Ombudsman Program Specialist, ACL/AoA What should a State Ombudsman expect from the Administration for Community Living/Administration on Aging? Louise Ryan, MPA Ombudsman Program Specialist, ACL/AoA October 24, 2013

Administration for Community Living An operating division within the Department of Health and Human Services (April 2012) Administration on Aging (administers Older Americans Act) Administration for Intellectual and Developmental Disabilities (administers the “DD Act”) Center for Disability and Aging Policy Center for Management and Budget Office of the Administrator Includes 10 Regions DD Act = Developmental Disabilities Assistance and Bill of Rights Act of 2000

ACL Mission Maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers.

Role of the Administration on Aging (AoA) AoA administers Older Americans Act (OAA): The OAA lays out duty and function of the Administration: “serve as the effective and visible advocate for older individuals within the Department of Health and Human Services and with other departments, agencies, and instrumentalities of the Federal Government by maintaining active review and commenting responsibilities over all Federal policies affecting older individuals;” Created, authorizes and funds grants to states State units on aging Area agencies on aging “Aging network” leverages state, local, and other funds AoA has an advocacy role in addition to being a grantee of OAA programs

OAA funded programs OAA funds services to individuals age 60+, including: In-home services and supports Nutrition services (congregate and home-delivered meals) Senior centers Caregiver support Services to tribes (American Indians, Alaskan Natives, and Native Hawaiians) Elder rights services, including LTC Ombudsman Note: with regards to LTCOP services there is no prohibition on serving people under age 60.

How ACL/AoA relates to your work AoA helps states understand and implement the Older Americans Act (OAA) through: Issuing grants to states (formula grants under OAA) Reviews and approves the State Plan on Aging -- Did you know that your work is part of the State Plan on Aging? Program guidance and interpretations Technical assistance and/or other intervention when issues arise Evaluation of OAA Programs Providing a framework for the National Ombudsman Reporting System Funding technical resource centers

analyze laws, regulations, programs, and practices; and OAA requires AoA to establish and operate the National Ombudsman Resource Center provide training, technical assistance, and information to State Long-Term Care Ombudsmen; analyze laws, regulations, programs, and practices; and provide assistance in recruiting and retaining volunteers for State Long-Term Care Ombudsman programs by establishing a national program for recruitment efforts that utilizes the organizations that have established a successful record in recruiting and retaining volunteers for ombudsman or other programs; OAA requires NORC to assist State Long-Term Care Ombudsmen in the implementation of State Long-Term Care Ombudsman programs. National Program for recruitment - For example AoA also funds the Volunteer collaborative that coordinates efforts with NORC.

State Planning Process: AoA coordinates with NASUAD to provide TASC Planning Zone resources for State Plan development. (www.nasuad.org) AoA Regional Offices review State Unit on Aging state plans (every 2-4 years): Evaluation of state aging population needs Description of core and discretionary programs and services to meet the need LTC Ombudsman Program is a “core program” and a “person-centered” service New: FY 2014 Focus Area: elder justice Assurances related to compliance with OAA includes assurance of carrying out a State Long-Term Care Ombudsman program in accordance with section 712. Goals and objectives for meeting needs of populations served We review state plans; raise potential concerns; look for inclusiveness of LTCOP into the plan

State Plans & Long-Term Care Ombudsman Specifically the plans should address how the state: Operates and meets the LTCO program requirements in the OAA (including how the State assures performance of requirements when the LTCO program is not housed within the SUA) Integrates LTCO plans into the broader Elder Rights context – as well as coordination with other aging services where applicable (for example, where does the LTCO help the SUA meet its objectives related to core programs and/or consumer control and choice?) Expects to measure the results of its goals and objectives. Additional Resources for Planning: “State Long-Term Care Ombudsman Participation in State Unit on Aging Plans” www.nasuad.org/documentation/tasc/State_ltc_ombudsman_participation_in_SUA_plans.pdf

AoA Program Guidance and Interpretation Older Americans Act provisions, especially Section 712 Regulations Notice of proposed rulemaking for LTCO Current OAA regulations from 1988 FAQs – Common TA Questions on http://aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Ombudsman/Program_Instructions.aspx Program Instructions (PIs) – Examples relative to LTC Ombudsman Program: Certification of minimum funding requirements (annually) Appropriate use of Title VII funds State Plan requirements

