The State Long Term Care Ombudsman Program

 

The Effective Ombudsman Program: A Symphony of Advocacy

 

 

Margaret Niederer, Ph.D., Director of Special Projects

Illinois Retired Teachers Association Foundation, May 2, 2004

 

 

Foreword   

 

This paper has been prepared for use by nursing facility residents; their families, legal representatives, and friends; family councils; and resident councils to help evaluate  their long term care ombudsman program.

 

The questions, based on federal law, reflect how the Office of Long Term Care Ombudsman should work within a state.   

 

The Office should be headed by a state ombudsman who can resolve major system problems and carry out all the duties of the program without interference from state agencies, political interests and other entities. 

 

Anyone who is a long-term care ombudsman (state, regional local—paid or volunteer) within a state is required to be free of conflicts.  This includes no fiscal interest in facilities, and it also includes all types of conflicts, including any organizational conflict.

 

Studies have shown that there are conflicts within states that prevent residents from having  an effective long term care ombudsman program  in most, but not all,  states. 

 

The Administration on Aging, which has oversight of the program, has not monitored the ombudsman program for years, and refused to respond to multiple requests from Illinois advocates to address conflict and willful interference issues in 2002-03.   Fortunately, the Illinois legislators and the governor saw fit to change the Illinois ombudsman law to address this issue.  Other  states with conflicts have not been as fortunate.

 

In order to fully protect residents in licensed long term care nursing facilities in any state, the long term care ombudsman program is required to operate in accord with federal law.  If any state law conflicts with the federal law, the federal law prevails.

 

If you have questions about conflicts or willful interference or how to obtain an efficient and effective ombudsman program,  contact your state ombudsman or email Margaret  Niederer, mniederer@icare.

 

 

 

 

The resident’s question:  “Is My Ombudsman Program Working?” 

 

I have the right to quality care and a quality of life.  This means that I have the right to be protected from physical and mental harm.   I have the right to choose what I want to do, including when to get up, when to eat, what to eat, when to take a bath and the right to have the medical treatment from my doctor and restorative care I need.  I need all of these things to stay active as along as possible and not be a burden to anyone.

 

I want to pursue my interests and hobbies and learn new things. I want to listen to music that I like, play the games that I like to play, and interact with friends and family as much as I want.  I want to have the pets that make me happy and plants to grow. 

 

I do not like to share my room, my dining table, and my games with people that I would never have chosen.    I want all of these things even though I may not remember that I want them.   The things that I want are important to my staying mentally and physically healthy as long as possible.

 

I do not want to be treated as if I am not a person, only a body. 

 

Because I am often afraid, I need to be able to complain if I do not get the care or have the quality of life that makes life worth living.  I need to complain often if I do not get the care I need.   Sometimes I observe serious situations, which makes me very upset.  I cannot stand to live in a place that is unable to care for me or give me the things I need.

 

 I need a home in which to live my last days.  I want my family and friends to be able to come and see me as often as they would like, at times that fit their schedule.  I want my family to join a family group to protect me.  I feel better when I know that there is a group of families that are working to improve this place in which I live.

 

I do not ask for gold, only an environment that allows me to have some quality in my life, an environment in which there are people who really know me, can take care of me and anticipate my needs.

 

I have questions about whether my ombudsman program can actually help me.

 

I want some questions answered to determine whether my ombudsman program can help me, really help me, and also help other residents of facilities in my state to overcome severe and chronic care problems.   What can my ombudsman program do when there are problems concerning issues that adversely affect my health, safety, welfare and rights, including my rights with respect to the activities of legal representatives and provider and public agencies?  Is my Ombudsman Program actually effective in every area of the State?

 

 

Resident Level Advocacy--Regular and Timely Access to Ombudsman Services:  What Does This Mean? 

 

  1. Do I know my ombudsman?

 

  1. Do I see him or her on a regular basis?

 

  1. I do not want the time between my ombudsman’s visit to be so long that I   forget what my concern is.

 

  1. Is my ombudsman sufficiently informed that he or she can inform me about long term care services in this state, including in-home services?

 

  1. Does my ombudsman tell me what I can do about a problem or what he or she will do to help?

 

  1. Is my ombudsman more concerned about the facility staff/administration’s feelings and concerns than my feelings, concerns, problems and ideas?

 

  1. Is my ombudsman more willing to believe what the facility staff says over what I have said?

 

  1. If the complaint is not resolved by what I do, or what my local ombudsman does, how will it get resolved?

 

  1. How long will it take to resolve my complaint?

 

  1. Will my ombudsman really fix the situation that caused my complaint?

 

  1. My complaint is about abuse—this needs to be fixed quickly, within a day or two.  How can the ombudsman resolve the issue when the facility does not agree with my complaint?

 

  1. Do I have to be injured before the situation that is likely to harm me is fixed?  What is the timeline for this type of complaint?  Who will handle it?  What is the procedure for handling this quickly?  What can my ombudsman do about chronic problems that put me in jeopardy for harm?

 

  1. My complaint is about neglect—I am not getting the restorative nursing services I need.  I do not like the food.  I do not get enough exercise nor do I have anything that I like to do.  I wish I were dead.  What can my ombudsman do to fix this type of situation?  How will this situation be addressed?  What will make my ombudsman’s strategy successful?

 

  1. How can my ombudsman address my fears of retaliation?  Does my ombudsman actually realize that retaliation is real in my facility?

