Ombudsmen: Championing adults in long-term care

Photo courtesy of Pixabay

By SELENA SEABROOKS

The Dallas Examiner

 

An ombudsman is an official or advocate who is appointed to investigate individuals’ complaints against an inefficient or dishonest administration. Since October, the ombudsman program has served 10,438 residents in Dallas County. African Americans make up nearly 24% of that population.

The Long-term Care Ombudsman program, offered through the Senior Source, is a federally mandated program that was established with the Older Americans Act of 1965. The act was the first federal-level initiative aimed at providing comprehensive services for older adults. Signed into law as a response to concerns about the lack of community social services for older persons, the act established grants to states for community planning and social services, research and development projects, and personnel training in the field of aging. Since the program is federally mandated, the services are free and available in all 50 U.S. states and Puerto Rico.

Assisted living and long-term care ombudsmen are resident-directed advocates, meaning that they must understand the wishes of the resident and have the resident’s permission or consent to take action. Issues of concern may include nutrition, personal care, safety concerns, financial mismanagement, etc. – anything that impedes or impairs the resident’s quality of life.

“If a family member calls me and says, ‘My mom is not showering and she’s not eating in the dining room. Can you please help?’ I’m going to say, ‘Definitely.’ I’m going to go talk with your mom, but I need her permission to take action, and I need to know what she wants to do. … Ultimately, I’m going to respect her wishes and her rights as a whole person to make a decision … I would get her permission and advocate for what it is she wants,” explained Assisted Living Ombudsman Mindy Kitchens

Long-term Care Ombudsman Arrelle Turner explained that in her role, she visits nursing and assisted living facilities daily, talks with the residents or their family members and addresses issues and concerns they may have regarding the resident’s care.

An ombudsman is also tasked with making quality-of-life observations, checking for quality-of-life concerns and systemic issues and potential violations of regulations.

“If I see egregious abuse or neglect happen, in front of my own face, I can’t do anything about it unless I have permission from the resident involved,” Kitchens said. “One of the things I’ll do in that instance is really encourage them to find a staff person they trust. If there is someone that we can identify together, we’ll get that person in the room and try to get them to tell the story to that staff person, and then I will remind that staff person that you are a mandate report and you must report this.”

An ombudsman has a complex role of being a confidant, an advisor, an advocate and a mediator. However, the reasons they become an ombudsman are usually more simplified.

When Kitchens was growing up, she and her family cared for her Aunt Tuts, whose husband had passed away. The family’s Saturday activity was to pick up Aunt Tuts and take her out to breakfast, do her shopping and to spend the day with her.

“My Aunt Tuts, I see her in every resident that I care for, that I help, and I feel like I see her every day,” Kitchens said explaining her motivation to become an ombudsman.

Turner stated that she has always been interested in helping older adults.

“That’s always been my passion, even when I was in college. I worked as a direct care staff in a state-supported living center, which isn’t necessarily long-term care, but it’s still providing most of the people in that facility, who are older, and that is where I found that I do like working with the older population. Especially because, most of the people in long-term care are more vulnerable, so I’ve always just had an interest in making sure that those who are most vulnerable are protected,” Turner explained.

 

Issues and concerns

As an assistant living ombudsman, Kitchens handles a variety of issues that include concerns with food preferences, roommate disagreements, housekeeping concerns, pest control, concerns with the staff, abuse and neglect, exploitation, misuse of money or the wishes of the resident not being respected by the power of attorney.

“A lot of times, I’ll get a resident that knows me, that’s comfortable with me, who will express some concerns that are very real concerns, and they don’t want me to do anything because they are afraid of the potential consequences. So, then, I need to keep their information confidential. I will make a note of that, and I’ll keep bringing it up. I’ll keep monitoring it, and if I can see that whatever this person has disclosed to me is happening to two or three, four or five other people, at that point, I can call it systemic. And I can be the complainant, and I can address it without having to bring up anyone’s name,” Kitchens stated.

Turner stated that the most common issue she addresses is connected to the failure to respond to requests for assistance.

