1. Ombudsman and Resident Rights Training
Natalie Nathan, MHS, certificate in Gerontology
Area 3 senior services agency

2. History of the Ombudsman Program
The word “Ombudsman” is a Swedish word meaning citizen advocate
Resident advocate
Reports of substandard conditions at facilities in the late 60’s and early 70’s led to the development of the Ombudsman Program in the United States
These are the stigmas many facilities are still fighting against today
Amendments to the Older Americans Act continue to improve the program’s ability to advocate on behalf of residents of long term care facilities
Including assisted living facilities
Many media reports regarding abuse, neglect and substandard conditions
Development of improved compliance standards
Senate report in September 1975 by the Subcommittee on LTC:
40% of drugs in NH’s are central nervous system drugs, painkillers, sedatives or tranquilizers
Tranquilizers constitute almost 20% of total drugs – the largest category of any NH drugs
20-50% of medications in the US NH’s were given in error
Nurses have little training in geriatrics and are unprepared to work in LTC facilities.
In 1973 there were 6400 NH fires with an estimated 500 deaths. Compounding the problems, many patients are under sedation and bound with restraints.
33% of all fires were caused by smoking or matches (most commonly between hours of midnight and 6am)
35% of all NH fires occurred in wood frame buildings or had flammable carpets, curtains and vinyl upholstery
Source:

3. 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 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.

4. What does the Ombudsman Program do?
Advocate and support resident concerns and complaints
RESIDENT directed
Help improve residents’ quality of life
Educate residents, their family and facility staff about resident rights
Provide information to the public on long-term care facilities and services, residents' rights and community resources
Help resolve complaints made by or on behalf of long-term care residents
Systemic change
Advocate – Meet with residents, resident council meetings, care plan meetings, Licensing and Certification & Bureau of Facility Standards
Community Education – presentations, facility lists, referrals - elder law attorneys, pay source, tip sheets on how to select a facility (size, menu, staffing, location, interview other residents, visit in evening or weekends).
Complaints may come from residents, staff, family, care providers – hospitals, home health / hospice
Violation of resident rights or dignity
Physical, verbal or mental abuse, deprivation of services necessary to maintain residents’ physical and mental health
Poor quality of care, including inadequate personal hygiene and slow response to requests for assistance
Improper discharge or transfer

5. What Ombudsman Programs cannot do
Conduct licensing and regulatory inspections or investigations
Perform Adult Protective Services investigations
Provide direct care for residents
This includes pushing wheelchairs
Advocate – Meet with residents, resident council meetings, care plan meetings, Licensing and Certification & Bureau of Facility Standards
Community Education – presentations, facility lists, referrals - elder law attorneys, pay source, tip sheets on how to select a facility (size, menu, staffing, location, interview other residents, visit in evening or weekends).
Complaints may come from residents, staff, family, care providers – hospitals, home health / hospice
Violation of resident rights or dignity
Physical, verbal or mental abuse, deprivation of services necessary to maintain residents’ physical and mental health
Poor quality of care, including inadequate personal hygiene and slow response to requests for assistance
Improper discharge or transfer

6. Five Most Frequent Assisted Living Facility Complaints in Administration on Aging website:
Quality, quantity, variation and choice of food
Administration and organization of medications
Inadequate or no discharge/eviction notice or planning
Lack of respect for residents, poor staff attitudes
Building or equipment in disrepair or hazardous
Obtained from Administration on Aging website

7. Five Most Frequent Nursing Facility Complaints in 2013
Improper eviction or inadequate discharge/planning
Unanswered requests for assistance
Lack of respect for residents, poor staff attitudes
Quality of life, specifically resident/roommate conflict
Administration and organization of medications

8. Residents have the right to:
Be Fully Informed
Available services and charges, facility rules and regulations, Ombudsman services, state survey reports
Participate in One’s Own care
Informed of changes,
review records, refuse
Restraints, participate in care plans & treatments
Transfer and Discharge
Receive 30 day written notice prior to d/c or transfer with notification of right to appeal
Dignity, Respect & Freedom
Free from abuse, neglect, seclusion; treated as an adult; self determination, security of possessions.
Complain
To staff, Ombudsman, Licensing and Cert, BFS without fear of reprisal and with prompt response
Privacy and Confidentiality
Unrestricted contact with person of choice; privacy regarding personal care, mail, medical or financial affairs
Visits
Doctor, friends, family, surveyor, legal – any person they want including the right to refuse
Independent Choices
Make personal decisions, needs and preferences, community activities, resident council
Ombudsman programs help residents, family members, and others understand residents’ rights and support residents in exercising their rights guaranteed by law. Most nursing homes participate in Medicare and Medicaid, and therefore must meet federal requirements, including facility responsibilities and residents’ rights.
Regardless of the type of facility all residents have the right to be protected from abuse and mistreatment and facilities are required to ensure the safety of all residents and investigate reports of mistreatment.

9. Staff’s Role in Protecting Resident’s Rights
Know the rights of your patients
State regulations require facilities develop policies and procedures to ensure that resident rights are promoted and protected in a facility.
It’s the administrators responsibility to provide appropriate training. Allow residents to make choices about their care
As a caregiver, it is important that you know and enforce those rights.
Protect resident’s dignity and privacy 24/7 – knock before entering room
Keep door closed during personal care
Don’t discuss resident information in hallways
Allow residents to make choices about their care
Listen to residents/families who have concerns about resident’s rights.

10. Why are Resident Rights Sometimes Ignored or Violated?
Lack of awareness of resident rights by residents,
caregivers, family and administrators
Loss of empathy or sensitivity to the plight of disabled,
elderly or ill residents by caregivers or others
Facility staff shortages
Treating residents as children, not adults
Lack of adequate training

11. How can we protect resident rights?
Ensure residents, family, caregivers, and managers are aware of the rights
Ensure caregivers have received the proper training for tasks they are performing
If you see something, say something. Report anything that doesn’t feel right
Learn more about the resident's life history which helps to see the person as an adult with a lifetime’s worth of experience
Are staff given a copy of the residents rights? How often are they reviewed?
When do residents receive a copy of residents rights? How often are they reviewed? Do you feel they understood the document on admission when facing an overwhelming amount of information.
“Walk a mile in their shoes.” Stress empathy and respect for residents. Ask yourself, “How would I feel if I were treated like that?”

12. Understanding that residents may go through a tremendous amount of loss moving into a facility – loss of loved ones, home, pets, possessions, independence
Each person will experience loss differently - Isolation, anger, grief
Understanding their needs and respecting their rights is an important step to creating a new home

13. Area 3 Senior Services Agency
Information and Assistance
Home delivered meals, home maker services, respite
Adult Protection
Investigates reports of abuse, neglect and exploitation of vulnerable adults 18+
Ombudsman
Advocate for residents in long-term care facilities
Area 3 Senior Services Agency
701 S. Allen St.
Meridian, Idaho 83642