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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State Compliance in Carrying Out the Long-Term Care Ombudsman Programs
State Compliance in Carrying Out the Long-Term Care Ombudsman Programs
Pages 79-100
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From page 79... ...
Two important related aspects of compliance are discussed in later chapters: conflicts of interest and adequacy of resources. The OAA sets forth several requirements for the LTC ombudsman programs regarding conflicts of interest.
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From page 80... ...
The committee explores whether the ombudsman programs are achieving what they are intended to achieve in Chapter 5. The committee decided that an analysis of whether states have implemented LTC ombudsman programs to an acceptable level of operation would provide the most meaningful information about compliance.
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From page 81... ...
Half of the state ombudsman programs continue to encounter problems gaining access to LTC facilities (AoA/OIG, 1993~. Two-thirds of state ombudsmen (66 percent)
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From page 82... ...
In general, all ombudsman programs report that complaints from residents in nursing facilities are responded to in some fashion (GIG, l991a,b,c; AoA/OIG, 1993; AoA, 1994c; Chaitovitz, 1994b; Kautz, 1994~. Ombudsman programs give priority to complaints that are potentially life-threatening.
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From page 83... ...
Certain questions arose often in the committee's deliberations, such as: "Are needs 'unmet' if the ombudsman is unable to resolve the complaint to the satisfaction of the resident? " and "What concern should the LTC ombudsman programs have for the unmet need of residents who are younger than age 60?
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From page 84... ...
. Each of these three categories of unmet need shares at least one common element: namely, an important prerequisite to meeting the need is effective coordination between ombudsman programs and other resources.
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From page 85... ...
According to information gathered during the committee's site visits, many state and local ombudsman programs have already decided to serve younger residents in LTC facilities in which primarily elderly residents reside by using private funds, instead of OAA monies, to support these efforts. They reason, for instance, that if one resident in a facility regardless of ag~has a problem, other residents might have similar problems.
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From page 86... ...
The agreement should include the transfer of adequate funds from the VA to the AoA to support the provision of ombudsman services to VAowned or VA-managed facilities. Systemic Advocacy Numerous questions arise in assessing whether state LTC ombudsman programs comply generally with the mandates that focus on systemic advocacy work.
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From page 87... ...
· Is the program's systemic advocacy focused on all kinds of LTC facilities residents and all aspects of residents' lives and concerns? · Is the work coordinated with others so that coalitions, rather than the ombudsman programs alone, are seeking systems change?
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From page 88... ...
Generally, factors that influence states' levels of compliance fall into three groups: leadership within the organizational framework, elements of infrastructure, and institutional care context. Leadership Within the Organizational Framework Leadership from the Administration on Aging During the developmental stage of the LTC ombudsman programs, AoA supported model grants to explore methods for promoting and developing ombudsman services.
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From page 89... ...
Nevertheless, to better inform states of the policies and procedures available to AoA to enforce compliance of states in implementing the LTC ombudsman programs, the committee offers the following recommendation: 3.3. The committee recommends that the Assistant Secretary for Aging develop and distribute a policy statement detailing the sanctions the AoA is authorized to use to enforce state compliance with statutory mandates of the long-term care ombudsman program.
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From page 90... ...
by which the state ombudsman program provides assistance (including training) to local ombudsman programs; methodist by which the state ensures that its ombudsman program has suitable access to facilities, records, and residents; · methodist by which the state ensures that its ombudsman program provides meaningful annual reports; and · methodist by which the state ensures that adequate legal counsel is an integral part of the ombudsman program both in representing the ombudsman program itself and in providing advice and counsel in matters related to long-term care facility residents.
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From page 91... ...
In authorizing this position and enunciating the essential responsibilities of the director through the 1992 OAA amendments, Congress acknowledged the need for substantive, effective, and visible advocacy at the federal level on behalf of elderly residents of LTC facilities. AoA supports a national LTC ombudsman resource center.
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From page 92... ...
Congress, as part of the GPRA initiative, will have to reckon with information that links performance with capacity indicators. Answers will now be sought and received for important questions that have been asked, but not answered, before: If the LTC ombudsman programs provide a meaningful and unique set of services to residents in nursing facilities and B&C facilities in some locales, what is the minimum of resources necessary to ensure fully operational programs across the nation?
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From page 93... ...
Adequate Legal Resources The OAA charges SUAs with the responsibility of ensuring adequate legal counsel for the LTC ombudsman program. In the same section, the OAA also charges the SUA with ensuring that the Office of the State LTC Ombudsman program pursues administrative, legal, and other appropriate remedies on behalf of residents.
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From page 94... ...
A survey by the National Ombudsman Resource Center (1994b) indicates that less than half of the 27 state ombudsmen who responded to the question about quality of their legal support rated it as "very good" or "excellent." Most rated it as "good," "fair," or "poor." In other studies, about one-third of state ombudsmen report that the available legal counsel is inadequate to meet their needs in representing the ombudsman program, and in providing advice and counsel in matters related to LTC residents (AoA/OIG, 1993; Chaitovitz, 1994b)
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From page 95... ...
The committee recommends that the Assistant Secretary for Aging develop plans of action and cooperative agreements with the Legal Services Corporation, the National Association of Protection and Advocacy Systems, the National Association of Medicaid Fraud Control Units, and the Office of the Inspector General of the Department of Health and Human Services, to foster and encourage a variety of legal assistance resources for residents of long-term care facilities. As noted, SUAs are responsible for ensuring that adequate legal counsel is available to the ombudsman program.
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From page 96... ...
The committee recognizes that adequate legal resources are not an end in themselves but are an essential element of the ombudsman programs' infrastructure. Without such resources, the program is greatly hampered in its ability to comply with other mandated provisions in the OAA such as to "identify, investigate, and resolve complaints that are made by or on behalf of residents," to"pursue administrative, legal, and other appropriate remedies on behalf of residents," and to "analyze, comment on, and monitor the development and implementation of federal, state, and local laws, regulations, and other government policies and actions." Institutional Care Context Nursing Facilities Many of the problems that ombudsmen confront in their work are embedded in the structure, financing, and ideology of the LTC system, features not easily changed with the tools available to the ombudsman (Greene and Monahan, 1981; Bulord, 1984; Holder and Frank, 1984; IOM, 1986; Feder et al., 1 988; Mason, 1 994~.
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From page 97... ...
Residents' rights applicable to B&C settings are not as clearly specified in most state licensure laws as they are in state and federal regulations affecting nursing facilities. Yet, Phillips and colleagues (1994)
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From page 98... ...
SUMMARY Although elements of the ombudsman programs have been vigorously implemented, in certain states and locales, overall the ombudsman program has not been fully implemented, especially with regard to the OAA provisions that call for ombudsman services to be available and accessible to residents of LTC facilities. The committee finds the following: .
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From page 99... ...
AoA has not mandated any level of implementation of the legislated LTC ombudsman program, nor has the agency monitored the implementation efforts of states. Although ombudsman programs vary in the amount of staff and volunteer resources they expend to serve the residents of LTC facilities, no minimum acceptable level of effort has been agreed upon to signify that an ombudsman program has been implemented appropriately.
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From page 100... ...
Two recommendations propose that the program serve those residing in LTC facilities who are not currently served by the ombudsman programs. Four recommendations suggest means by which the federal government can strengthen its leadership and oversight role for the ombudsman programs.
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