OMBUDS-WHO?Office of Ombudsmanfor Long-Term Care

Ombudsman MissionEnhance the Quality of Life and

Quality of Care for Adultsby

Promoting the Rights of Long-Term Care Residents, Home Care Consumers and Medicare

Beneficiaries through

Advocacy, Education andEmpowerment.

Ombudsman Philosophy

•Person Centered

•Consumer Driven

•Individualized Care and Service

Ombudsman Duties• Educate for Self-Advocacy

Information and Consultation

Consumer Resources

• Investigate & Resolve Complaints• Recruit, Train & Manage Volunteers• Conduct Regular On-Site Visits• Represent Client Interests to Government Agencies• Inform Public & Policy Makers of Consumer Concerns• Recommend Policy & Legislative Changes• Monitor Laws & Rules

Ombudsman Access

• Access to LTC residences

• Access to Clients/Meet Privately

• Access to Records Facility Records

State Records

Confidentiality• Identity of Client & Related Data• Identity of Complainant & Related Data

Prohibition Against Discrimination or Retaliation

• Against Employees, Volunteers, Patients, Residents, Guardians, Family Members

• Rebuttable Presumption within 90 Days of a Report

Ombudsman Volunteers• Conflict of Interest (Disqualifying & Declared)• Application, Background Study & Reference Check• Interview, Orientation & Assignment Visit• Designation as “Volunteer Advocate”• Visit Residents 6 Hours Monthly• Monthly Contact with Regional Ombudsman• 12 Annual Hours of Continuing Education

– Bi-Monthly or Quarterly Regional Meetings– Annual Statewide Meeting

• Annual Renewal of Designation

Who Does the Ombudsman Serve?

• Nursing Home Residents• Housing With Services Tenants• Assisted Living Tenants• Home Care Clients (adults receiving in-home support services &

health-related services for a fee)• Adult Foster Care Clients (age 55 & older)• Hospice Clients• Hospital Patients (Medicare Beneficiaries)• Adult Day Program Participants

Who Contacts the Ombudsman?

2006(10/1/05 to 9/30/06)

• Family/Friends 39% • Consumers 24%• Provider Staff 17%• Social Service Staff & Others 13%• Unknown 7%

Ombudsman Complaint Data

2000 Complaints Closed in 2006• Rights 47% Admission/Discharge/Move Out, Autonomy,

Finances, Access to Information/Ombudsman• Care/Services 33% Direct care, Staffing, Abuse, Rehab, Restraints,

Policies/Procedures• Factors Outside Facility/Agency 11% Certification/Licensing, State Medicaid Agency,

Legal Issues (POA, Guardianship)• Quality of Life 9% Environment, Dietary, Activities

Outcome of Complaints

2006• Resolved 56%• Partially Resolved 27%• Withdrawn 3%• No Action 4%• Other 5%• Not Resolved 5%

Ombudsman Complaint Investigation

• Obtain informed consent • Obtain facts and verify the complaint

Who is involvedWhat happenedWhere did the situation happen

When did the situation happenWhy did the situation happen

Ombudsman Complaint Investigation

• Formulate an action planHow will the problem be resolved?Who is responsible for implementing the

plan?When will the plan be implemented?

• Monitor Implementation of the action planIs the client satisfied with the outcome?Follow up with client to ensure continued

satisfaction.

Follow up with staff responsible for implementation.

Fostering Positive Systems Change

• Consultation to providersShare resources and information

• Periodic meetings with administrator to discuss systemic issues being raised by residents, families or staff

• Assist in implementing person-centered, relationship-based care

• Assist in developing and maintaining resident and family councils