RELOCATING NURSING HOME RESIDENTS

in CLOSURES

Tom La Duke; Relocation Ombudsman Specialist

State of Wisconsin-Board on Aging and Long Term CarePO Box 180, Kenosha, WI 53141

(262) 654-4952 (phone) (262) 654-6194 (fax)Tom.Laduke@wisconsin.gov

Wisconsin’s Ombudsman Program

Wisconsin statutes authorize the Ombudsman program to

Investigate complaints concerning improper conditions in long term care

Serve as mediator or advocate to resolve disputes

Promote public education to improve conditions Monitor laws, regulations, and policies Publish materials and initiate legislation to

correct inadequacies

Wisconsin’s Ombudsman ProgramRegional Assignments

PAUL SOKOLOWSKI

Volunteer Ombudsmen Program

90 volunteers in SNF’s in 3 regions of the State and 15 in select CBRF’s

Training-orientation and quarterly training

Responsibilities-weekly visit to assigned facility. Monthly written reports to a volunteer coordinator that shared with the assigned Regional Ombudsman

Wisconsin Statistics

90 Nursing Home closures and/or down-sizings, since 1999

Since the project began in March, 2006, there have been

6 Nursing Home closures and 1 Nursing Home down-sizing which have affected

hundreds of residents who’ve had to relocate 3 replacement relocations that involved the moving of

another 350 residents as well as Numerous down-sizing and closing of ICF’s-MR and

CBRF’s

3 Types of Relocation Activities in which a Nursing Home files a Plan in Wisconsin

CLOSURE- everyone must leave

DOWN-SIZING- some must leave

REPLACEMENT*- everyone must leave, but have a new place for everyone to move to.

Wisconsin State Statues require that a facility file a RELOCATION PLAN when:

The Facility is closing, intends to close or is changing its type or level of service or means of reimbursement

and

Will relocate at least 5 or 5% of the residents whichever is greater

JOB DESCRIPTION

Title:Relocation Ombudsman Specialist

Status: Temporary Project Position (March, 2006-March, 2009)

Funding: Civil Money Penalties

GOAL: To advocate focusing on quality of Care and

the protection of rights while residents relocate from closing nursing homes

JOB DESCRIPTION-continued

OBJECTIVES:

– Inform, educate and assist residents and their families (develop informational materials and present to Resident and Family Councils)

– Participate in Relocation Team meetings to represent the interests of the resident and promote preferences for alternate placement

– Participate in Discharge Planning Sessions as authorized

Follow up on residents after having relocated

– Monitor closing facilities (communicate concerns about care) Provide technical assistance to staff

– Identify deficiencies related to the facility closure and resident relocations. Advocate for changes in public policy. Advise the State Ombudsman and Board

WORKING with OTHER OMBUDSMEN

Relocation Specialist

-Sits on Relocation Team-Refers to Regional Ombudsman-Monitors conditions-Advises staff-Reports on processes

Regional Ombudsman

-Does Case work -Takes Complaint referrals -Assists with appeals -Monitors conditions

Work with Volunteers

Volunteer at the Closing Facility to

Monitor general conditions Report concerns for

conditions Introduce program and

offer services Communicate

developments to residents and families

Take referrals for questions/complaints

Volunteers at the Receiving Facility to

Follow up on residents that relocate from a closing facility

Introduce program and offer services

Report on adjustment to new facility

Take referrals for questions/complaints

INFORMATION and ASSISTANCE to

RESIDENTS and their FAMILIES

Touring and introducing the Ombudsman Program to Residents

Participating at Resident and Family Informational Sessions

Setting up and maintaining a Resource Room.

Providing written information on residential options and services, funding, directories of nearby facilities and contact lists for agencies and programs. Brochures on the Ombudsman program, resident rights and recommendations for discharge planning

Presenting to the Resident and Family Councils

More Touring and meeting to maintain contact with residents

EDUCATION to FACILITIES

Reviewing elements of their Relocation Plan Reviewing a Roster of Residents to identify

potential obstacles for relocation (clarifying legal status, diagnoses, special needs.)

Recognizing and addressing Transfer Trauma Providing Discharge Planning and Orientation Working with the Relocation Team and

understanding Processes (screening for funding, etc.)

Understanding Ombudsmen’s and other agencies’ roles

RELOCATION TEAM

Wisconsin Statutes assign responsibility the state DHFS

– Offer relocation assistance to the resident– Prepare removal plans and transfer trauma mitigation care

plans– Assure safe and orderly removal from the facility– Protect the resident’s health, safety, welfare and rights

Wisconsin Statutes authorize the state DHFS to

– Place relocation teams in any facility for any reason for the purpose of implementing removal plans and training staff of transferring and receiving facilities in transfer trauma

mitigation.

RELOCATION TEAM

The DHFS Coordinator directs the activities of a “relocation team” that’s made up of representatives from the

Facility (Social Worker, Director of Nursing, Nursing Home Administrator) County (Resource Centers and Care- Management Organizations) State (Relocation Coordinator) Advocacy (Ombudsmen and the Protection and Advocacy Organization

TRANSFER TRAUMA

Relocation Stress Syndrome, also called Transfer Trauma, is a formal nursing diagnosis and defined as “physiologic and/or psychosocial disturbances as a result of transfer from one environment to another.” It is otherwise defined as “the combination of medical and psychological reactions to abrupt physical transfer that may increase the risk of grave illness or death.”

