History and Responsibility

The Long-Term Care Ombudsman Program

History and Responsibilities under the Older Americans Act Sara S. Hunt, Consultant National Long-Term Care Ombudsman Resource Center May 2004

History • Growth in Nursing Homes – 1965 Medicare and Medicaid •Provided public money for care

History Development

• What Happened – – – –

Evaluation Conclusions Job Description Rewards

Long-Term Care Ombudsman Program

• • • •

Abuse Neglect Substandard care Fires resulting in deaths

Publicity About Poor Care and Owner Profits Congressional Hearings 1970 Apparent that systems to protect individuals had failed Improvements in quality of care needed

Development •

Ombudsman Program

History

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Idea developed by Dr. Arthur Flemming

Development

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Influenced by Swedish model

Evaluation

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Proposed to President Nixon and included in his nursing home agenda in 1971

Conclusions Job Description

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Presidential directive — help states establish units to respond to complaints made by or on behalf of individual patients

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Nursing Home Ombudsman Demonstration Projects contracts granted in 1972

Rewards

Long-Term Care Ombudsman Program

Development—Initial Steps • History Development Evaluation Conclusions Job Description Rewards

Long-Term Care Ombudsman Program

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Projects had impressive record of complaint resolution In 1975 all states could seek funds for ombudsman activities – Funding through the Administration on Aging (AoA) – To develop capabilities of Area Agencies on Aging for ombudsman activities

Development—Growth • History Development Evaluation Conclusions Job Description Rewards

Long-Term Care Ombudsman Program

1978 All states were required to operate a Nursing Home Ombudsman Program – Enacted in amendments to Older Americans Act (OAA) – 1981 changed to Long-Term Care Ombudsman Program due to expanded responsibilities

Evaluation • History Development Evaluation Conclusions Job Description Rewards

Success of first Ombudsman Programs judged by – Number of community programs – Effectiveness in receiving and resolving complaints in • An effective and • A constructive manner.

AoA Commissioner Flemming 1976

Long-Term Care Ombudsman Program

Conclusions History Development Evaluation Conclusions Job Description Rewards

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The laws and regulations enacted will be of little avail unless – “…communities are organized…to deal with the individual complaints of older persons living in nursing homes.

– The individual in the nursing home is powerless.”

AoA Commissioner Flemming 1976

Long-Term Care Ombudsman Program

Job Description •

The Ombudsman Program was created to represent individuals in long-term care facilities.

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Ombudsmen help individual residents benefit from relevant laws and regulations.

History Development Evaluation Conclusions Job Description Rewards

Long-Term Care Ombudsman Program

Job Description • Prevention History Development Evaluation Conclusions Job Description Rewards

– Provide information to residents – Promote development of citizen organizations – Provide technical support for resident and family councils – Recommend changes in laws, regs, and policies to benefit residents – Provide access to ombudsman – Assist residents in asserting rights

Long-Term Care Ombudsman Program

– Identify, investigate, and resolve complaints made by, or on behalf of, residents

Job Description • Intervention History Development Evaluation Conclusions Job Description Rewards

Long-Term Care Ombudsman Program

– Seek legal and other remedies to protect residents – Analyze, comment on, and monitor laws, regs, and governmental policies on behalf of residents – Facilitate public comment pertinent to residents

Job Description-Summary • History Development

On behalf of residents, ombudsmen are advocates for Resolving Individual Complaints

Evaluation Conclusions Job Description Rewards

Long-Term Care Ombudsman Program

Resolving Systems Issues Laws, Regulations, Policies

Rewards Ombudsman perspective on the job: History Development Evaluation Conclusions Job Description Rewards

“The opportunity to speak up for someone who cannot do so for herself, to advocate for individuals or groups of people who otherwise might have no voice, no ‘seat at the table,’ keeps every day fresh and gives every meeting the potential to be important.”

Esther Houser, Oklahoma State LTCO

Long-Term Care Ombudsman Program

Rewards Ombudsman perspective on the job: History Development Evaluation Conclusions Job Description Rewards

Long-Term Care Ombudsman Program

“The greatest experiences I have had working as an ombudsman are listening to people and treating them as a valued human being; working with citizens to become volunteer ombudsmen, and facilitating staff, residents, and families to communicate with each other.�

Vivian Omagbemi, Maryland Local LTCO

Rewards Ombudsman Perspective on the job: History Development Evaluation Conclusions Job Description Rewards

“The handshake and thank you from a family member after a 2 hour care plan meeting…$500 That beautiful smile lighting up the face of the resident that you just promised to come back and chat with again real soon…$50,000 Filling out monthly reports and progress notes…$5

Long-Term Care Ombudsman Program

Rewards The look on the administrator’s face when you tell her History Development Evaluation Conclusions Job Description Rewards

Long-Term Care Ombudsman Program

that you personally have observed the facility in making a mistake that she considered nothing more than complaining by family member whose expectations were too high‌Priceless

Rewards History Development

Ah, the power of… an ombudsman!”

Evaluation Conclusions Job Description Rewards

Long-Term Care Ombudsman Program

Carol Schmidt, Maryland LTCO Volunteer

History Development Evaluation Conclusions Job Description Rewards

Long-Term Care Ombudsman Program

Thanks to the Administration on Aging for their support in the development and distribution of this presentation

History Development Evaluation Conclusions Job Description Rewards

Long-Term Care Ombudsman Program

The National Long-Term Care Ombudsman Resource Center thanks all ombudsmen who work so diligently on behalf of long-term care residents.