Most SSI recipients are women—53% of all SSI recipients and 67% of older SSI recipients. Women are disproportionately reliant on SSI because they are more likely to have spent time out of the workforce caring for their families, or to have worked in low-wage or part-time jobs, or in jobs where they did not receive Social Security credits. Check out this fact sheet by Justice in Aging for more information. SSI Fact-Sheet Justice in Aging 2017
I don’t know about you, but for me, 2016 has at times felt overwhelming. Listening to the news and looking at the world around us, it can be easy to forget that we, as individuals, truly can make things better. In the midst of what may seem like chaos, even a simple action can have a profound effect.
Not long ago, one of our ombudsmen told me about a family he recently helped. Margaret, a resident at the nursing home he serves, has a serious illness. One Friday, Margaret’s daughter Linda spent the night. In the morning, Linda could tell her mother’s condition had worsened. Margaret was very confused and obviously distressed. She had tremors and her body was “jerking all over.”
Linda went to the nurses’ station to get help. A nurse came and gave Margaret pain medicine and oxygen, but the problems persisted. When Linda continued to ask for help, the nurse became rude and abusive, asking, “What more do you want me to do?”
Linda asked the staff to call an ambulance. But they couldn’t reach the doctor and refused to call an ambulance without the doctor’s approval. Distraught, Linda called the ombudsman and asked him what to do. He told her to call 911 and if she got in trouble for calling, he would take responsibility.
When the ambulance arrived at the hospital, medical staff sent Margaret directly to the Intensive Care Unit. They told her family Margaret had a urinary tract infection, a MRSA infection, and that she was anemic. They pulled back the covers and showed the family sores under her arms, between her legs, and around her neck. Her urine was strawberry red and her blood was septic. The doctors administered antibiotics and gave her three bags of blood. If Linda hadn’t called 911, they said, Margaret might not be alive.
This is one of the more dramatic examples, but it reminded me of the vital role our ombudsmen play in protecting long-term care residents’ well-being. And it also reminded me that even a simple act can have a huge impact. Making a phone call. Answering a question. Making a donation.
It costs about $100 a year to provide ombudsman services for a long-term care resident. By donating what you can—whether it’s $10, $100 or $1,000—you can help make sure residents in the Bluegrass district get the help they need, when they need it. Our program’s success relies on the generosity of compassionate people like you!
Director of Fundraising & Administration
WHAT IS THE LONG-TERM CARE OMBUDSMAN PROGRAM (LTCOP)?
Under the federal Older Americans Act (OAA) every state is required to have an Ombudsman Program that addresses complaints and advocates for improvements in the long-term care system. Each state has an Office of the State Long-Term Care Ombudsman (Office), headed by a full-time State Long-Term Care Ombudsman (Ombudsman) who directs the program statewide. Across the nation, staff and thousands of volunteers are designated by State Ombudsmen as representatives to directly serve residents.
WHAT DOES THE OMBUDSMAN PROGRAM DO?
The Ombudsman program advocates for residents of nursing homes, board and care homes, assisted living facilities, and other similar adult care facilities. State Ombudsmen and their designated representatives work to resolve problems individual residents face and effect change at the local, state, and national levels to improve quality of care. In addition to identifying, investigating, and resolving complaints, Ombudsman program responsibilities include:
• Educating residents, their family and facility staff about residents’ rights, good care practices, and similar long-term services and supports resources;
• Ensuring residents have regular and timely access to ombudsman services;
• Providing technical support for the development of resident and family councils;
• Advocating for changes to improve residents’ quality of life and care;
• Providing information to the public regarding long-term care facilities and services, residents’ rights, and legislative and policy issues;
• Representing resident interests before governmental agencies; and
• Seeking legal, administrative and other remedies to protect residents.
Ombudsman programs do not:
• Conduct licensing and regulatory inspections or investigations;
• Perform Adult Protective Services (APS) investigations; or
• Provide direct care for residents.
RESIDENTS’ RIGHTS Ombudsman programs help residents, family members, and others understand residents’ rights and support residents in exercising their rights guaranteed by law. Most nursing homes participate in Medicare and Medicaid, and therefore must meet federal requirements, including facility responsibilities and residents’ rights. For more information about residents’ rights visit http://ltcombudsman.org/issues/residents-rights and http://theconsumervoice.org/ issues/recipients/nursing-home-residents/residents-rights. Regardless of the type of facility all residents have the right to be protected from abuse and mistreatment and facilities are required to ensure the safety of all residents and investigate reports of mistreatment.
