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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Overview of the Older Americans Act Long-Term Care Ombudsman Program
Overview of the Older Americans Act Long-Term Care Ombudsman Program
Pages 41-78
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From page 41... ...
Arthur S Flemming, former Commissioner on Aging, 1975 Concerns with the quality of nursing facilities, the care provided in them, and the government's ability to enforce regulations in these facilities led to the creation of the long-term care (LTC)
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From page 42... ...
Additionally, classic ombudsman models involve intervention between the government and individual citizens. In the case of the LTC ombudsman program, however, intervention usually also includes a private third party- the nursing facility or board and care (B&C)
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From page 43... ...
In May 1975, then Commissioner on Aging Arthur S Flemming invited all SUAs to submit proposals for grants "to enable the State Agencies to develop the capabilities of the Area Agencies on Aging to promote, coordinate, monitor and assess nursing facility ombudsman activities within their service areas." The grants sought primarily to inaugurate, in as many areas as possible, community action programs dedicated to identifying and dealing with the complaints of older persons or their relatives regarding the operation of nursing facilities.
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From page 44... ...
Many volunteers joined the program motivated by poor treatment of friends and relatives in nursing facilities (Holder and Frank, 1984~. Although some nursing facility and B&C home providers believe that the original, and only legitimate, mission for LTC ombudsmen was to follow the classic, neutral, ombudsman model, in fact, the ombudsman program has always been designed to hold the residents' interests as paramount.
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From page 45... ...
The 1992 OAA amendments highlighted the role of local ombudsman programs and the state ombudsman's leadership role while reemphasizing each LTC ombudsman's role as an advocate and agent for. systemwide change.
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From page 46... ...
The other half are part of larger "umbrella" agencies, in which several other agencies report to a head office that in turn reports to the governor; in 9 of these states, the umbrella agency includes the agency responsible for licensing or certifying LTC facilities. Of the 10 state ombudsman programs that are not housed in a SUA, 3 reside in independent state-run ombudsman agencies and 7 reside completely outside state government (5 in legal services agencies, 2 in nonprofit citizen advocacy agencies)
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From page 53... ...
The nationwide ratio of FTEs to beds is 1 to 2,698. The OAA requires states to employ at least one person as the "State LTC Ombudsman," who "shall serve on a fill-time basis." All states have named such a person, although the committee found that, in several states, that person's time is not devoted solely to the program.
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From page 54... ...
54 REAL PEOPLE, REAL PROBLEMS TABLE 2.2 Number of Nursing Home and Board and Care Home Beds, by State, 1992 State Nursing Homes Board & Caret Total Alabama 23,025 3,678 26,703 Alaska 1,033 495 1,528 Arizona 16,719 5,116 21,835 Arkansas 23,790 4,027 27,817 California 130,955 138,194 269,149 Colorado 20,106 6,327 26,433 Connecticut 30,118 3,176 33,294 Delaware 4,867 430 5,297 District of Columbia 3,129 1,837 4,966 Florida 71,162 61,086 132,248 Georgia 39,923 11,473 51,396 Hawaii 3,415 2,632 6,047 Idaho 5,804 2,198 8,002 Illinois 100,557 8,482 109,039 Indiana 58,993 9,589 68,582 Iowa 35,391 6,895 42,286 Kansas 27,664 1,694 29,358 Kentucky 23,145 8,902 32,047 Louisiana 37,496 307 37,803 Maine 10,236 3,921 14,157 Maryland 27,587 5,179 32,766 Massachusetts 52,828 5,681 58,509 Michigan 50,961 44,091 95,052 Minnesota 45,073 10,003 55,076 Mississippi 16,051 2,302 18,353 Missouri 61,922 17,695 79,617 Montana 6,495 1,043 7,538 Nebraska 19,492 4,689 24,181 Nevada 3,563 1,643 5,206 New Hampshire 6,966 2,342 9,308 New Jersey 44,314 12,426 56,740 New Mexico 6,783 2,614 9,397 New York 106,124 34,803 140,927 North Carolina 35,174 23,862 59,036 North Dakota 7,084 1,215 8,299 Ohio 91,580 10,383 101,963 Oklahoma 34,581 2,858 37,439 Oregon 14,758 12,986 27,744 Pennsylvania 89,963 43,039 133,002 Puerto Rico
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From page 55... ...
This work involves such unrelated activities as insurance counseling and monitoring all cases of elder abuse, including abuse that occurs outside of nursing facilities or B&C homes. Salaries of LTC ombudsmen vary greatly.
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From page 56... ...
