1. Ombudsman Partnerships with Legal Services: Enhancing Advocacy
Claudette Royal, NYS Long Term Care Ombudsman
Lisa Newman, Director, Region 15 Long Term Care Ombudsman
Lindsay Heckler, Staff Attorney, Center for Elder Law & Justice

2. NYS Ombudsman Program Structure
State Office: State Ombudsman, Senior Assistant State Ombudsman,
3 Assistant State Ombudsman, 1 Clerical, 1 Half-time Legal Counsel
15 Regional Programs: 14 Not for Profit Agencies, 1 AAA
(Approximately 35 full-time and 15 part-time staff statewide)
Volunteers: Recruited/trained in each region
(Approximately 560 statewide)

3. NYS Ombudsman Program Mission
To serve as an advocate and resource for older adults and persons with disabilities who live in long-term care facilities
NYS LTCOP provides services to Nursing homes, Adult Care Facilities and Family Type Homes
Approximately 1500 facilities
Over 160,000 residents
New York City encompasses about 1/3 of all homes and residents

4. NYS Ombudsman Program Overview

5. NYS Ombudsman Regionalization
Prior to regionalization 34 local programs
Post regionalization 15 local programs
Region 15 contracting agency-People Inc
Subcontract with Center for Elder Law and Justice

6. People Inc. Region 15 LTCOP Host Agency
Buffalo, NY non-profit People Inc. was created in 1970 by a small group of parents wanting to address intellectual disabilities
Now over in 9 counties, 200 residential sites, day programs, and regional offices with nearly 4000 employees
In 1993 People Inc. expanded to include senior living apartments; also, the agency operates a Senior Companion Program
When NYS LTCOP regionalized in October 2015, People Inc. looked to add the Ombudsman Program; talking with Center for Elder Law and Justice, there was mutual interest and the partnership was formed

7. NYS Region 15 LTCO Program
Most western region in the state and includes 4 counties totaling 5,543 square miles: Erie, Niagara, Chautauqua, Cattaraugus
60 skilled nursing facilities (SNF), 8826 beds; 60 adult care facilities (ACF), beds; 9 family type homes (FTE); 14,338 total residents
70+ volunteer ombudsmen covering 78 facilities, some covering more than one, some share a facility, some are “roving” ombudsmen
Currently 2 program staff and 1 contracted legal liaison
Assign volunteers to SNF first as priority, focusing on 1-2 stars
Complaints that are of legal matter are navigated to Center for Elder Law and Justice legal liaison

8. Center for Elder Law & Justice (CELJ)-Partner
Civil legal services agency in Buffalo, NY serving 8 WNY Counties.
Provide free legal services to older adults, people with disabilities, and the low income population.
Mission is to use the legal system to help clients live independently and with dignity.
Services help people maintain the essentials of life:
Access to health care;
Access to safe and affordable housing;
Access to sufficient income;
Protective services to improve overall quality of life.

9. Forming the Reg. 15 LTCOP-CELJ Partnership
Similar missions and same coverage area
Prior partnership: Western New York Pooled Trust
Same goal: improve quality of care in WNY nursing homes and assisted living facilities
Contractual relationship

10. Role of the Legal Liaison
Referring (“navigating”) the client (resident) between LTCOP and CELJ.
Training:
New ombudsman certification training presentations
Current ombudsman in-service presentations
Facility training and presentations
Community presentations
Guidance and research support – “in-house” legal support
Legislative advocacy
Systems advocacy
* Legal Liaison should (must) become a certified ombudsman! *

11. Common Referrals to CELJ
Discharge/eviction appeals: nursing home and assisted living
Medicare Appeals: Jimmo (skilled therapy); Coverage Denials
Medicaid Appeals:
Institution vs community budgeting
NAMI/Spenddown-budgeting
Denials
Representative Payee: facility is named representative payee
Financial Abuse: power of attorney
Substituted Decision Making (power of attorney; health care proxy)
Medical Bills

12. Training: Example Health Care Proxy
Basic resident right: right to make health care decisions
Situation: staff determination a resident ‘lacks capacity’ if they disagree with the resident’s decisions or if the resident has an outspoken family member who is the Agent.
Solutions:
Legal Liaison prepared NYS Health Care Proxy resident rights handout explaining the law;
With Region 15 LTCOP staff support, provided training to volunteer ombudsmen how to utilize the handout to advocate for the resident’s right to make own health care decision.
Joint CELJ/Region 15 LTCOP education to facility staff.

13. Ombudsman Advocacy and Legal Services Working Together
Ensuring residents receive skilled therapy services
Situation: nursing home states therapy services will be cut off because Medicare will not pay for as resident is “not showing improvement or “plateaued”.
Reg. 15 LTCOP-CELJ Partnership: goal is to keep therapy going
Legal Liaison: ombudsman and facility training on proper standards/Jimmo; connect resident to CELJ
Ombudsman: works with resident and facility to keep therapy going or to get it re-started
CELJ Attorney: handles the Medicare Appeal
Discharge to the community
Situation: resident is caught in the middle of ‘facility said’ ‘insurance said’
Ombudsman: discharge care planning
CELJ Attorney: investigates and handles insurance issues, Medicaid, other potential legal barriers

14. Nursing Home Discharges
Federal regulatory requirement to send discharge/transfer notices to LTCOP.
Reg 15 LTCOP receives the notices from regional nursing homes.
Legal Liaison-a certified ombudsman-: reviews and tracks the notices
Potential inappropriate discharges (i.e. to homeless shelters; different nursing home for “LTC”) and connect resident to CELJ for appeal assistance
Track patterns amongst ownership groups
Share information with State LTCOP for state-wide trends and potential future action

15. Assisted Living Evictions
New York Law:
30 day written notice is required
Facility responsibility to assist in safe transfer
Facility must commence a special court proceeding
Problem:
Facility pressure on resident to leave
Facility bears cost of bringing the litigation.
Ombudsman and Attorney pressure on facility to follow the law
30 day written notice?
Care plan meeting to discuss alleged change in condition?
Safe transfer?
Resident object to 30 day notice?

16. Reg 15 LTCOP and CELJ Partnership Current/future systems advocacy initiatives
Meetings with elected officials
Proposing and supporting legislation to improve quality of care
Public hearings
Comment on regulations
Media Interviews
Public Education
Emerald South White Paper
Resident Empowerment Initiatives

17. Considerations when forming a partnership with a Legal Services Organization
Research potential partners
Do they share similar mission with LTCOP? Goals? How will the partnership benefit the LTCOP client? Will the partnership further the goals of both the organizations?
Determine the type of partnership: contractual partnership vs memorandum of understanding
Define roles and expectations: i.e. Legal Liaison – CELJ staff attorney responsible for ensuring residents are connected to appropriate legal service.
Develop conflict of interest and confidentiality policies

18. Questions/Thank you