FREQUENTLY ASKED QUESTIONS (FAQ)
Who does the Ombudsman program represent? The Ombudsman program’s mandate is to represent the resident and assist at his or her direction. The Older Americans Act (OAA) requires the Ombudsman program to have resident consent prior to investigating a complaint or referring a complaint to another agency. When someone other than the resident files a complaint, the ombudsman must determine, to the extent possible, what the resident wants.
What happens after I bring a concern to the Ombudsman program? If someone other than a resident contacts the Ombudsman program with a complaint the ombudsman will visit the resident to see if the resident has similar concerns and wants to pursue the complaint. The ombudsman will explain the role of the program, the complaint investigation process, share information about residents’ rights, ask about the resident’s quality of life and care, and seek to understand the resident’s capacity to make decisions. Many residents, even residents with dementia, are able to express their wishes. If the resident wants the ombudsman to act on the problem, the ombudsman will investigate the complaint and continue to communicate with the resident throughout the investigation process. If the resident cannot provide consent the ombudsman will work with the resident representative or follow program policies and procedures if the resident does not have a representative.
What types of complaints does the Ombudsman program investigate? Ombudsmen handle a variety of complaints about quality of life and care. Not all complaints are about the care provided by a facility, some complaints are about outside agencies, services or individuals (e.g., Medicaid or Medicare benefits). They can also receive and respond to complaints from individuals other than the resident (e.g. family member), but still need resident permission to investigate or share information.
Do ombudsmen investigate complaints involving allegations of abuse, neglect, and exploitation? Yes. The Ombudsman program investigates and resolves complaints that “relate to action, inaction or decisions that may adversely affect the health, safety, welfare, or rights of the residents” and that includes complaints about abuse, neglect, and exploitation. Ombudsmen are directed by resident goals for complaint resolution and limited by federal disclosure requirements. Therefore, the Ombudsman program’s role in investigating allegations of abuse is unique and differs from other entities such as, adult protective services and state licensing and certification agencies. Ombudsman programs attempt to resolve complaints to the residents’ satisfaction (including those regarding abuse) and do not gather evidence to substantiate that abuse occurred or to determine if a law or regulation was violated in order to enforce a penalty. If necessary, with resident consent or permission of the State Ombudsman if the resident can’t consent and does not have a legal representative, the ombudsman will disclose resident-identifying information to the appropriate agency or agencies for regulatory oversight; protective services; access to administrative, legal, or other remedies; and/or law enforcement action about the alleged abuse, neglect or exploitation.
Is the Ombudsman program required to report allegations of abuse? There are strict federal requirements regarding disclosure of Ombudsman program information. Resident-identifying information cannot be disclosed without resident consent, the consent of the resident representative, or a court order. Therefore, these disclosure requirements prohibit Ombudsman programs from being mandatory reporters of suspected abuse.
Information gathered from
This fact sheet was completed in association with the National Consumer Voice for Quality Long-Term Care for the National Center on Elder Abuse situated at Keck School of Medicine of USC and is supported in part by a grant (No. 90AB0003-01-01) from the Administration on Aging (AOA), U.S. Department of Health and Human Services (DHHS). Grantees carrying out projects under government sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official Administration on Aging or DHHS policy.
October is Residents’ Rights month, a month that Long-Term Care Ombudsmen have been celebrating since 1981 when Residents’ Rights was a week long event. We have a lot to celebrate here in Kentucky, there are over 34,000 residents in long-term care facilities across the state and during this month we celebrate their right to be fully informed! We often hear how challenging it is for families and nursing home residents to access their medical records from facilities. Accessing your medical records is vital in advocating for quality care for residents. Residents and their legal representatives have the right to access all records pertaining to their care, including current clinical records, within 48 hours of oral or written request (this excludes weekends and holidays). Residents also have the right to purchase additional photocopies of their medical records. To receive a copy of your medical record, you must submit a written request to the facility. A facility must provide a copy of your records within 48 hours of receiving your written request. Some nursing homes have their own form for you to fill out, but they should honor a letter. In your letter, include a clear statement requesting the records and instructions on how they should get them to you. Will you pick them up at the facility and if so, what time will you be there? Don’t forget to sign and date your letter! The residents’ right to their records is just one of the many residents’ rights we celebrate every October. If you or a loved one are having difficulties accessing medical records from a nursing home call me for help at 859-277-9215.
Jodi Holsclaw, Regional Long-Term Care Ombudsman
On September 30, 2016, five very special people were awarded the 2016 NHOA Leadership Awards as part of our 35th Anniversary Celebration.
