Greetings and Thank you for inviting me... introduce myself. Greetings and good afternoon to everyone Thank you for allowing me to present and educate the Council members on the Long Term Care Ombudsman Program My Name is Pamela Williams, I am the Regional Long Term Care Ombudsman for King County What I plan for today's presentation is :   Describe and provide a Summary overview of the program. The history of the program and ombudsman role Share a few examples of our work Focus some time on Resident's Rights Give a case example Then open up to questions and answers the discussion Pamela Williams, MS Regional LTC Ombuds – King County LTC Ombudsman Program March 2019

. Ensuring the rights, dignity and well-being of individuals living in long-term care today and tomorrow   Role of the LTC Ombudsman- Long-term Care ombudsmen are advocates for residents of nursing homes, assisted living facilities and adult family homes. We believe that “Dignity and Quality of life are a Right and not a Privilege”. We are trained to receive complaints and resolve problems in situations involving quality of care, use of restraints, transfer and discharge, abuse and other aspects of resident dignity and rights.  Basic Program Description LTCOP is Mandated by the federal Older American’s Act Our mission statement is: Ensuring the dignity, rights and well being of individuals living in long-term care, today and tomorrow. When I say LTCOP--- its an acronym for the Long-Term Care Ombudsman Program. The origins History of Ombudsman Program was a result of a directive by President Nixon in 1971 in response to abuses that were occurring in nursing homes and failed oversight by regulators. There was Rapid growth in the nursing home industry after the creation of Medicare and Medicaid- 1965. In the late1960's several publications were written about abuse, neglect and the substandard conditions in nursing homes. A notable report by Ralph Nader was a catalyst for public action. There was testimony shared in US Senate Hearings where lawmakers heard about the stories of poor care resulting in the death or residents, making headlines.

We are facilitators of informal conflict resolution. The role of the ombudsman: Here is a simple graph showing Ombuds roles. The word ombudsman is a Swedish word . It means “one who speaks on behalf of another.” What do we do? Listen to problems concerning quality of care and quality of life. Provide information about residents rights and We clarify and respond to questions raised by residents, family members, staff and the community. We are facilitators of informal conflict resolution. Investigate and resolve long-term care facility residents' complaints; Promote the development of citizen's organizations and train volunteers; Identify significant problems systemic issues and bring them to the attention of appropriate public agencies; Monitor the development and implementation of federal, state and local long-term care laws and policies; Some key things to know about how we do our work: Work at the lowest possible level, we work on behalf of the resident, Our work is resident oriented and driven. We are advocate ombudsmen impartial investigatior’s, determining the facts pertinent to a case. *** Then we become the advocate, seeking a resolution the residents want. Gain access to long-term care facilities and to residents' records; and Protect the confidentiality of residents' records, complainants' identities and ombudsman files.  

Long-Term Care Ombudsman Role Work to resolve problems Analyze and make recommend changes in laws Advocate We have three primary responsibilities: Ombudsmen work to resolve problems of individual residents and to bring about changes at the local, state and national levels to improve care. We also analyze, comment on and make recommend changes in laws and regulations pertaining to the health, welfare and rights residents and facilitate public comment on laws, regulations, policies and actions. We advocate for changes to improve residents’ quality of life and care

35 Certified Ombuds Volunteers 4 Full-time Equivalent Staff Ombudsman Read the slide: How do we do all of this? We do it through our localized program that is managed by the regional ombudsman, who oversees a group of fantastic staff and volunteers. King County local office is located in Federal Way, we currently have 35 volunteers as certified ombudsmen and about 6 paid staff. More about Ombuds qualifications: Pass a Background and criminal history check Pass our interview screening, including attend a mandated certification course which takes approximately 32 hours. It includes site visits. They must of course meet the COI law requirements. No special prior background in aging, disability rights or law needed. Most of our ombuds are retirees, most are professionals. Some come to us with backgrounds in health and human services, but most do not. They must maintain their certification by volunteering at minimum 4 hours per week, in visiting assigned facilities, complete documentation as required, maintain strict code of confidentiality, ombuds are not mandated reporters and are not allowed to recommend facilities. They must attend 75% of monthly meetings. 35 Certified Ombuds Volunteers 4 Full-time Equivalent Staff Ombudsman 1 Victims of Crime Assistant- VOCA Training Specialist 1 State Office Technical Assistance