56 REAL PEOPLE, REAL PROBLEMS TABLE 2.3 Long-Term Care Ombudsman Human Resources, Paid Staff and Volunteers, by State Number Ratio Ratio of Paid of Paid Number of Paid Staff Staff of Staff to State (FTEs) to Bedsa Volunteers Volunteers Alabama 12 1 :2,225 0 Alaska 1 1:1,528 12 1:12 Arizona 7 1:3,119 125 1:18 Arkansas 13 1:2,140 43 1:3 California 153 1:1,759 1,325 1:9 Colorado 21 1: 1,259 50 1:2 Connecticut 10 1 :3,329 29 1 :3 Delaware 6 1:883 40 1:7 District of Columbia 3 1:1,655 60 1:20 Florida 12 1:11,021 219 1:18 Georgia 33 1:1,557 60 1:2 Hawaii 2 1 :3,024 0 Idaho 14 1:572 0 Illinois 15 1 :7,269 283 1: 19 Indiana 13 1:5,276 8 1:1 Iowa 8 1 :5,286 0 Kansas 4 1 :7,340 0 Kentucky 27 1: 1,187 275 1: 10 Louisiana 37 1:1,022 375 1: 10 Maine 3 1 :4,719 5 1:2 Maryland 17 1:1,927 124 1:7 Massachusetts 30 1: 1,950 323 1:11 Michigan 21 1 :4,526 69 1:3 Minnesota 15 1:3,672 121 1:8 Mississippi 8 1 :2,294 200 1:25 Missouri 20 1 :3,981 335 1: 17 Montana 18 1:419 10 1:1 Nebraska 1 1:24,181 15 1:15 Nevada 5 1:1,041 0 New Hampshire 7 1: 1,330 94 1:13 New Jersey 2 1:28,370 29 1:15 New Mexico 7 1:1,342 100 1:14 New York 31 1:4,546 575 1:19 North Carolina 18 1:3,280 0 North Dakota 1 1:8,299 0 Ohio 44 1:2,317 205 1:5 Oklahoma 13 1 :2,880 263 1:20
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From page 57... ...
Other volunteers serve as "friendly visitors" and assist the ombudsmen in maintaining a presence in the facilities, keeping residents informed of their rights and of the LTC ombudsmen's services, and identifying problem conditions, which they refer to a paid ombudsman for resolution. Many programs believe that the use of volunteers adds authenticity to the program and helps to keep it focused on the resident in a way that a typical government bureaucracy cannot.
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From page 58... ...
. Funding Funding for LTC ombudsman programs is patched together from multiple sources at the federal, state, and local levels (Figure 2.1 and Table 2.4~.
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From page 62... ...
Such factors as increased percentage of residents with mental incapacities, isolation of residents from families, and difficult access to telephones strengthen the claim for continuous, predictable visitation by LTC ombudsmen. States often set standards for how often a facility should be visited by an ombudsman or volunteer (Table 2.5~.
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From page 63... ...
Investigating and Resolving Complaints Throughout the nation, LTC ombudsmen advocate on behalf of residents of LTC facilities, including those who cannot speak for themselves, and work to empower all residents and their agents to be stronger advocates on their own behalf. However, state and local programs differ in the way this end is achieved.
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From page 64... ...
64 TABLE 2.5 Visitation Standards, by State REAL PEOPLE, REAL PROBLEMS Standard State Nursing Home Board and Care Alabama Alaska Arizona Arkansas Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Iowa Kansas Kentucky Louisiana Massachusetts Michigan Minnesota Missouri Montana Nevada New Hampshire New Mexico Ohio Oklahoma Oregon Pennsylvania Puerto Rico Tennessee 1 exas Vermont Virginia Washington West Virginia Wisconsin Quarterly None Weekly Quarterly Monthly None None Weekly/Biweekly Annually Quarterly Annually Quarterly Annually None None Monthly Monthly Biweekly None Biweekly None Monthly Weekly/Quarterly None Weekly Varies by region Weekly Weekly Annually Quarterly Annually Annually Quarterly None Weekly Quarterly Quarterly None None None None Quarterly None None Annually Annually Quarterly None Quarterly Annually None None Monthly Monthly Biweekly None Biweekly None Monthly Annually None Weekly Varies by region Weekly Weekly Annually Quarterly Annually Annually Quarterly None Weekly Annually Annually NOTE: Only 38 states responded to the survey from which this information was taken. SOURCE: Kautz, 1994.
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From page 65... ...