SERVICE TO RESIDENTS AWARD
The NHOA Service to Residents Award honors ombudsmen who have worked directly with and for consumers to improve the lives of long-term care residents. This award honors ombudsmen who have effectively advocated for residents and performed exemplary ombudsman service. Honorees not only serve consumers, but are supportive mentors to other ombudsmen.
2016 Recipients – Ann Evans and Madge Lynn
Ann Evans has been with the Nursing Home Ombudsman Agency of the Bluegrass for nearly 30 years, making her our longest continuously serving ombudsman. Ann has stuck by NHOA’s side through thick and thin, tirelessly advocating for residents in Lawrenceburg and mentoring her fellow ombudsmen. We thank Ann for her commitment to protecting and promoting residents’ rights and for all of the work she has done for NHOA.
Madge Lynn has been an invaluable asset to NHOA from the start of her time with us. Madge has helped guide and mentor new ombudsmen. She is quick to volunteer to help NHOA in anything the agency needs, whether it’s covering an out-of-town facility or helping with our signature fundraiser, Decorator’s Showcase. Thank you, Madge, for your dedication to the residents of the Bluegrass and to NHOA.
This award honors individuals or organizations who advance the financial sustainability of NHOA. Honorees go to extraordinary lengths to ensure that NHOA’s services are funded and our mission to improve care for long-term care residents is achieved.
2016 Recipient – Paula DeBoor
Paula DeBoor joined NHOA’s Board of Directors in 1985 and has played a major role in ensuring NHOA’s financial sustainability ever since. Even before joining the Board, Paula was involved in the Women’s Neighborly Organization’s Decorators’ Showcase. After WNO disbanded and passed the Showcase on to NHOA, Paula helped make it our signature fundraiser. She has chaired many Showcases and other events, working tirelessly to make them memorable and successful, down to the last detail. Paula is masterful at garnering resources and support for our agency, and we can’t thank her enough!
This award honors individuals or organizations who have positively impacted legislation and policy affecting long-term care residents. Honorees have provided exemplary leadership in the public policy field in advancing quality of care and quality of life for residents of long-term care facilities.
2016 Recipient – Nancy Andrews Leonard
Nancy Andrews Leonard retired from Lexington-Fayette Urban County Government’s Department of Social Services after a long career as an Aging Services Specialist. Since retiring from city government Nancy has been performing legislative education and advocacy services as a volunteer for the Nursing Home Ombudsman Agency.
Nancy joined the NHOA Board in 1982. She served as Chairman of the board several times and is the Chairman of the Legislation Committee. When you really think about it, few voices are silenced as much as the voices of our sickest, oldest, and frailest citizens tucked away in long-term care facilities. Nancy presents the resident/consumer experience when talking with lawmakers. It is very difficult to keep an eye on legislation related to long-term care services as it touches the judicial, appropriations, veterans’ affairs, and health and welfare committees, as well as state and federal benefits such as Medicare and Medicaid.
Nancy performs an excellent job of gathering information about legislation, bills and sharing that information with residents, consumers, families, and other advocates. Nancy has a deep passion for helping the little man be heard at the capitol.
LIFE TIME ACHIEVEMENT AWARD
This award honors an individual who has dedicated their career or retirement to advocating for quality care and services for residents of long-term care facilities. Honorees have demonstrated a commitment to advancing long-term care reform while maintaining a personal commitment to integrity.
2016 Recipient – Kathy Gannoe
For more than 25 years Kathy Gannoe worked to improve the quality of care for residents of long-term care facilities as the Executive Director of NHOA & the Bluegrass District Ombudsman from 1984 until her retirement in 2009. Kathy’s knowledge and dedication to ombudsman skills, volunteer work, advocacy training, administrative and fundraising skills, gerontology and public policy were most impressive. These are all evident in the solid foundation and successes of NHOA she was responsible for during her 25-year career at NHOA.
Both locally and nationwide Kathy was known for her continuously well-reasoned, good tempered, and knowledgeable approach to ombudsman work and nonprofit management. Kathy was one of the pioneers of nursing home reform. Kathy has always been regarded as an outstanding national leader, often representing Kentucky in public policy and legislative forums. National nursing home reform activist Elma Holder once spoke these words about Kathy while congratulating her for receiving the Howard Hines award from the National Association of Local Long-Term Care Ombudsmen: “In my travels in other states, I’ve often cited her program and it’s creative, solid activities as a model for others.”
