THE LONG-TERM CARE OMBUDSMAN PROGRAM: This presentation provides a general overview of the Long-Term Care Ombudsman Program (LTCOP) highlighting the history, role and responsibilities of the program. Every state has a LTCOP, but each state operates their program differently. Therefore, this presentation will only address the program responsibilities required by federal law so the information is applicable in every state. At the conclusion of this presentation you should have an understanding about what the LTCOP does, who Long-Term Care Ombudsmen (LTCO) represent and how to work with the LTCO. History, role and responsibilities

What is a Long-Term Care Ombudsman? A Long-Term Care Ombudsman (LTCO) is a resident advocate. LTCO advocate for quality of care and quality of life of residents in long-term care. LTCO help residents benefit from relevant laws and regulations. First and foremost, a Long-Term Care Ombudsman is a resident advocate. Residents guide all LTCO advocacy and work.

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.

LTCOP Responsibilities Program requirements in the federal Older Americans Act include: Identify, investigate and resolve complaints made by or on behalf of residents Provide information to residents about long-term care services Provide technical support for the development of resident and family councils Advocate for changes to improve residents’ quality of life and care Represent resident interests before governmental agencies Seek legal, administrative and other remedies to protect residents Ensure residents have regular and timely access to the LTCOP

LTCO are Resident Advocates LTCO seek to resolve complaints to the residents’ satisfaction LTCO represent residents’ interests LTCO empower residents and promote self-advocacy LTCO need resident consent before sharing information The resident guides LTCO action The primary responsibility of the LTCOP is to serve as the resident advocate. LTCO support resident-centered care and residents guide all LTCO work.

Long-Term Care Ombudsmen… Role of the LTCOP: Long-Term Care Ombudsmen… Do not conduct licensing and regulatory inspections or investigations LTCO are knowledgeable of federal and state regulations and will advocate to ensure residents benefit from relevant laws and regulations. If necessary, LTCO will file a complaint with licensing and regulatory or advise another individual to do so. Are not Adult Protective Services (APS) investigators LTCO provide information regarding preventing and reporting abuse, neglect and exploitation. LTCOPs in some states investigate complaints about abuse, most LTCOPs refer complaints about abuse to the appropriate state agency. If necessary, LTCO will file a complaint about alleged abuse or advise another individual to do so. Do not provide direct care for residents LTCO share information about quality care practices and ways to enhance the quality of life for residents. It is mentioned several times throughout this presentation that Long-Term Care Ombudsmen (LTCO) need resident permission prior to investigating a complaint or referring a complaint to another agency. This is due to the OAA confidentiality requirement. If a resident cannot give consent, the LTCO will speak with the resident’s legal representative prior to continuing with a complaint.

State LTCO Programs Who are LTCO? Volunteer Ombudsmen 53 State Long-Term Care Ombudsmen (each state and Guam, Puerto Rico and Washington D.C.) Local Long-Term Care Ombudsmen (574 local programs) Volunteer Ombudsmen (9,061 certified volunteers in 2011) Volunteer Ombudsmen Not all state and local programs have volunteer LTCO Volunteer LTCO duties vary depending on the state program Volunteer LTCO may: Investigate complaints, provide in-service training, visit residents and support resident and family councils The State Long-Term Care Ombudsman is responsible for operating the statewide LTCOP. The LTCOP is designed to be a local, community program utilizing staff and volunteer LTCO to visit residents in their local community. In 2011, there were 574 local programs across the country.

State LTCO Programs LTCO visit residents in: Nursing homes and assisted living facilities/board and care homes. In a small number of states, LTCOPs also visit individuals that receive long-term care services in their own home. Do LTCO represent all residents, regardless of age? OAA programs provide services to individuals 60 and older, but the LTCOP will assist residents younger than 60 as advocacy for individuals younger than 60 will also benefit other residents. How often do LTCO visit? LTCO regularly visit facilities in order to provide access to the program, but how often depends on the program (e.g. weekly, monthly, quarterly).

LTCO Complaint Investigation LTCO investigate individual complaints and address concerns that impact several or all residents in a facility. LTCO also address general concerns they personally observe during a visit (e.g. odors, concerns about the environment, staff not knocking on resident doors before entering). During complaint investigations LTCO cannot share information without resident consent.

LTCO Complaint Investigation Investigate to gather the facts, but the main goal is to resolve the issue to the residents’ satisfaction. LTCO call upon others to fulfill their responsibilities to residents. LTCO represent resident needs by working for legislative and regulatory changes.

Complaint Data LTCO 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). LTCO can receive and respond to complaints from individuals other than the resident (e.g. family member), but LTCO still need resident permission to investigate or share information. Nationwide, in 2011 the LTCOP investigated 204,044 complaints in nursing homes and board and care facilities.

Top 10 Nursing Home Complaints (2011) Discharge/eviction-planning, notice, procedure, implementation, including abandonment 2 Failure to respond to requests for assistance 3 Dignity, respect - staff attitudes 4 Medications - administration, organization 5 Accident or injury of unknown origin, falls, improper handling 6 Resident conflict, including roommates 7 Care plan/resident assessment - inadequate, failure to follow plan or physician orders 8 Food service - quantity, quality, variation, choice, condiments, utensils, menu 9 Exercise preference/choice and/or civil/religious rights, individual’s right to smoke 10 Personal hygiene (includes nail care and oral hygiene) and adequacy of dressing & grooming These are the Top 10 nursing home complaints received by LTCOPs across the country in 2011.

How to Work with the LTCOP When LTCO request information on behalf of a resident or ask questions related to a complaint, please remember that the LTCOP represents residents and advocates on their behalf. Federal law grants LTCO access to resident information (with resident permission) and LTCO are required to keep that information confidential. In accordance with federal law, facilities must provide the LTCOP with immediate access to residents. Respect the residents’ right to complain and their right to contact the LTCOP.

How to Work with the LTCOP Keep in mind that LTCO cannot share resident information without their consent. Some residents may choose to remain anonymous during the complaint process. Contact the LTCOP if you know a resident that may benefit from a visit with a LTCO. Share information about the LTCOP with residents, family members and your co-workers.

How to Contact the LTCOP Nursing homes are required to post contact information for the LTCOP so you can reach the program using that information. Some states require assisted living facilities/board and care facilities to post information about the LTCOP. Visit the National Long-Term Care Ombudsman Resource Center website to locate your local or state LTCO: http://www.ltcombudsman.org/

Ombudsman Resource Center (NORC) website For additional information about the LTCOP, please visit The National Long-Term Care Ombudsman Resource Center (NORC) website www.ltcombudsman.org ombudcenter@theconsumervoice.org The National Consumer Voice for Quality Long-Term Care (formerly NCCNHR) http://www.theconsumervoice.org/ This presentation was supported, in part, by a grant from the Administration on Aging, Department of Health and Human Services.