 

  1. Is my ombudsman sufficiently trained to know how to handle my complaints and that of other residents?

 

  1. Does my ombudsman know what to do about confidentiality issues when a family member/friend reports abuse and neglect?

 

  1. Does my ombudsman know what to do about confidentiality when a capable resident reports abuse or neglect, but does not authorize the ombudsman to report this to the state certification agency?

 

  1. Does my ombudsman know what to do about confidentiality when a resident who is not capable reports abuse or neglect, but does not authorize the ombudsman to report this to the state certification agency?

 

  1. Does my ombudsman know what procedures to follow that will quickly address the issue when he or she observes physical or mental abuse or neglect?   How will the ombudsman keep this neglect from happening again?

 

  1. Can my ombudsman have immediate access to the State Ombudsman when there are serious complaints?  What is my State Ombudsman able to do?

 

  1. Does my ombudsman have a trainer, a certified ombudsman, who can accompany my ombudsman to a facility to help in resolving my complaints?

 

  1. Does my ombudsman have a trainer who continues to have first hand experience in handling complaints?

 

  1. Does my state ombudsman have someone in the local provider ombudsman entity that is able to identify problems in handling complaints, by monitoring and handling the documentation of complaints, and then use that information to improve the training for ombudsmen?

 

  1. Can my ombudsman secure the services of the ombudsman legal counsel to help me with my complaint, including filing a lawsuit?

 

 

Systems-Level Advocacy—Consistently and Aggressively Address the Broader or Underlying Causes of Residents’ Problems:  What Does This Mean?

 

  1. Do other facility residents have the same or similar problems that I have?  How does my ombudsman program know this?

 

  1. How does my ombudsman program know if the number of problems that has been identified by my ombudsman program is all or part of the problems that exist?  Does my ombudsman program visit my facility and others often enough, talk to the residents long enough to actually know and report the extent of the problems?

 

  1. If my ombudsman program knows the number and kind of problems, to whom does the program give this information?  Do those agencies or legislators receive the ombudsman report believe the report?  Do these legislators and agencies do anything about the causes of the problems?  What does my ombudsman program do if nothing is done to address these problems?

 

  1. Does my ombudsman program discuss what needs to be changed in laws, regulations and policies to address the underlying causes of residents each year?  What is the outcome of those discussions?  What is the plan of action?

 

  1. What are my ombudsman program’s next steps to fix the underlying causes of the problems?

 

  1. What is my ombudsman program’s record on having been successful in fixing residents’ problems and the underlying problems of the complaints?

 

  1. When educating facility owners and staff, what nursing home improvement models does my ombudsman program use to demonstrate the need for change? 

 

  1. How does my ombudsman program use Pioneer Practices information, which when supported by the facility administration, can solve the problem of direct care staff not knowing or not being interested in me?

 

  1. How does my ombudsman program work with my family  (friends) and others to form an independent family council?  How is that family council trained so that both family members and the residents know how these members can be the “eyes and ears” for residents and help solve problems?

 

  1. My state has powerful citizens’ groups who work toward better care for me and other residents in  all certified facilities.  How does my ombudsman program work with these citizens groups?  If there are not citizens groups in other communities, does my ombudsman program help to develop these citizen organizations?

 

  1. Does my ombudsman check to see that my resident council is not controlled by the facility?   What does my ombudsman do to make certain that my resident council can function, as it should? Does my ombudsman check to see if the facility has addressed my resident council’s concerns so there isn’t a constant repetition of the problems?

 

  1. Is my ombudsman or the state ombudsman able to represent me and others who have the same or similar problem before the governor, or any federal, state, or local official, without first asking permission from a governmental or other agency/entity?

 

  1. Does my ombudsman program have a public relations plan in which my ombudsman program facilitates the public knowing about facility deficiencies identified by the certification agency?  Facilitates public knowledge of residents’ rights and the long-term care system?  Facilitates public comment on issues that affect residents?

 

  1. Does my ombudsman operate within the Office of State Long Term Care Ombudsman, a program headed by the State Long-Term Care Ombudsman who designates local ombudsman program provider entities and designates paid and volunteer ombudsmen?

 

  1. Does my ombudsman operate within a system in which the State Long Term Care Ombudsman coordinates the plans and activities of the local ombudsman entities?

 

  1. Does my ombudsman operate within a system in which the State Unit on Aging has established in writing, polices and procedures for monitoring my local ombudsman entity?  Monitoring identification of conflicts and willful interference?  Procedures for handling conflicts and instances of willful interference from state and local agencies?

 

  1. Does my ombudsman operate within a system in which the ombudsman legal counsel can file a lawsuit against a facility because of poor care?

 

  1. Does my ombudsman operate within a system in which the local entity is more concerned about the relationship with the facility than my protection?

 

  1. Does my ombudsman operate within a system in which time and effort is focused on concerns of residents, as opposed to conflicts within the Office of State Long Term Care Ombudsman Program?

 

  1. Does my ombudsman operate within a system in which there are clear lines of authority of the State Ombudsman who controls the administrative, advocacy and budget decisions of the Office in order to accomplish the task of resolving my complaints and identifying the underlying problems of my complaints and that of other residents?

 

  1. Does my ombudsman operate within a system that functions like a cacophony in which there are there distinct groups of musicians, each playing their own tunes, or does my Long Term Care Ombudsman Program operate like a symphony, playing in perfect harmony, a magnificent song of protection?