Ombudsman Partnerships with Legal Services: Enhancing Advocacy Claudette Royal, NYS Long Term Care Ombudsman Lisa Newman, Director, Region 15 Long Term Care Ombudsman Lindsay Heckler, Staff Attorney, Center for Elder Law & Justice

NYS Ombudsman Program Structure State Office: State Ombudsman, Senior Assistant State Ombudsman, 3 Assistant State Ombudsman, 1 Clerical, 1 Half-time Legal Counsel 15 Regional Programs: 14 Not for Profit Agencies, 1 AAA (Approximately 35 full-time and 15 part-time staff statewide) Volunteers: Recruited/trained in each region (Approximately 560 statewide)

NYS Ombudsman Program Mission To serve as an advocate and resource for older adults and persons with disabilities who live in long-term care facilities NYS LTCOP provides services to Nursing homes, Adult Care Facilities and Family Type Homes Approximately 1500 facilities Over 160,000 residents New York City encompasses about 1/3 of all homes and residents

NYS Ombudsman Program Overview

NYS Ombudsman Regionalization Prior to regionalization 34 local programs Post regionalization 15 local programs Region 15 contracting agency-People Inc Subcontract with Center for Elder Law and Justice

People Inc. Region 15 LTCOP Host Agency Buffalo, NY non-profit People Inc. was created in 1970 by a small group of parents wanting to address intellectual disabilities Now over in 9 counties, 200 residential sites, day programs, and regional offices with nearly 4000 employees In 1993 People Inc. expanded to include senior living apartments; also, the agency operates a Senior Companion Program When NYS LTCOP regionalized in October 2015, People Inc. looked to add the Ombudsman Program; talking with Center for Elder Law and Justice, there was mutual interest and the partnership was formed

NYS Region 15 LTCO Program Most western region in the state and includes 4 counties totaling 5,543 square miles: Erie, Niagara, Chautauqua, Cattaraugus 60 skilled nursing facilities (SNF), 8826 beds; 60 adult care facilities (ACF), 5512 beds; 9 family type homes (FTE); 14,338 total residents 70+ volunteer ombudsmen covering 78 facilities, some covering more than one, some share a facility, some are “roving” ombudsmen Currently 2 program staff and 1 contracted legal liaison Assign volunteers to SNF first as priority, focusing on 1-2 stars Complaints that are of legal matter are navigated to Center for Elder Law and Justice legal liaison

Center for Elder Law & Justice (CELJ)-Partner Civil legal services agency in Buffalo, NY serving 8 WNY Counties. Provide free legal services to older adults, people with disabilities, and the low income population. Mission is to use the legal system to help clients live independently and with dignity. Services help people maintain the essentials of life: Access to health care; Access to safe and affordable housing; Access to sufficient income; Protective services to improve overall quality of life.

Forming the Reg. 15 LTCOP-CELJ Partnership Similar missions and same coverage area Prior partnership: Western New York Pooled Trust Same goal: improve quality of care in WNY nursing homes and assisted living facilities Contractual relationship

Role of the Legal Liaison Referring (“navigating”) the client (resident) between LTCOP and CELJ. Training: New ombudsman certification training presentations Current ombudsman in-service presentations Facility training and presentations Community presentations Guidance and research support – “in-house” legal support Legislative advocacy Systems advocacy * Legal Liaison should (must) become a certified ombudsman! *

Common Referrals to CELJ Discharge/eviction appeals: nursing home and assisted living Medicare Appeals: Jimmo (skilled therapy); Coverage Denials Medicaid Appeals: Institution vs community budgeting NAMI/Spenddown-budgeting Denials Representative Payee: facility is named representative payee Financial Abuse: power of attorney Substituted Decision Making (power of attorney; health care proxy) Medical Bills

Training: Example Health Care Proxy Basic resident right: right to make health care decisions Situation: staff determination a resident ‘lacks capacity’ if they disagree with the resident’s decisions or if the resident has an outspoken family member who is the Agent. Solutions: Legal Liaison prepared NYS Health Care Proxy resident rights handout explaining the law; With Region 15 LTCOP staff support, provided training to volunteer ombudsmen how to utilize the handout to advocate for the resident’s right to make own health care decision. Joint CELJ/Region 15 LTCOP education to facility staff.

Ombudsman Advocacy and Legal Services Working Together Ensuring residents receive skilled therapy services Situation: nursing home states therapy services will be cut off because Medicare will not pay for as resident is “not showing improvement or “plateaued”. Reg. 15 LTCOP-CELJ Partnership: goal is to keep therapy going Legal Liaison: ombudsman and facility training on proper standards/Jimmo; connect resident to CELJ Ombudsman: works with resident and facility to keep therapy going or to get it re-started CELJ Attorney: handles the Medicare Appeal Discharge to the community Situation: resident is caught in the middle of ‘facility said’ ‘insurance said’ Ombudsman: discharge care planning CELJ Attorney: investigates and handles insurance issues, Medicaid, other potential legal barriers

Nursing Home Discharges Federal regulatory requirement to send discharge/transfer notices to LTCOP. Reg 15 LTCOP receives the notices from regional nursing homes. Legal Liaison-a certified ombudsman-: reviews and tracks the notices Potential inappropriate discharges (i.e. to homeless shelters; different nursing home for “LTC”) and connect resident to CELJ for appeal assistance Track patterns amongst ownership groups Share information with State LTCOP for state-wide trends and potential future action

Assisted Living Evictions New York Law: 30 day written notice is required Facility responsibility to assist in safe transfer Facility must commence a special court proceeding Problem: Facility pressure on resident to leave Facility bears cost of bringing the litigation. Ombudsman and Attorney pressure on facility to follow the law 30 day written notice? Care plan meeting to discuss alleged change in condition? Safe transfer? Resident object to 30 day notice?

Reg 15 LTCOP and CELJ Partnership Current/future systems advocacy initiatives Meetings with elected officials Proposing and supporting legislation to improve quality of care Public hearings Comment on regulations Media Interviews Public Education Emerald South White Paper Resident Empowerment Initiatives

Considerations when forming a partnership with a Legal Services Organization Research potential partners Do they share similar mission with LTCOP? Goals? How will the partnership benefit the LTCOP client? Will the partnership further the goals of both the organizations? Determine the type of partnership: contractual partnership vs memorandum of understanding Define roles and expectations: i.e. Legal Liaison – CELJ staff attorney responsible for ensuring residents are connected to appropriate legal service. Develop conflict of interest and confidentiality policies

Questions/Thank you