ACL Regional Support Centers Technical Assistance to States, AAAs and others in Aging and Disabilities Networks Includes TA letters & visits, examples: Iowa, (systems advocacy), Utah (abuse investigations), California (minimum funding, reimbursement for bankruptcy work) Florida(designation of local ombudsman volunteers, legislative advocacy, and information dissemination) State plan assistance and review. Generally, your first point of contact with questions for ACL (OLTCO works closely with regions) Some RSCs host regular dialogues among SLTCOs in the region. Relationship with other HHS agencies on regional level. Site visits to States; compliance reviews when necessary On-site travel is not common

Office of Long-Term Care Ombudsman Programs Becky Kurtz, Director Support States’ implementation of OAA grants for LTC Ombudsman programs Advocate for interests of LTC facility residents within federal government Louise Ryan, Ombudsman Program Specialist Support State program operations (in coordination with Regions) Programmatic lead for National Ombudsman Reporting System (NORS) Project Officer for National Ombudsman Resource Center

Frequent State Issues State Ombudsman ability to fulfill role as required by OAA: An independent problem-solver focused on individual resident interests Ability to perform effective system-level policy advocacy for residents of LTC facilities (includes recommendations to legislature) Ability to communicate to the general public and media Full-time position (some states have had other elder rights’ protection duties assigned)

Frequent State Issues (continued) Designate individuals (and local entities, in many states) to represent the Office of the State Long-Term Care Ombudsman Relationship with local Ombudsman entities Confidentiality of Ombudsman information Access to adequate legal counsel The proposed rules address many of these issues.

Living with the inherent tensions within the aging & disability tent: The LTC Ombudsmen experience: The interests of elder rights advocates often conflict with the interests of service providers; To succeed, the Aging Network must be explicit about its roles and clarify its boundaries; It’s not personal, it’s systemic – the OAA creates both service providers and advocates; Persons receiving LTC services & supports need leaders to embrace, not fear, their advocacy mandate under the OAA. Without clear understanding of and respect for the unique benefits of each program/service, we risk losing effective services for consumers. ACL staff seeks to support LTCO to live within the tent and to be effective in representing the interests of residents.

Current ACL/AOA Activities AoA Office of Performance and Evaluation NORC University of Chicago – completed a LTC Ombudsman Program Evaluation Study Design Developed a methodology to evaluate LTCO program: Efficiency and Effectiveness and Outcomes Next step: Implement the evaluation – once funding available “NORS Next” – NASOP, NALLTCO and ACL staff involved in a workgroup. Focus groups will occur next year. Continued work with CMS on nursing home initiatives, Medicaid Admin claiming, accessing Civil Monetary Penalty funds and ACL/AoA staff - HCBS regulations, PASRR, Olmsted Planning, injury prevention, to name a few

Notice of Proposed Rulemaking published June 2013 – comment period ended August 18, 2013 State Agency Policies Definitions: B. Immediate Family C. Office of the State Long-Term Care Ombudsman D. Representatives of the Office of the State Long-Term Care Ombudsman E. Establishment of the Office of the State LTC Ombudsman F. Functions and Responsibilities of the State LTC Ombudsman G. State Agency Responsibilities Related to the LTC Ombudsman Program H. Functions and Duties of the Office of the State LTC Ombudsman I. Conflicts of Interest Find proposed rule and comments at: www.regulations.gov NPRM limited to areas of greatest inconsistency/need for guidance to States.

What should a State Ombudsman Expect from the ACL? You should expect us to: Help you be able to do your job as a problem-solver for LTC residents Represent the LTC Ombudsman Program at the federal/national level Represent the interests of residents to other federal agencies so keep us informed!

“Our nation has been conducting investigations, passing new laws and issuing new regulations relative to nursing homes . . . . If the laws and regulations are not being applied to [the individual], they might just as well not have been passed or issued.” U.S. Commissioner on Aging Arthur S. Flemming, 1976 We take these words seriously and aim to help you to live out the mandate to be an effective advocate for the individuals that your program serves.

Contact information: Becky Kurtz Becky.Kurtz@acl.hhs.gov 202-357-3586 Louise Ryan Louise.Ryan@acl.hhs.gov 202-357-3503