The thousands of consumers Kathy assisted could always count on her to help advance the nursing home reform movement. Kathy developed, piloted, researched and carried out dozens of programs and initiatives to help residents. Kathy’s unique way of explaining Residents’ Rights and the complicated system of long-term care was always so helpful to consumers and continues to shape how NHOA communicates with consumers even today. Kathy truly deserves this tribute for significant life’s work to improve the care and quality of life for people living in long-term care.
It’s that time of year again…. Residents’ Rights Month! The official designation of October as a time when we celebrate and focus on rights is my favorite time of year. It is a time for recognizing rights and raising the awareness of dignity, respect and the value of each individual resident. October is also Domestic Violence Awareness Month and our friends at Green House 17 asked if I could share some information with them about domestic abuse later in life. Check out my blog at http://greenhouse17.org/2016/10/12/later-life-abuse/ or see the message below.
Domestic Violence & Residents of Long-Term Care Facilities
Guest blog for GreenHouse17 “17 Voices: Let’s talk about ending domestic violence.”
Sherry Huff Culp, Kentucky State Long-Term Care Ombudsman
Nursing Home Ombudsman Agency of the Bluegrass, Inc. www.ombuddy.org
Have you ever considered what it must be like to be a survivor of domestic violence, aging, disabled, and living in a nursing home? In KY there are over 34,000 residents living in licensed long-term care (LTC) facilities. The majority of these residents are impoverished older women with two or more disabilities. Some have experienced domestic violence their entire lives while others may have only experienced it since becoming dependent upon caregivers.
A significant portion of elder abuse cases reported in the United States involve spouse/partner violence. The aggressors include spouses and former spouses, partners, adult children, extended family, and in some cases caregivers. Often abusers threaten survivors with nursing home placement if they tell anyone about the abuse. Some abusers use their role and power to financially exploit their victims. Others feel that they are entitled to get their way because they are the “head of the household,” or because they are younger and physically stronger than their victim is.
Older women are likelier than younger women to experience violence for a longer time, to be in current violent relationships, and to have health and mental health problems, but no one seems really prepared to address the needs of a survivor once they move into a nursing facility. So often new admissions are asked to quickly conform to the institution’s daily flow. Some residents never have an opportunity to express their needs and wishes. One of the roles of the Long-Term Care Ombudsman is to visit with residents and learn more about who they are and what they need from their caregivers. We work very hard to develop relationships with residents and teach them about their rights.
One issue that consistently arises while we advocate to improve care and resolve problems is short or insufficient staffing in these institutions. In KY there are no staffing ratios like we have in child care settings. When there are not enough staff working in nursing homes the needs of residents are neglected and it increases the likelihood that domestic violence can begin or continue. Isolation and vulnerability are two of the scariest things about aging, but we can help reduce these fears and protect each other if we demand more caregivers by the bedside, better training for workers, and more person centered care.
Call us today to learn more about volunteering with your local Long-Term Care Ombudsman Program 1-800-372-2991
Whereas, there are nearly 2,000 individuals in Lexington, and more than 34,000 individuals in the state of Kentucky, living in nursing homes, personal care homes, or family care homes; and
Whereas, the federal Nursing Home Reform Act of 1987 guarantees residents their individual rights in order to promote and maintain their dignity and autonomy; and
Whereas, all residents should be aware of their rights so they may be empowered to live with dignity and self-determination; and
Whereas, we wish to honor and celebrate these citizens, to recognize their rich individuality, and to reaffirm their right to vote and participate politically, including the right to have a say in their care; and
Whereas, the Lexington-Fayette Urban County Government and the Nursing Home Ombudsman Agency of the Bluegrass have partnered for more than three decades to improve the quality of care and quality of life for residents living in long-term care facilities;
Long-Term Care Ombudsmen have been celebrating Residents’ Rights since 1981 when it originated as Resident’s Rights Week. A major turning point for residents occurred when the Nursing Home Reform Act passed in 1987. This enumerated many residents’ rights including those around discharge from a long-term care facility. A nursing home becomes a resident’s home. There are a limited number of circumstances where involuntary discharge from a nursing home is allowable such as when it is necessary for resident’s welfare (acute care at a hospital); because the health of the resident has improved beyond nursing level care; because the safety or health of other individuals would be endangered; non-payment; or closure of facility. The nursing home generally has to provide 30 days written notice. Federal regulation 483.12 (a)(6) also provides that “the facility is required to provide sufficient preparation and orientation to residents to ensure safe and orderly discharge from the facility.” Many times ombudsman are able to successfully appeal discharges so that residents are allowed to stay in their home. Discharge rights are just one of the many residents’ rights we celebrate every October. If you or a loved one are faced with eviction from a nursing home call me for help at 859-277-9215.
