Ombudsman and Resident Rights Training Natalie Nathan, MHS, certificate in Gerontology Area 3 senior services agency

History of the Ombudsman Program The word “Ombudsman” is a Swedish word meaning citizen advocate Resident advocate Reports of substandard conditions at facilities in the late 60’s and early 70’s led to the development of the Ombudsman Program in the United States These are the stigmas many facilities are still fighting against today Amendments to the Older Americans Act continue to improve the program’s ability to advocate on behalf of residents of long term care facilities Including assisted living facilities Many media reports regarding abuse, neglect and substandard conditions Development of improved compliance standards Senate report in September 1975 by the Subcommittee on LTC: 40% of drugs in NH’s are central nervous system drugs, painkillers, sedatives or tranquilizers Tranquilizers constitute almost 20% of total drugs – the largest category of any NH drugs 20-50% of medications in the US NH’s were given in error Nurses have little training in geriatrics and are unprepared to work in LTC facilities. In 1973 there were 6400 NH fires with an estimated 500 deaths. Compounding the problems, many patients are under sedation and bound with restraints. 33% of all fires were caused by smoking or matches (most commonly between hours of midnight and 6am) 35% of all NH fires occurred in wood frame buildings or had flammable carpets, curtains and vinyl upholstery Source: https://www.aging.senate.gov/imo/media/doc/reports/rpt575.pdf

History of the Long-Term Care Ombudsman Program (LTCOP) 1972 Five Nursing Home Ombudsman Demonstration programs established to focus on nursing home resident complaint resolution 1978 Older Americans Act (OAA) amendments required all states to establish an Ombudsman Program Program designed to be a local, community program utilizing volunteers 1981 Duties expanded to board and care homes (e.g. Assisted Living Facilities) Name changed from Nursing Home Ombudsman to Long-Term Care Ombudsman (LTCO) 1987 LTCO access to resident records (with resident consent) States must prohibit willful interference of official LTCO duties and/or retaliation against a LTCO, resident or other individual related to LTCOP duties The nursing home industry experienced rapid growth after the introduction of Medicare and Medicaid in 1965. Complaints about substandard care lead to the realization that the systems in place to protect individuals had failed and improvements in quality of care were needed. In addition to increasing the number of state regulatory inspectors, enhancing the federal enforcement standards and process, the federal government also established the Nursing Home Ombudsman Demonstration grants. Through amendments in the Older Americans Act the responsibilities of the LTCOP continue to expand.

What does the Ombudsman Program do? Advocate and support resident concerns and complaints RESIDENT directed Help improve residents’ quality of life Educate residents, their family and facility staff about resident rights Provide information to the public on long-term care facilities and services, residents' rights and community resources Help resolve complaints made by or on behalf of long-term care residents Systemic change Advocate – Meet with residents, resident council meetings, care plan meetings, Licensing and Certification & Bureau of Facility Standards Community Education – presentations, facility lists, referrals - elder law attorneys, pay source, tip sheets on how to select a facility (size, menu, staffing, location, interview other residents, visit in evening or weekends). Complaints may come from residents, staff, family, care providers – hospitals, home health / hospice Violation of resident rights or dignity Physical, verbal or mental abuse, deprivation of services necessary to maintain residents’ physical and mental health Poor quality of care, including inadequate personal hygiene and slow response to requests for assistance Improper discharge or transfer

What Ombudsman Programs cannot do Conduct licensing and regulatory inspections or investigations Perform Adult Protective Services investigations Provide direct care for residents This includes pushing wheelchairs Advocate – Meet with residents, resident council meetings, care plan meetings, Licensing and Certification & Bureau of Facility Standards Community Education – presentations, facility lists, referrals - elder law attorneys, pay source, tip sheets on how to select a facility (size, menu, staffing, location, interview other residents, visit in evening or weekends). Complaints may come from residents, staff, family, care providers – hospitals, home health / hospice Violation of resident rights or dignity Physical, verbal or mental abuse, deprivation of services necessary to maintain residents’ physical and mental health Poor quality of care, including inadequate personal hygiene and slow response to requests for assistance Improper discharge or transfer

Five Most Frequent Assisted Living Facility Complaints in 2013 Administration on Aging website: http://www.aoa.acl.gov/AoA_Programs/Elder_Rights/Ombudsman/index.aspx Quality, quantity, variation and choice of food Administration and organization of medications Inadequate or no discharge/eviction notice or planning Lack of respect for residents, poor staff attitudes Building or equipment in disrepair or hazardous Obtained from Administration on Aging website

Five Most Frequent Nursing Facility Complaints in 2013 Improper eviction or inadequate discharge/planning Unanswered requests for assistance Lack of respect for residents, poor staff attitudes Quality of life, specifically resident/roommate conflict Administration and organization of medications

Residents have the right to: Be Fully Informed Available services and charges, facility rules and regulations, Ombudsman services, state survey reports Participate in One’s Own care Informed of changes, review records, refuse Restraints, participate in care plans & treatments Transfer and Discharge Receive 30 day written notice prior to d/c or transfer with notification of right to appeal Dignity, Respect & Freedom Free from abuse, neglect, seclusion; treated as an adult; self determination, security of possessions. Complain To staff, Ombudsman, Licensing and Cert, BFS without fear of reprisal and with prompt response Privacy and Confidentiality Unrestricted contact with person of choice; privacy regarding personal care, mail, medical or financial affairs Visits Doctor, friends, family, surveyor, legal – any person they want including the right to refuse Independent Choices Make personal decisions, needs and preferences, community activities, resident council 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. 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.

Staff’s Role in Protecting Resident’s Rights Know the rights of your patients State regulations require facilities develop policies and procedures to ensure that resident rights are promoted and protected in a facility. It’s the administrators responsibility to provide appropriate training. Allow residents to make choices about their care As a caregiver, it is important that you know and enforce those rights. Protect resident’s dignity and privacy 24/7 – knock before entering room Keep door closed during personal care Don’t discuss resident information in hallways Allow residents to make choices about their care Listen to residents/families who have concerns about resident’s rights.

Why are Resident Rights Sometimes Ignored or Violated? Lack of awareness of resident rights by residents, caregivers, family and administrators Loss of empathy or sensitivity to the plight of disabled, elderly or ill residents by caregivers or others Facility staff shortages Treating residents as children, not adults Lack of adequate training

How can we protect resident rights? Ensure residents, family, caregivers, and managers are aware of the rights Ensure caregivers have received the proper training for tasks they are performing If you see something, say something. Report anything that doesn’t feel right Learn more about the resident's life history which helps to see the person as an adult with a lifetime’s worth of experience Are staff given a copy of the residents rights? How often are they reviewed? When do residents receive a copy of residents rights? How often are they reviewed? Do you feel they understood the document on admission when facing an overwhelming amount of information. “Walk a mile in their shoes.” Stress empathy and respect for residents. Ask yourself, “How would I feel if I were treated like that?”

Understanding that residents may go through a tremendous amount of loss moving into a facility – loss of loved ones, home, pets, possessions, independence Each person will experience loss differently - Isolation, anger, grief Understanding their needs and respecting their rights is an important step to creating a new home

Area 3 Senior Services Agency Information and Assistance Home delivered meals, home maker services, respite Adult Protection Investigates reports of abuse, neglect and exploitation of vulnerable adults 18+ Ombudsman Advocate for residents in long-term care facilities Area 3 Senior Services Agency 701 S. Allen St. Meridian, Idaho 83642 208-898-7060