The primary activity required of LTC ombudsmen by the OAA and clearly perfonned by the program is the identification, investigation, and resolution of individual complaints relating to the residents of LTC facilities. The total number of complaints received by LTC ombudsmen increased 94 percent, from 102,231 to 197,820, between 1988 and 1993 (Schiman and Lordeman, 1989a; AoA, 1994c)
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From page 66... ...
Many governmental agencies are involved with regulating and reimbursing both nursing facilities and B&C homes and protecting the residents in both types of facilities. Such agencies include Health Care Financing Administration, SUAs, AAAs, departments of health, divisions of licensure and certification, adult protective services (APS)
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From page 67... ...
OVERVIEW OF THE OMBUDSMAN PROGRAM 67 TABLE 2.6 Long-Term Care Ombudsman Complaints per 1,000 Beds, by State Complaints State Complaints per 1,000 Bedsa Alabama 1,443 54 Alaska 368 241 Arizona 1,817 83 Arkansas 443 16 California 46,777 174 Colorado 8,613 326 Connecticut 2,261 68 Delaware 1,034 l 9S District of Columbia 3,691 743 Florida 7,035 53 Georgia 3,464 67 Hawaii 274 45 Idaho 934 117 Illinois 4,329 40 Indiana 2,648 39 Iowa 611 14 Kansas 2,856 97 Kentucky 4,042 126 Louisiana 2,517 67 Maine 316 22 Maryland 2,388 73 Massachusetts 10,463 179 Michigan 6,559 69 Minnesota 2,658 48 Mississippi 344 19 Missouri 8,128 102 Montana 809 107 Nebraska 3,438 142 Nevada 3,297 633 New Hampshire 1,165 125 New Jersey 3,781 67 New Mexico 1,445 154 New York 3,485 25 North Carolina 2,323 39 North Dakota 117 14 Ohio 3,530 35 Oklahoma 3,416 91 Oregon 5,967 215 Pennsylvania 6,696 50 Puerto Rico 1,451 Rhode Island 1,079 97
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From page 68... ...
Initially, many ombudsman programs spent considerable effort in developing memoranda of understanding (MOUs) with regulators to clarify the responsibilities of each party.
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From page 69... ...
The state ombudsman and the head of licensing and 2The Nursing Home Reform Law of 1987 specified a number of other ways regulators should interact with ombudsmen, including sharing the results of their surveys with ombudsmen, informing residents appealing a transfer of how to contact the ombudsman, and corroborating resident rights' problems with ombudsmen.
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From page 70... ...
, 23 state LTC ombudsman programs (n = 50) , or about half, reported good relations with APS.
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From page 71... ...
The OAA requires the Office of the State LTC Ombudsman to coordinate ombudsman services with these organizations since they share similar concerns and mandates regarding such matters as statutes and regulations affecting the disabled, inadequate care in LTC facilities, and resident rights issues such as improper discharges and placement of individuals in inappropriate environments (although there is no similar mandate for P&As to coordinate with ombudsmen)
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From page 72... ...
When working on the systems level, ombudsmen advocate for policy change by evaluating laws and regulations, providing education to the public and facility staff, disseminating program data, and promoting the development of citizen organizations and resident and family councils. Evaluating Laws and Regulations The OAA directs state and local ombudsmen to analyze, comment on, recommend changes in, and monitor the development and implementation of laws affecting residents.
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From page 73... ...
In Oklahoma, for example, the ombudsman helped convene a series of meetings with six different state divisions to develop a system of intermediate sanctions for nursing facilities. The Connecticut state ombudsman worked with other agencies in monitoring the implementation of a law against Medicaid discrimination in nursing facility admissions.
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From page 74... ...
Oklahoma and Colorado publish information regarding the deficiencies of individual nursing facilities that are cited in surveys by the state's licensure and certification program. The committee asked the SUA directors whether the state LTC ombudsman provided information to them about trends and issues that affect residents' wellbeing.
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From page 75... ...
Others limit themselves to education and advocacy to reform nursing facilities. Yet others choose to provide oversight of these facilities and supportive services to residents, families, and those in the community considering a nursing facility placement.
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From page 76... ...
Some states operate from one centralized office; others have developed separate and distinct local programs. Recent estimates of LTC ombudsman staffing put the number of FTE paid staff at about 865.
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From page 77... ...
Ombudsmen must also address and attempt to rectify the broader underlying causes of problems for residents of LTC facilities. When working on the system level, ombudsmen advocate for policy change by evaluating laws and regulations, providing education to the public and facility staff, disseminating program data, and promoting the development of citizen organizations and resident and family councils.
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