Long-Term Care Ombudsman Services in Indian Country Louise Ryan, Ombudsman Program Specialist, Office of LTC Ombudsman Programs, ACL/AoA C. Ruthie Albert-Tulene, Long-Term Care Ombudsman

Overview Long-Term Care Ombudsman Program Long-Term Care Facilities- A Broad Perspective One Tribal/State Specific Example Next Steps to Interact with Your Long-Term Care Ombudsman Program

Broad perspective Questions for Dialogue Do you have unmet needs for your tribal members who live in long-term care facilities? Do your tribal members who live in long-term care facilities currently have access to long-term care ombudsman services? Do you have suggestions for how ACL/AoA can support development of culturally competent services to tribal members who live in long-term care facilities?

Long-Term Care Ombudsman Programs seek resolution of problems and advocate for the rights of residents of long-term care facilities. The goal? Enhancing the quality of life, promotion of rights and ensuring care of residents.

Long-Term Care Ombudsman Program The Older Americans Act (OAA) establishes the Long-Term Care (LTC) Ombudsman program as a person-centered consumer protection service. It resolves problems and advocates for the rights of individuals in order to maximize the independence, well-being, and health of individuals residing in: Nursing facilities Assisted living Board and care Other similar adult care facilities. 5

LTC Ombudsman Functions: OAA Section 712 Requires the State Ombudsmen to: Identify, investigate and resolve complaints made on behalf of residents; Provide information to residents about long-term care services; Ensure that residents have regular and timely access to ombudsman services; Represent the interests of residents before governmental agencies and seek administrative, legal and other remedies to protect residents; and Analyze, comment on, and recommend changes in laws and regulations pertaining to the health, safety, welfare and rights of residents. 6

LTC Ombudsman Program There are 53 state ombudsmen (50 states, plus the District of Columbia, Puerto Rico, and Guam) State LTC Ombudsman designates representatives of the Office both staff (1233 FTE) and volunteers (8290) Both centralized and de-centralized program structures (often through area agencies on aging) Ombudsmen nationwide completed resolution work on 190,592 complaints (FFY 2013). Ombudsmen resolved or partially resolved 73 percent of these complaints to the satisfaction of the resident or complainant. 7

Staff and volunteers Each state has one State Long-Term Care Ombudsman The State LTC Ombudsman has the authority to designate representatives Representatives may be staff or volunteers (and are often called “ombudsmen”) Nationally, there are: 1226 FTE staff ombudsmen 8,290 certified ombudsmen volunteers 3,992 other volunteers Source: Administration on Aging, FFY 2013

Current Funding States support their LTC Ombudsman Programs through: ‒ Federal -- Older Americans Act funds (Title III, Title VII) and other funds (58%) ‒ State funds (36%) ‒ Local funds (6%) Extent to which these funds are available to tribes depends on tribal relationship to State. Title VI ‒ Tribes may use Title VI funds for ombudsman services, the services are to be “substantially in compliance” with provisions of Title III (Section 614(a)(9) of OAA).

Long-Term Care Facilities (as defined by the Older Americans Act) Nursing facilities, Board and care homes (i.e. personal care homes, adult family homes), Assisted living facilities, and Similar adult care facilities.

Facilities on tribal lands Any Medicaid and/or Medicare-certified nursing facility is required to provide residents with access to an ombudsman ‒A CMS (Center for Medicare and Medicaid Services) requirement ‒At least one tribal facility has been cited because residents did not have access to ombudsman services Regardless of the CMS requirement, ACL would like to work with tribes to assure that tribal members have access to culturally competent ombudsman services

What Should Residents & Families Expect? Rights – A person does not lose their basic rights when living in a long-term care facility Nursing Home residents have a protected set of rights – in federal law Every state has different regulations & laws for board & care, assisted living & similar - your Ombudsman is a great resource to explain the standards

Expectations? (some examples) Residents have the right to be free from abuse and chemical & physical restraints To have a care assessment and plan and to participate in one’s own care planning Right to privacy and confidentiality of records Right to choice, participate in the community Worship or practice traditions Protections from illegal evictions (in nursing homes)

Top Ten Complaint Categories Nursing Facilities – FFY ) Care plan/resident assessment inadequate, failure to follow plan or physician orders 7.) Accident or injury of unknown origin, falls, improper handling 8.) Symptoms unattended, including pain 9.) Food service - quantity, quality, choice 10.) Exercise preference/choice and/or civil/religious rights 1.)Discharge/eviction-planning, notice, procedure, implementation, including abandonment 2.)Failure to respond to requests for assistance 3.)Dignity, respect - staff attitudes 4.)Resident conflict, including roommates 5.)Medications - administration, organization

Top Ten Complaints – B&C/AL – FFY ) Resident conflict, including roommates 7.) Cleanliness, pests, general housekeeping 8.) Accident or injury of unknown origin, falls, improper handling 9.) Exercise preference/choice and/or civil/religious rights 10.) Care plan/resident assessment - inadequate, failure to follow plan or physician orders 1.)Food service - quantity, quality, choice 2.) Medications - administration, organization 3.) Discharge/eviction-planning, notice, procedure, implementation, including abandonment 4.) Dignity, respect - staff attitudes 5.)Equipment/building - disrepair, hazard

Food (Farmed to Foraged) Community (Local News) Family & End of Life Choices Advocacy via Education, Mediation and Interpretation Root of Concerns Language Hopi: Hopi & Tewa Pascua Yaqui: Yaqui & Spanish White Mountain Apache: Apache Care Touching Body Washing Clothing Cleaning Rooms

Next Steps Work with your AoA Regional Specialist, AoA Office of LTC Ombudsman Programs and AoA Title VI office to explore needs and options Contact your State Ombudsman to learn about various opportunities to work with the program – Most facilities are required to post ombudsman contact information – The National Ombudsman Resource Center (funded by ACL/AoA) has contact information for every State LTC Ombudsman and local entities: or (phone)

Next Steps in detail Create or expand LTC ombudsman services 1.Measure need for LTC advocacy Tribal members have access to LTC facility to remain on tribal lands Tribal members have to move off tribal lands to access a LTC facility 2.Review requirements of funding source(s), such as reporting: Example: Title VI 1 contact = 1 unit of service 3. Identify types of services that can benefit your tribal members Example: Title VI a)Provide information about problems of resident older Indians b)Investigate and resolve complaints made by or for older Indians residing in LTC facilities 4. Identify possible tribal staff that could deliver the service 5. Identify training needs to help staff deliver services successfully a)Locate local resources on or near tribal lands to provide information and make referrals b)Attend an Ombudsman Training to gain basic skills to investigate and resolve complaints of residents 6. If resources are limited, consider a working partnership with the State Ombudsman Office a)COSTS: Contractual Agreements, information sharing, and expense to support staff salary, training and travel b)BENEFITS: Access Title III and State funds, state/regional network, technical assistance and ongoing training

Discussion Topics with your State Ombudsman How do you train staff and volunteers to advocate in culturally sensitive ways? End of life needs and choices Care issues (collaboration between facility staff, physician, Tribal healer) Communication tools

Broad perspective Questions for Dialogue Do you have unmet needs for your tribal members who live in long-term care facilities? Do your tribal members who live in long-term care facilities currently have access to long-term care ombudsman services? Do you have suggestions for how ACL/AoA can support development of culturally competent services to tribal members who live in long-term care facilities?

Contact information: Ryan C. Ruth