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.
5
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.
6
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.
7
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 ombudsmen
8,290 certified ombudsmen volunteers
3,992 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 restraints
• To have a care assessment and plan and to participate in one’s
own care planning
• Right to privacy and confidentiality of records
• Right to choice, participate in the community
• Worship or practice traditions
• Protections from illegal evictions (in nursing homes)
Top Ten Complaint Categories
Nursing Facilities – FFY 2013
1.) Discharge/eviction-planning,
notice, procedure,
implementation, including
abandonment
2.) Failure to respond to requests
for assistance
3.) Dignity, respect - staff attitudes
4.) Resident conflict, including
roommates
5.) Medications - administration,
organization
6.) Care plan/resident assessment
inadequate, failure to follow
plan or physician orders
7.) Accident or injury of unknown
origin, falls, improper handling
8.) Symptoms unattended,
including pain
9.) Food service - quantity,
quality, choice
10.) Exercise preference/choice
and/or civil/religious rights
Top Ten Complaints – B&C/AL – FFY 2013
1.) Food service - quantity,
quality, choice
2.) Medications - administration,
organization
3.) Discharge/eviction-planning,
notice, procedure,
implementation, including
abandonment
4.) Dignity, respect - staff attitudes
5.) Equipment/building - disrepair,
hazard
6.) Resident conflict, including
roommates
7.) Cleanliness, pests, general
housekeeping
8.) Accident or injury of unknown
origin, falls, improper handling
9.) Exercise preference/choice
and/or civil/religious rights
10.) Care plan/resident assessment
- inadequate, failure to follow
plan or physician orders
Root of Concerns
Language
• Hopi: Hopi & Tewa
• Pascua Yaqui: Yaqui & Spanish
• White Mountain Apache: Apache
Care
Food (Farmed to Foraged)
Community (Local News)
• Touching Body
• Washing Clothing
• Cleaning Rooms
Family & End of Life Choices
Advocacy via Education, Mediation and
Interpretation
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 detail
Create 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 VI
a) Provide information about problems of
resident older Indians
b) 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 successfully
a) 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 Office
a) 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