The Long-Term Care Ombudsman Program History and Responsibilities under the Older Americans Act and California Law Sara S. Hunt, Consultant Adapted from a presentation of the National Long-Term Care Ombudsman Resource Center May 2007

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards History Growth in Nursing Homes –1965 Medicare and Medicaid Provided public money for care What Happened –Abuse –Neglect –Substandard care –Fires resulting in deaths Publicity About Poor Care and Owner Profits Congressional Hearings 1970 Apparent that systems to protect individuals had failed Improvements in quality of care needed

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Development Ombudsman Program –Idea developed by Dr. Arthur Flemming –Influenced by Swedish model –Proposed to President Nixon and included in his nursing home agenda in 1971 Presidential directive — help states establish units to respond to complaints made by or on behalf of individual patients Nursing Home Ombudsman Demonstration Projects contracts granted in 1972

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Development—Initial Steps Projects had impressive record of complaint resolution In 1975 all states could seek funds for ombudsman activities –Funding through the Administration on Aging (AoA) –To develop capabilities of Area Agencies on Aging for ombudsman activities The California LTCOP began in 1975 in the Department of Aging.

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Development—Growth 1978 All states were required to operate a Nursing Home Ombudsman Program –Enacted in amendments to Older Americans Act (OAA) –1981 changed to Long-Term Care Ombudsman Program due to expanded responsibilities –In 1979 California established the Long-Term Care Ombudsman Program in law.

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Evaluation Success of first Ombudsman Programs judged by –Number of community programs –Effectiveness in receiving and resolving complaints in An effective and A constructive manner. AoA Commissioner Flemming 1976

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Conclusions The laws and regulations enacted will be of little avail unless –“…communities are organized…to deal with the individual complaints of older persons living in nursing homes. –The individual in the nursing home is powerless.” AoA Commissioner Flemming 1976

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Job Description The Ombudsman Program was created to represent individuals in long-term care facilities. Ombudsman representatives help individual residents benefit from relevant laws and regulations.

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Job Description Prevention –Provide information to residents –Promote development of citizen organizations –Provide technical support for resident and family councils –Recommend changes in laws, regs, and policies to benefit residents

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Job Description Intervention –Provide access to ombudsman services –Assist residents in asserting rights –Identify, investigate, and resolve complaints made by, or on behalf of, residents –Seek legal and other remedies to protect residents –Analyze, comment on, and monitor laws, regs, and governmental policies on behalf of residents –Facilitate public comment pertinent to residents

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Additional Roles for California Ombudsman Representatives The witness of advance health care directives and property transfers Mandated reporters of abuse Responders to abuse

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Job Description-Summary On behalf of residents, ombudsman representatives are advocates for Resolving Individual Complaints Resolving Systems Issues Laws, Regulations, Policies

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Ombudsman perspective on the job: “The opportunity to speak up for someone who cannot do so for herself, to advocate for individuals or groups of people who otherwise might have no voice, no ‘seat at the table,’ keeps every day fresh and gives every meeting the potential to be important.” Esther Houser, Oklahoma State LTCO

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Ombudsman perspective on the job: “The greatest experiences I have had working as an ombudsman are listening to people and treating them as a valued human being; working with citizens to become volunteer ombudsmen, and facilitating staff, residents, and families to communicate with each other.” Vivian Omagbemi, Maryland Local LTCO

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Ombudsman Perspective on the job: “The handshake and thank you from a family member after a 2 hour care plan meeting…$500 That beautiful smile lighting up the face of the resident that you just promised to come back and chat with again real soon…$50,000 Filling out monthly reports and progress notes…$5

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards The look on the administrator’s face when you tell her that you personally have observed the facility in making a mistake that she considered nothing more than complaining by family member whose expectations were too high…Priceless

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Ah, the power of… an ombudsman!” Carol Schmidt, Maryland LTCO Volunteer

Long-Term Care Ombudsman Program History Development Evaluation Conclusions Job Description Rewards Thanks to the Administration on Aging and the California HealthCare Foundation for their support in the development and distribution of this presentation.