Mark P. Burress, Regional Long-Term Care Ombudsman
Today I’m sharing a very informative post from Justice in Aging. Thank you for your continued support,
Sherry Culp, Kentucky State Long-Term Care Ombudsman
The Centers for Medicare & Medicaid Services has just released a comprehensive revision of federal nursing facility regulations. The regulations and explanatory material (over 700 pages total) are available here. The positives for nursing facility residents include expanded training requirements, and a new provision that an initial care plan be developed and implemented within 48 hours. The negatives include a failure to improve nurse staffing standards, and weakening the regulations limiting antipsychotic drug use.
Some important provisions are highlighted below. Additional analysis of the regulations will be developed in coming weeks by Consumer Voice, the Center for Medicare Advocacy, and Justice in Aging.
Quality of Care
Staffing: Although inadequate staffing is the greatest problem in nursing facilities today, the new regulations do not include a minimum staffing standard or a requirement for a 24-hour Registered Nurse. Instead, the new regulations continue the current policy: requiring “sufficient” staffing levels, and registered nurse presence for eight hours daily. Staff must have “appropriate competencies and skills sets,” and staffing levels must take into consideration the number, acuity and diagnoses of the resident population, based on a newly-mandated facility assessment.
Person-Centered Care: The previous regulations required that care be individualized, and based on a care plan, but the new regulations add emphasis. The new regulations define person-centered care and require that facilities learn more about who the resident is as a person, provide greater support for resident preferences, and give residents increased control and choice.
Care Planning: Under the new regulations, facilities must develop and implement a baseline care plan for a new resident within 48 hours of admission. The care planning process itself calls for greater resident involvement and participation. In addition, the certified nursing assistant responsible for the resident, and a member of the food and nutrition services staff must participate in the care planning process.
Abuse, Neglect and Exploitation: Provisions related to abuse, neglect and exploitation are now included in a separate section, which brings more attention and focus to these issues. New protections include prohibiting licensed individuals with a disciplinary action from being hired, and requiring that suspicion of a crime be reported to law enforcement and the state survey and certification agency.
Antipsychotic Drugs: Many residents with dementia are inappropriately given harmful antipsychotic drugs, despite strong current federal rules. The new regulations water down existing protections by folding antipsychotic drugs into a broader category of psychotropic drugs, and moving them from quality of care regulations to pharmacy services.
Training: Training requirements have been expanded to apply to all staff, contractual employees, and volunteers. Mandatory topics include communication, residents’ rights, and abuse, neglect and exploitation. Certified nursing assistants will be required to receive training on dementia management and resident abuse prevention.
Prohibiting Pre-Dispute Arbitration: Currently, many nursing facility admission agreements include provisions obligating the resident to have disputes adjudicated through private arbitration. Such “pre-dispute” arbitration agreements now will be prohibited. Arbitration agreements will be allowed only when the events at issue occurred before the arbitration agreement was signed.
Improvements to Involuntary Transfer-Discharge Procedures: The new regulations specify that transfer-discharge for non-payment is inappropriate when the resident has submitted necessary paperwork to a third-party payor (such as Medicaid), and that payor is now evaluating the claim for payment. Also, facilities now will be obligated to send a copy of each transfer-discharge notice to the state’s long-term care ombudsman program, which is available to advise the resident.
Limiting Facility’s Ability to “Dump” Resident at Hospital: In an effort to evade transfer-discharge requirements, some facilities “dump” residents by refusing to readmit them from hospitalizations. To address the problem, the new regulations explicitly require a facility to follow the transfer-discharge procedures when the facility claims that a hospitalized resident cannot return to the facility.
Modifying Residents’ Rights to Have Visitors: The new regulations continue current law providing each resident with a right to receive visitors at any time. In an unwelcome change, however, if a visitor is not a family member, the right to receive a visit now is “subject to reasonable clinical and safety restrictions,” as set forth in facility policy.
Grievances: Far too often, complaints from residents and families have been dismissed or not taken seriously. The regulations will now call for facilities to have a grievance policy and a grievance official to oversee the grievance process. Complainants will receive a written grievance decision that includes the steps taken to investigate, a summary of the finding or conclusions, a statement as to whether the grievance was confirmed or not confirmed, and the action taken or to be taken by the facility.
This alert has been jointly developed by Consumer Voice, the Center for Medicare Advocacy, and Justice in Aging.