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

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.

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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.

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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.

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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 ombudsmen8,290 certified ombudsmen volunteers3,992 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 restraintsTo have a care assessment and plan and to participate in one’s own care planningRight to privacy and confidentiality of recordsRight to choice, participate in the communityWorship or practice traditionsProtections from illegal evictions (in nursing homes)

Top Ten Complaint Categories Nursing Facilities – FFY 2013

6.) Care plan/resident assessment inadequate, failure to follow

plan or physician orders7.) Accident or injury of unknown

origin, falls, improper handling8.) Symptoms unattended,

including pain

9.) Food service - quantity,

quality, choice10.) Exercise preference/choice

and/or civil/religious rights

1.) Discharge/eviction-planning, notice, procedure,

implementation, including abandonment

2.) Failure to respond to requests for assistance3.) Dignity, respect - staff attitudes4.) Resident conflict, including

roommates5.) Medications - administration, organization

Top Ten Complaints – B&C/AL – FFY 2013

6.) Resident conflict, including roommates

7.) Cleanliness, pests, general housekeeping

8.) Accident or injury of unknown origin, falls,

improper handling9.) Exercise preference/choice

and/or civil/religious rights10.) Care plan/resident assessment

- inadequate, failure to follow plan or physician orders

1.) Food service - quantity, quality, choice

2.) Medications - administration, organization3.) Discharge/eviction-planning, notice, procedure, implementation, including abandonment4.) Dignity, respect - staff attitudes5.) Equipment/building - disrepair, hazard

Food (Farmed to Foraged)

Community (Local News)

Family & End of Life Choices

Advocacy via Education, Mediation and Interpretation

Root of ConcernsLanguage• 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: www.ltcombudsman.org or 202.332.2275 (phone)

Next Steps in detailCreate 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 VIa) Provide information about problems of

resident older Indiansb) 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 successfullya) 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 Officea) 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 Louise Louise.Ryan@acl.hhs.gov

202-357-3503

C. Ruth Albert-Tulene cruthalbert-tulene@wmat.us