In 1972, when the federal Long-Term Care Ombudsman (LTCO) program began as a demonstration project, Boomers were just out of college or beginning junior high. The project was in response to widely reported problems involving poor quality of care in nursing homes. Over time, the program was expanded to all 50 states and now its scope includes board and care, community living homes for the disabled, and assisted living facilities.
Today, it plays a unique role in protecting and promoting long-term care residents’ health, safety, welfare, and rights. The program’s services are not duplicated by any other federal agency, according to The National Ombudsman Resource Center.
Based out of the Athens Community Council on Aging, the local office is responsible for facilities in 25 counties in the region, employing seven staff people and four trained volunteers who make at least 700 on-site visits in a year. They must go in every licensed long-term care facility at least once a quarter.
However, that proved impossible during last year during the Covid-19 pandemic, says Liz Schulze, program coordinator. “From March to October, we were not able to be in the buildings although we were still doing complaint work by phone and virtually.”
As might be expected, many complaints during 2020 were about infection control, which the ombudsman has limited ability to address, instead referring complainants to the state Department of Public Health or the state licensing division.
Once the facilities began to open up a little in the fall, some residents and their families were frustrated because some facilities were strict and others more flexible in terms of number of visits and whether visits were in rooms or lobbies. Nursing homes must go by the strictest guidelines from the Centers for Medicare and Medicaid Services, while personal care homes and assisted living facilities must adhere to guidelines from the state department of health or executive orders from the governor. Some of those decisions were based on the community’s rate of infection. Now following a May update on guidelines, there’s more flexibility depending on the vaccination status of the visitor and the resident.
“While we have been allowed in since October, we also have to wait 30 days if a facility has had an active Covid infection,” says Schulze. There was a spike in January and February but by May and June, “things have felt more normal.”
Typically, in-person visits include observations of the building, staff interactions, residents’ clothing and appearance, and communication with residents themselves. These visits are conducted by the local ombudsman staff or trained and certified volunteers. Each facility also has a residents’ council, which ombudsmen are required to attend and inform the council of their rights. In addition, the ombudsmen train staff on residents’ rights and their legal obligation to report abuse.
According to Melanie McNeil, state ombudsman, the number of complaints statewide during the past year was down by a third; 2019 saw 5,199 complaints compared to 3,672 in 2020.
“We take complaints from anyone – clergy, friends, service providers,” she explains.” The program’s mandate is to represent the resident and assist at his or her direction. The resident must consent to investigating a complaint or referring it to another agency. If someone else files the complaint, the ombudsman must determine, to the extent possible, what the resident wants.
Year in and year out, nursing home complaints tend to fall into three categories according to The National Ombudsman Resource Center: improper eviction; unanswered requests for assistance, and lack of respect for residents, poor staff attitudes. In other types of residential care communities, the most frequent complaints include improper eviction, administration and organization of medications, and quality, quantity, variation, and choice of food.
“We’re there to help them have as good an experience as they can,” explains McNeil, “but we don’t have enforcement power. We don’t get into clinical care. If there’s a problem in that area, we encourage them to call the regulatory folks.”
And sometimes a resident will complain to an ombudsman but not give permission to relay that complaint or take any kind of action. In that case, the ombudsman might discreetly inquire of other residents to see if the issue is broad based or individual.
“We look for strategies that won’t get anyone in trouble or retaliation,” explains McNeil. “We try to create rapport with residents.”
Schulze adds, “We’re a resident’s advocate—we provide an extra voice for them. We remind staff that while this may be your workplace, this is the resident’s home. Knock before entering, provide choice in diet, self-determination. This is a person, not just a resident. It’s not moving boxes, it’s people.”
What concerns does an ombudsman address?
- Violation of residents’ rights or dignity
- Physical, verbal, or mental abuse, deprivation of services necessary to maintain residents’ physical and mental health, or 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
The right of citizenship
Nursing home residents do not lose any of their rights of citizenship, including the right to vote, to religious freedom and to associate with whom they choose.
- The right to dignity. Residents of nursing homes are honored guests and have the right to be so treated.
- The right to privacy. Nursing home residents have the right to privacy whenever possible, including the right to privacy with their spouse, the right to have their medical and personal records treated in confidence, and the right to private, uncensored communication.
- The right to personal property. Nursing home residents have the right to possess and use personal property and to manage their financial affairs.
- The right to information. Nursing home residents have the right to information, including the regulations of the home and the costs for services rendered. They also have the right to participate in decisions about any treatment, including the right to refuse treatment.
- The right of freedom. Nursing home residents have the right to be free from mental or physical abuse and from physical or chemical restraint unless ordered by their physician.
- The right to care. Residents have the right to equal care, treatment and services provided by the facility without discrimination.
- The right of residence. Nursing home residents have the right to live at the home unless they violate publicized regulations. They may not be discharged without timely and proper notification to both the resident and the family or guardian.
- The right of expression. Nursing home residents have the right to exercise their rights, including the right to file complaints and grievances without fear or reprisal.