Authority to Act Federal Statute: Older Americans Act, Title III, Sec. 307 (a)(12) State Statute: Revised Code of Washington 43.190 State Regulation: Washington Administrative Code 365.18 In 1978 Amendments to the Older Americans Act (OAA) elevated the Nursing Home Ombudsman Program to a statutory level. The statute and subsequent amendments required all state agencies on aging to establish an ombudsman program that would carry out activities: Resolves complaints made by or for residents of long-term care facilities Educates consumers and long-term care providers about residents' rights and good care practices Promotes community involvement through volunteer opportunities Provides information to the public on nursing homes and other long-term care facilities and services, residents' rights and legislative and policy issues Advocates for residents' rights and quality care in nursing homes, personal care, residential care and other long-term care facilities Promotes the development of citizen organizations, family councils and resident council (One of the things noteworthy about Washington State Ombuds is that the office is not within the State Government) we are housed in a non-profit, private organization and not within a state agency   Then in 1987 OBRA happened which changed nursing homes significantly. Omnibus Reconciliation Act of 1987… Amendments were made to the Older Americans' Act, changes related to the LTCOP were: States required to provide for Ombudsman access to residents and residents' records; RCW Immunity for ombudsmen for good faith performance of their duties; and RCW Prohibition of willful interference with the official duties of an ombudsman and/or retaliation against an ombudsman, resident, or other individual for assisting the ombudsman program in the performance of their duties. Show Yellow Poster- read hotline phone number.

Certification Process Find the right volunteer and staff to do the work! Screen for qualifications Criminal background and history check References, experiences, interview Attend and complete training Be recommended for certification Assigned to facility Performance evaluations and ongoing training requirements must be met

WAC 365-18-040 Conflicts of Interest All ombuds shall be free from conflicts of interests including: (a) No ombuds shall be or have been employed by or participated in the management of any long-term care facility, or have or have had the right to receive remuneration from a long-term care facility, including work as a paid consultant or independent contractor, currently or within the past year; (b) No ombuds or member of his or her immediate family shall have, or have had within the past year, any pecuniary interest in a long-term care facility or a long-term care service; One of the key criteria for the LTC Ombudsman Program is that the Ombuds must be free from conflicts of interest. This goes for me as the Regional Ombuds, as well as all certified ombuds. It also stands true for the State Office of the Ombuds.

Training Topics include: Program History, laws, and regulations Ombuds roles and functions Aging and common illnesses Communication The Long-Term Care Setting and licensing regulations Residents’ Rights Legal issues Documentation, policies and procedures Data collection

Residents Rights Laws and Regulations in Washington State RCW 70.129 (AFHs, BHs and ALs) WAC 388-97 (Nursing Homes) http://www.leg.wa.gov/wac/ (title 388) (Federal; 42 CFR 483) These are the specific resident rights laws and regulations in Washington State that you must know if you work with LTC residents. Residents Rights laws apply to all licensed long-term care facilities in Washington. These rights are provided through OBRA Act of 1987- federal nursing home reform law and then later through federal regulations under Medicare and Medicaid requirements for Long-Term Care Facilities in 1991. Federal laws pertain only to nursing home settings and not other settings. However most states have residents’ rights laws addressing all settings, which is the case for our state. The law can be found under RCW 70.129.

RCW 70.129 Residents Rights Residents shall: receive appropriate services be treated with courtesy continue to enjoy their basic civil and legal rights have opportunities to exercise reasonable control over life decisions have choice, participation, privacy have opportunities to engage in religious, political, civic, recreational, and other social activities that foster a sense of self-worth and enhance the quality of life.
     When our State Legislature Passed 70.129 it was their intention that all the rights given to nursing home residents be the same for all licensed long-term care facilities. All LTC Residents shall: Read slide

RCW 70.129 Residents Rights LTC facilities must promote maintenance or enhancement of each resident's quality of life. Residents should have a safe, clean, comfortable, and homelike environment. LTC facility should allow the resident to use his or her personal belongings to the extent possible. (Read slide) Facilities as institutions and the people who work in them must promote resident rights, and actively assist residents in exercising their rights. Ex.(Ask) A resident who asks for legal assistance? Who’s responsibility is it to assist the resident in this matter? Case: SE Washington Individual with dementia, placed against his will in a care facility by his Durable Power of Attorney.