REDUCING TRANSFER TRAUMA

The involvement of familiar people, the maintaining of consistent daily patterns and routines, and assisting the resident in becoming acquainted with new surroundings can help minimize stress associated with relocation.

Slow and thorough discharge planning that provides the resident with an opportunity to tour alternate living arrangements and, most importantly, that asks the residents what it is that they want can help ease the adjustment of needing to move.

DISCHARGE PLANNING

F204 Orientation for transfer or discharge

A facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.

Wisconsin’s Transfer and Discharge Activities

HFS 132.53(3)(b)3.

Transfer and discharge activities shall include: Counseling Opportunity to visit potential alternate placement Assistance with moving Provisions for medications and treatments

Wisconsin Requirements for Discharge Planning Conferences

HFS 132.53(3)(b).

Prior to any involuntary discharge, a planning conference shall be held at least 14 days before discharge to

- Review the need for relocation- Assess the effect of relocation on the resident- Discuss alternatives placements- Develop a relocation plan

Post Discharge Plan of Care

F284 When a facility anticipates discharge a resident must have a discharge summary that includes : a post-discharge plan of care that is developed with the participation of the resident and his or her family, which will assist the resident to adjust to his or her new living environment

HFS 132.45(5) Documents, prepared upon a resident’s discharge, summarizing needed continued care and instructions

Notice and Appeal Rights

F203 Notice before transfer

Before the facility transfers or discharges a resident, the facility must notify the resident…of the transfer or discharge…in writing and in a language and manner they understand

Notice Timing and Contents

F 203 The notice must (usually) be made…at least 30 days before the resident is transferred or discharged and must include:

The reason for the transfer or discharge

The effective date of the transfer or discharge

The location to which the resident is transferred or discharged

A statement of the right to appeal the action

The name, address and telephone number of the State long term care ombudsman (or the protection and advocacy agency)

MONITORING CARE and TREATMENT

Staffing levels and Unmet Needs

Food and Menus

Activities

Certain Regulatory Standards of Care (for choice, notice, dignity, restraints and abuse.)

REPORTING CONDITIONS

To the facility

To the Department of Health and Family Services Relocation Coordinator

To the State Regulatory Agency

Other Duties as Assigned

Identify and report deficiencies in processes

Make recommendations to the department and the Board on Aging and Long Term Care

Assist in rewriting the State’s Relocation manual

Follow Up Activities

By the Facility By the County By the State By the Ombudsmen

– By the Volunteers– By the Regional Ombudsman– By the Relocation Specialist

Different Problems for Different Kinds of Relocation Activities

CLOSURES DOWN-SIZING

REPLACEMENTS Any/All of the ABOVE

PROBLEMS in CLOSURES

Stress of having to move (involuntarily.) Not having options or knowing they exist. Not being kept apprised of developments Moving before being ready Inadequate discharge orientation and planning Being Unaware of Notices and appeal rights Experiencing Subsequent relocations from

closing facilities

Recommendations in Closures

Keeping residents and families informed and up to date

Explaining options and facilitating discovery Repeated “mini” discharge planning sessions Develop adequate discharge materials

(summaries, post discharge plans.) Demand some kind of notice Follow up contacts and visits

Problems is Down-Sizing Facilities

Stress of possibly having to move (involuntarily) or to lose contact with other residents (survivors remorse)

Anger and resentment related to arbitrary decisions being made (unfair selection for being discharged.)

Loss of faith after being confronted with having to go through appeal process.

Recommendations in Down-sizings

Encourage facilities to plan ahead and to decrease census through attrition (to avoid involuntary discharges.)

Educate residents and families (and facilities) about the rights to notice and appeal

Monitor for violations of those rights and be prepared to assist in appealing a discharge decision.

Problems in Replacement Relocations

New buildings aren’t fully ready for occupancy (beds unavailable, call lights/electronic systems not operational.)

Residents/families unsure of details for the move Residents’/families’ preferences aren’t

accommodated (for room/roommate choice) Residents aren’t fully prepared (belongings not

packed or left behind.) Staff aren’t oriented to the new building (can’t find

equipment and supplies)

Recommendations in Replacements

Facilities should plan well in advance and expect the contractor’s dates to be off.

The regulatory agency should ensure the building is completely ready for occupancy well in advance of anticipated move date (and should require beds be made immediately available upon the residents’ arrival.) Plans should be required and monitored for implementation

Residents and families should be included in the planning and their preferences accommodated.

They should be offered tours and periodic updates on how the project is proceeding.

Belongings should be sent simultaneously and promptly unpacked

Staff should be oriented to the building and have access to all needed equipment and supplies.

Extra staff and volunteers should be on hand before, during and after the move.

Educational Materials

Business CardRights BrochureRights BookletAdmission Agreement BrochureWebsites

Ombudsman BrochureAvoiding Problems BrochureSurvey Brochure

Other materials include lists of area nursing homes, residential types, etc.

QUESTIONS

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For more information, please call or write

Tom La Duke; Relocation Ombudsman SpecialistState of Wisconsin-Board on Aging and Long Term Care

P.O. Box 180, Kenosha, WI 53141(262) 654-4952 (800) 815-0015

Thomas.Laduke@wisconsin.gov