“That’s mainly associated with call lights … I get a lot of concerns from residents that staff aren’t answering their call lights in a timely manner or at all and that they’re not getting whatever care assistance that they need from staff,” Turner said.

Additionally, although an ombudsman cannot make recommendations, he or she can speak to families and potential residents and discuss how to select an assisted living facility or nursing home. They can also discuss the types of complaints they have handled at a specific facility.

“We can help family members narrow the list, as far as long-term care facilities. So, we often get calls from family members or people who are looking for long-term care. And we can help them go through that list and figure out what they need to do in order to find a place for their loved one. Things they need to look out for, different facilities that are more applicable to their loved one’s needs,” Turner added.

 

The importance of involving an ombudsman

Residents and family members should try to resolve concerns with the facility, but if the issues aren’t resolved, an ombudsman may be a welcoming advocate.

“The importance of having the ombudsmen involved is that you have someone in your corner that knows the regulations and who knows how to appeal to the facility to do the right thing,” said Kitchens. “When I’m involved in a case, I am the one directly communicating with the facility, doing the advocacy. But I may also be on the sidelines, teaching the family, the resident, what their rights are, what they have the ability to ask for, what they can expect for an outcome.”

It is the resident’s right to choose whether they would like to have an ombudsman and an ombudsman cannot guarantee success.

“When an ombudsman is not involved in something, what I can see happening is families, residents, not really knowing their rights and not really knowing the rules, and so maybe not having a successful self-advocacy strategy just because they’re not really sure, and there’s nobody there to tell them what they can reasonably expect,” Kitchens emphasized.

Nursing homes have different rules and regulations than assisted living facilities. And though facility management is aware of those rules and regulations, they may not always act in the best interest of all of its residents.

“I have seen sometimes maybe the facility has told the family member or resident something that is a direct violation of the regulations, and maybe that family member or resident doesn’t know because the regulations are pretty detailed and lengthy. It’s not something you would just know off hand. I’ve seen where the facility has been able to get away with giving them incorrect information that I may have otherwise been able to tell them or how them that, that wasn’t correct,” Turner shared.

The time that it takes to resolve a single concern varies based on the specific issue and the severity of the matter.

“In my experience, it’s a lot faster to get something resolved if I can point to a rule or point to something in the contract and say, ‘You’ve agreed to this. They’re asking for this thing that you’ve agreed to. How can we come together and make this work?’ That’s a pretty fast resolution time, typically, but if it’s something a little more objective and there’s not an associated rule, it can drag,” Kitchens explained.

 

Challenging cases    

“The most challenging case for me was a situation where there was a serious, serious pest control issue, where I was able to observe it with my own eyes, and I had residents that were bedbound, who had no way to seek help because assistant living facilities are not required to have a call button system unless they have more than one floor.… So pest and beds, with bedbound residents who can’t get assistance, and to see that … broke my heart because these people that I know are suffering.”

Fortunately, Kitchens was able to get the appropriate assistance and was able to have the residents temporarily moved to safety, until pest control was able to remedy the situation. This specific situation was resolved in approximately one month, from the time that the issue was reported to residences being able to return to the facility.

“It took a lot to get the folks that are able to enforce the regulations to actually make the move,” Kitchens said reflecting on the incident.

Turner recalled an incident that occurred within the pandemic and cited that there were several issues with visitation in long-term care facilities. She explained that several facilities were not allowing family members to visit their loved ones due to fears of a COVID outbreak. She explained that at some point, some of those restrictions were uplifted.

“This family member was not being allowed to visit their loved one and their loved one was in the process of passing. I was able to advocate for that family member to be able to get into the facility and visit with her loved one during their final moments,” Turner remembered.

 

Contacting an ombudsman

Ombudsmen make regular visits to nursing homes and long-term care facilities and visit as many residents as possible during their visits. They also leave their business cards at the facilities for those that would like to contact them. Additionally, facilities are required to include the ombudsman’s contact information in the resident’s packet at the time of admission and to post signs at the facility. Residents and family members can also learn more at https://www.theseniorsource.org.

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