al., 1994~.
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From page 31... ...
Similarly, the level of chronic disease and dependency in ADLs is lower among B&C residents than among nursing facility residents, but the types and levels of impairment are noteworthy. One-third of residents reported some form of degenerative joint disease, one-quarter reported circulatory and heart disorders, one-quarter reported hypertension, and one-seventh reported respiratory disorders (DiKmar and Smith, 1983~.
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From page 32... ...
Nursing facility care consumes the bulk of current spending and projected spending on LTC, despite the preference of most elderly to remain in their own homes. Of the roughly $60 billion spent on nursing facility care in 1991, Medicaid paid more than $28 billion, nursing facility residents and their families paid nearly $26 billion, Medicare paid nearly $3 billion and other private sources (including private insurance)
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From page 33... ...
Because in almost all states the Medicaid reimbursement rate is lower than the private-pay rate, ombudsmen have become involved in Medicaid discrimination issues, where nursing facility residents or their families believe that a resident receiving Medicaid has been transferred inappropriately in the facility, discharged to a hospital and not taken back, or generally treated worse than private-pay residents. Ombudsmen have also advocated for systemic reform on the amount of money residents are allowed to retain for personal needs.
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From page 34... ...
For example, structural criteria such as the training and supervision of staff, the record system, the procedures for infection control, and the quality of the physical plant and equipment may all reasonably be thought to affect the processes of care md, hence, subsequent health and functional outcomes. While the current emphasis is in resident outcomes arid evaluation of the actual care provided, historically, nursing facility regulations relied heavily on such criteria; B&C regulations have remained at a far less developed state.
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From page 35... ...
After all, a nursing facility is more than a setting in which residents receive care, it is their home, although for some it is only a temporary home. Unfortunately, however, the physical structure of most nursing facilities allows for little privacy, especially as most residents must share rooms.
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From page 36... ...
She advocates private occupancy rooms with full baths, kitchenettes, locking doors, and individual temperature controls. Procedures for handling such issues as individualized care planning, resident governance, complaints and grievances, lost property, room transfers, and informed consent may well facilitate quality of life; LTC ombudsmen in some jurisdictions have been active in efforts to establish,such procedures.
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From page 37... ...
Nursing facilities receiving payment from Medicaid and Medicare (virtually all nursing facilities in the country) are certified by the government; the rules for certification are established federally, but a state agency, usually a unit within the department of health, actually conducts the inspections, known as "surveys." Local health and safety inspectors typically examine nursing facilities to make sure that they are following building codes, food safety codes, fire codes, and other ordinances.
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From page 38... ...
Although the Health Care Financing Administration of the Department of Health and Human Services (DHHS) at the federal level and various state certification agencies bore the responsibility of implementing these changes, LTC ombudsman programs have been active in advocating for changes, monitoring the conduct of regulatory reform, providing training and consultation to state surveyors and the staff at individual facilities on quality of life and rights issues, training at the individual facility level, and informing residents and families about the reform.
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From page 39... ...
ORGANIZATION OF THIS REPORT This report addresses the issues raised by the congressional mandate and its charge. The committee offers findings and recommendations where it concluded that current strengths of the state LTC ombudsman program could be built upon or present deficiencies warranted explicit correction.
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From page 40... ...
Appendix A provides descriptive information on OAA programs and the network of agencies providing them. Appendix B is the statutory base for the LTC ombudsman program (Title VII, Chapter 2, of the OAA)
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