History of the Long Term Care Ombudsman Program

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History of the Long Term Care Ombudsman Program
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Social Security Act of 1965

• Indirectly responsible for the Nursing Home
  Industry as it exists today
• Due to availability of NH Grew
• Medicaid is the Main Payer of NH
• Medicare pays for NH on a limited basis

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Contributing Factors to NH Growth

• Decline in the Extended Family
• Families became mobile
• Women (primary caregivers) enter
  workforce

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Contributing Factors to NH Growth

• Life Expectancy Increases
• People age 70 increases
• Better health care
• More accessible health care
• Standard of living improved
• Baby Boomer Generation increases birth rate
  decrease expended population of older persons

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Rapid Growth Exceeds Regulation

• By 1971
• Industry has gained a negative reputation
  county poor house
• Media reports highlight scandals
• Fire in a Ohio NH kills 32
• Salmonella poisoning in a Maryland NH kills 25

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Nixons 8 Point Plan

• New office established to oversee NH
• Train 2000 state NH inspectors
• 100 Federal support of state inspections under
  Medicaid
• Strengthening of standards
• Crackdown on substandard NH cut off federal
  funding

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Development Natl NH Ombudsman Program

• Dr. Arthur Fleming legal consult to Nixon
• Based on a Swedish Model Everyones citizen
• Resident Focused
• Neutral Arbitrary
• Advocate for long-term care resident respond to
  complaints made by or on behalf of individual
  residents

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Congress Authorizes Pilot Programs

• 1971- 1972
• Congress funds seven state pilot programs
• Developed state units to respond to complaints
• Impressive number of complaint resolution was
  submitted by demonstration programs
• Identification of NH problems

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State Grants

• 1975-
• All state Agencies on Aging invited to submit
  proposals for grants
• To identify and deal with complaints regarding NH
• Hire a NH Ombudsman Developmental Specialist
• NYS highest elderly population - 57,000
• 1977 - Development of NYS Plan local area
  programs developed to address specific complaints

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Older Americans Act - 1978

• Strengthened Ombudsman Program
• Mandatory Status
• All stated agencies on aging must establish an
  ombudsman program
• Investigate and resolve resident complaints
• promote citizen organizations train
  volunteers
• Identify significant problems- monitor laws
  policies
• Gain access to LTC facilities
• Protect confidentiality of resident records

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1981 Amendments to OAA Reaffirmed personal
care homes added
1983 Ombudsmen Records Access
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1987

• OBRA
• National Nursing Home Reform Act
• Focus is on Resident Rights
• Quality of Care
• Quality of Life
• Regulations are minimum standards
• Residents must be free of chemical/physical
  restraints
• Funding changes gt for gt care (PRI)
• NCCNHR

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1995
O R T OPERATION RESTORE TRUST Anti-fraud
Healthcare Campaign Crackdown on Medicare and
Medicaid Fraud, Waste and Abuse
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1997
N Y S O A New York State Ombudsman
Association NYSOA advocates for the highest
possible quality of life for people who reside in
Long Term Care facilities by unifying and
strengthening local Substate Programs of the
Office of the State Long Term Care Ombudsman
Program.
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1999 H I P A A Health Insurance Portability
and Accountability Act
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Who Are We?
Advocates for Long Term Care Residents
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• WE RECEIVE, INVESTIGATEand RESOLVE CONCERNS!!
• EMPOWER
• IMPROVE QUALITY OF LIFE
• PROTECT RIGHTS
• SEEK A COOPERATIVE WORKING ARRANGEMENT

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How We Do This

• Rights of Access
• 24 Hour Access
• Identification
• Food Preparation Off Limits

• Records Access
• Medical Record
• Property of Doctor and Facility
• Resident and Doctor has legal access
• Resident not informed

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Medical Records Access Ombudsmen

• Need Written Release of Information
• Request Professional Interpretation

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Financial/Personal Property Records

• Property of the resident
• Need written permission from resident
• Facility may choose to make records/personal
  monies available only during certain business
  hours
• personal needs allowance law provides personal
  needs monies to qualifying residents which is
  regulated under residents bill of rights

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Role of the Ombudsman

• COMPANION friendly visiting is an important and
  necessary function in getting to know your
  resident and establishing trust.
• ADVOCATE Ombudsmen work on behalf of a
  resident in resolving complaints. It may take on
  the form of negotiating with a staff person,
  filing a complaint, working with a resident
  council, etc.

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Role of the Ombudsman

• EDUCATOR we work to educate residents,
  families, friends or potential consumers of LTC
  about their rights and responsibilities.
• MEDIATOR serve as mediator between resident and
  facility, resident and community and/or local
  government agency, resident and resident, or
  resident and family
• BROKER referral agents to another agency.
  Squeaky Wheel
• MANDATED REPORTERS suspected abuse, neglect and
  mistreatment. No permission needed, not
  investigators, do monitor.

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DOs of Advocacy

• CONFIDENTIALITY
• Resident Protections
• Need residents permission to use their name to
  work on an issue.
• Secure your notes.
• No discussion of ombudsman work outside of
  program.
• Assure resident that you are there for them.

• FACTS, TACT, DIPLOMACY vs. CONFRONTATION,
  EMOTIONAL OUTBURST
• Salt vs. sugar.
• Maintain a professional attitude.
• Treat staff with respect.
• Never interrupt, make an appointment.

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• DO GET TO KNOW THE RESIDENT
• Give yourself time.
• Be a good listener.
• Be objective yet understanding.
• Respect their dignity, privacy and right to
  choice.
• DO VERIFY AND INVESTIGATE
• Check things out what is the real problem?
• Do involve the resident.
• Do maintain confidentiality.
• Do keep accurate records.
• Do check with program coordinator.

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Remember the NOs

• NO Conflict of Interest
• Not Friendly Visitors
• No hands on care
• Not Staff

• NO Confusion of Role
• No chumminess with staff no friends
• No volunteering for the facility or residents
• No unauthorized articles into the facility such
  as food, candy, tobacco products, matches,
  lighters, prescriptions, alcoholic beverages
• No political, religious materials or views

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• Dont sell or buy raffle tickets, etc.
• No promises we cant keep
• No judgment calls
• No takeovers
• No information to media/political office (talk
  about your role/never facility/case)
• No legal/business advice

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As the old man walked the beach at dawn, he
noticed a young man ahead of him picking up
starfish and flinging them into the sea.
Finally catching up with the youth, he asked
him why he was doing this. The answer was that
the stranded starfish would die if left until the
morning sun. But the beach goes on for miles
and there are millions of starfish, countered
the other. How can your effort make any
difference? The young man looked at the
starfish in his hand and then threw it to safety
in the waves. It makes a difference to this
one, he said.
- Minnesota Literacy Council