King County Region FTE Staff = 4 Volunteers = 35 Facility Count Bed Count Skilled Nursing 56 5,788 Assisted Living Facility 156 9,402 Adult Family Home 1,099 6,227 Totals 1,311 21,417 Each year we Seattle funds the program $73, 354 or 3.54 per resident. We are an advocacy program for people who cannot speak for themselves. Everyday approximately 10,000 people are turning sixty five and may need long-term care. The bed count of our shared jurisdiction for long term care is currently 21, 217 and still growing. It is imperative that this program continue to grow. Please consider our program when making discretionary funding decisions. FTE Staff = 4 Volunteers = 35 FY 2018 Complaints Resolved = 1,364 **City of Seattle contributes $73,354 annually, or $3.54/resident bed

We identify, receive and resolve complaints Approx. 21,412 beds 1,364 complaints/3,768 consultations 5,100 volunteer service hours 2,423 LTC facilities visited Data from the Federal Fiscal Year 2018  To give you some idea of the breadth of our work, here are some statistics: And there are approximately 21412 care beds across the spectrum. LAST YEAR: • We received approximately 1520 complaints and resolved 90% of those complaints. • 2423 individual visits were made to care facilities in 2018 King County • 5100 hours of service were donated by volunteers. King County has Approximately 1311 care facilities. The majority of the facilities are adult family homes. Here in King, there 35 active volunteer ombudsmen. King county staff ombudsmen recruit and support the volunteers, as well conduct investigations, conduct outreach and facilitate meetings with providers We Receive and work to resolve complaints between residents and the service provider or care facility. This is the primary task of King County LTCOPs and the State LTCOP Hotline. We inform and assist individuals in understanding their rights as citizens and as residents of care facilities. Residents and facilities often don’t understand that residents have the same basic civil rights that we all have and enjoy. In fact, residents of care facilities have extra rights. Ombudsmen educate others about residents rights often and we monitor to make sure that rights are being exercised. We’ll talk more about that later today. The Legislature directed LTCOP to resolve complaints “at the lowest level.” Therefore, LTCOP’s policy is to attempt to resolve complaints that have to do with the facility, as their first step. Only if the facility refuses to work on a solution or fails to cooperate, then we’ll refer to an enforcement agency, such as DSHS. Some advocates refer to the Ombudsman as the “canary in the coal mine”. By this they mean that the Ombudsman are the trusted confidant and advocate on behalf of the residents- we have information that’s very useful administrators and state regulators and we should be accessed when they are looking at quality issues

Common Types of Complaints care complaints (failure to respond for calls of help) medication issues failure to provide therapies abuse/Neglect (verbal, emotional and psychological) poor staff attitudes, lack respect, dignity issues personal care issues failed to exercise choice, preferences unlawful discharges/transfers/abandonment What Concerns Does an Ombuds Address? The top three complaint topics have to do with Problems with Care, violations or problems with residents exercising their individual rights and problems regarding admissions, transfers, and discharges. •Problems with Care- examples- call lights not being answered, medication administration problems, and poor attention to personal hygiene care… •Violations or problems with residents exercising their individual rights. -examples Privacy issues, loss of dignity, poor staff attitudes – emotional abuse. •Problems regarding admissions, transfers to/from care facilities and discharges. (most complicated time) All Violations of residents' rights or dignity consist of: Physical, verbal or mental abuse, The deprivation of services necessary to maintain residents' physical and mental health, unreasonable confinement Poor quality of care, including inadequate personal hygiene and slow response to requests for assistance Improper transfer or discharge of patient Inappropriate use of chemical or physical restraints Any resident concern about quality of care or quality of life

Thank you! From the Ombuds perspective, we see the world of long-term care through the lens of Residents Rights. A good quality of life, good quality of care is achieved through, Residents Rights. Its from this foundation, this law, this mandate, that drive ombuds work.   For anyone interested in becoming a certified LTC volunteer we have an upcoming certification class scheduled April 23,24, 29 and 30. Please see me for additional information. At this time I would like to invite questions, your comments and let’s have a dialogue. Thank you. Pamela Williams, Regional LTC Ombuds - 253.838.6810 or pamela.williams@mschelps.org www.waombudsman.org