Enhancing Collaborations Between Long-Term Care Ombudsmen and Legal Services Programs

LTC Ombudsman Program Empowers residents Addresses complaints Advocates for improvements in the long-term care system

53 State Ombudsman Programs State Units on Aging & Disability Other State Agencies Legal Services Programs Other nonprofit organizations 575 Local Ombudsman Entities Area Agencies on Aging 1200+ Local Program Staff 8200+ Certified Volunteers

2013 Ombudsman Activities 190,000+ complaints 24,000 resident and family council meetings 5400 trainings for facility staff 129,000 consultations to facilities 335,000 consultations to individuals …plus… Individual and community education Public comments on laws and regulations Legislative testimony Working groups, committees

State and Local Coordination with others responsible for the health, safety, well-being or rights of residents: AAA Programs Aging & Disability Resource Centers Adult Protective Services Protection & Advocacy Programs Licensing & Certification Medicaid Fraud Control Units Law Enforcement Courts Victims Assistance Programs Legal Services Developers Legal Assistance Programs

Legal Services Providers Title III-B, Section 321 of the Older Americans Act Provides legal assistance to older individuals with economic or social needs Approximately 1000 OAA-funded legal services providers nationwide

Examples of Legal Services Provided by Title III-B Service Providers: Accessing public benefits Draft advance directive, designate surrogate decision-makers Guardianship issues, including representation for older persons facing guardianship actions Accessing housing options Facing foreclosure or eviction proceedings Protecting the rights of individuals transferring from long-term care facilities to HCBS Assistance for victims of elder abuse and financial exploitation

Legal Services Corporation – Legal Aid Funded by Congress to provide access to legal assistance to people living in households with annual income at or below 125% of the federal poverty guidelines Issues include: Family law Housing and Foreclosure Consumer issues Employment and income maintenance Helping Military families Responding to disasters

LTCO Collaboration w/ Title III-B Legal Services Providers Collaborative Efforts Case referral* Provision of legal services to LTCOPs through contract Development of consumer information Comments on proposed regulations Legal advice, counsel, opinions to LTCOPs Technical assistance between the programs Training Policy analysis Issues for case referral include: Involuntary discharge; guardianship; other surrogate decision-making issues; Medicaid and other program eligibility issues; access to medically necessary services or supports; subpoenas; …

Barriers/Challenges to Collaboration Confidentiality restrictions Limited resources Program priorities do not align Time constraints Lack of MOUs cause challenges in coordination Lack of LTCO access to a III-B service provider contracting with their agency

Recommendations Create opportunities for cross-training at the state and national levels through conference, webinars, conference calls to increase exposure and recognition of programs Develop MOU to detail roles and responsibilities of entities when working on cases, sharing of information, establishing referral processes, exploring avenues for cross-training Promote regular meetings to discuss cases and issues, and how they can more effectively collaborate Seek out opportunities to work together on systemic issues through joint participation on legislative coalitions, training conferences, Olmstead Councils Coordinate legislative agendas or priorities to identify common areas of interest or concern

Examples of Issue Support Clients with Diminished Capacity Guardianship Powers of Attorney Transfer/Discharge Access to Benefits – Medicaid, SSI Therapy (Jimmo) Getting Durable Medical Equipment – power wheelchairs Transitions to HCBS Concerns about Abuse, Neglect, Exploitation

Examples of Ombudsman Program Support Technical Assistance Legal Advice Subpoenas Legal Representation Public Policy Systemic Advocacy – Legislation, Regulations, Working Groups/Task Forces Training

The National Long-Term Care Ombudsman Resource Center (NORC) www.ltcombudsman.org