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Breakout B - New Role of Ombudsman in Assisted Living
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Breakout B - New Role of Ombudsman in Assisted Living

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  • 1. Assisted Living: What to Expect From Us Patty Ducayet, State Long-Term Care Ombudsman
  • 2. Agenda • Give background about the ombudsman program • Explain why our services are expanded • Let you know what to expect on a visit • Most common complaints to ombudsmen • Q and A 5/6/2014 2
  • 3. Objectives • Distinguish between the role of an ombudsman and surveyor • Be prepared for an ombudsman visit • Know how to contact an ombudsman 5/6/2014 3
  • 4. LTC Ombudsman Overview • State- and federally-mandated program • DADS contracts with 28 area agencies on aging to operate the long-term care ombudsman program under the direction of the state ombudsman • Texas operates its program with 68 FTEs and 675 volunteer ombudsmen, ranking 4th in the nation in program size • Texas has 2nd most nursing facilities and 11th most assisted living facilities in the country 5/6/2014 4
  • 5. Distinguishing Ombudsmen • Medicaid services • Waiver services • Managed care • Independent Ombudsman for SSLCs – State Supported Living Centers – Staff and volunteers • State Long-term Care Ombudsman Program – Nursing home – Assisted living – Staff and volunteers 5/6/2014 5
  • 6. Ombudsman Program History • 1972, a grant program— operated as the Nursing Home Ombudsman Program—by the Texas Department of Aging • 1980, Texas began to operate statewide; focused on developing volunteer component • 1981, assisted living and board and care homes added to program responsibilities • 1999, assisted living facilities licensed by the State of Texas • 2000, Texas ombudsman statute updated to include AL • 2000-2003, Unlicensed facility project • 2003 and 2008 State performance measures of AL • 2013, funded by the Texas Legislature to expand services in assisted living facilities 5/6/2014 6
  • 7. LTC Ombudsman Overview • Protect the health, safety, welfare, and rights of residents of nursing and assisted living facilities • Identify, investigate, and resolve problems affecting residents • Work with residents, family and friends, facility staff, and outside agencies to resolve problems • Represent the interests of residents to facilities and agencies • Make policy recommendations to government agencies and elected officials 5/6/2014 7
  • 8. Ombudsmen Advocate • Nursing facilities • Intermediate care facilities for persons an intellectual disability • Adult day care facilities • Assisted living facilities • Home health care providers • Hospice providers • Intellectual disabilities waiver providers • For quality of life and care for residents in nursing homes and assisted living facilities. • Federal and state authority mandates ombudsmen to identify, investigate and resolve complaints made by, or on behalf of, people living in nursing homes • Provide services to help in protecting their health, safety, welfare and rights. • Provide information and assistance in choosing the most appropriate living residence. 5/6/2014 8
  • 9. There are the people who walk across the bridges as though they built them. The bridge builders are few and far between. 5/6/2014 9
  • 10. Ombudsman History with ALFs • 2011, 2012, 2013 ALF quarterly visits – 11% and 13% and 10% – 5000+ total • 2011, 2012, 2013 NH quarterly visits – 82% and 86% and 82% – 30,000+ total 5/6/2014 10
  • 11. Why Ombudsman Services Are Needed in ALFs Proliferation of ALFs Complexity of residents’ needs Compared to nursing homes, fewer standards 5/6/2014 11
  • 12. Ombudsman Training on ALFs • October 2013 • December 2013 • DADS computer based training – Aging in Place and Retaliation (aka Annual Surveyor) – Basic Licensure – Desk Review Process • March 2014 – ALF rules, specialized services 5/6/2014 12
  • 13. Two-Way Education Process • Staff may… – Appear resistant – Protective of information • Educate staff… – On ombudsman program – Role • Bring resources 5/6/2014 13
  • 14. Two-Way Education Process • Educate yourself – Ask good questions – Listen to language • On the visit… – Ask for a blank admission packet – Familiarize yourself – Request a copy of the Disclosure Statement 5/6/2014 14
  • 15. ALF Fee Structures and Billing • Ombudsmen have been educated about ALF fee structures, such as: – Private pay environment – Three main delivery approaches: – All inclusive – A la carte • Packaged plans – Fixed service plans – Flexible service packages – Time specific packages – Other common fees 5/6/2014 15
  • 16. Visit Basics • Educate • Request facility documents • Collect roster • Locate postings • Talk with residents, staff • Build trust, relationships • Resident councils • Strategize approach 5/6/2014 16
  • 17. Visitation Schedule and Expectations • Generally, quarterly visits • Visit Schedule Exceptions: – Large programs (100+) • 2x/yr to small facilities (Type A,C) – Small and Medium ombudsman programs • 6x/yr to large facilities (Type B) (6 diff. mos. & 4 quarters) 5/6/2014 17
  • 18. When a Complaint is Identified • Listen to the resident, take time, speak privately if resident is willing • Observe, Interview, Record Review • Determine if other people can help and whether the res. tried to address the problem • Collect information • Speak to the resident • Observe, Interview, Record Review • ONLY TAKE ACTION WITH PERMISSION FROM RESIDENT or COMPLAINANT 5/6/2014 18
  • 19. Most Common Complaints 1. Food service 2. Equipment and building in disrepair 3. Medications 4. Discharge process 5. Information regarding rights 5/6/2014 19
  • 20. • Home kitchen • Check food supplies • Request menu • Adult day lunch • Commercial kitchen–like nursing home • Visit at mealtime to see more residents 5/6/2014 20 Food Service
  • 21. • Neighborhoods • Decaying buildings • Fire safety in old homes • More people at risk • Multiple stories • Wheelchairs and evacuation 5/6/2014 21 Equipment and Building Disrepair
  • 22. • Common medication storage area • Attendants and residents as reminders • Common medication storage area • In-room storage • Bubble packaging • Automatic dispensing 5/6/2014 22 Medications
  • 23. Questions and Answers
  • 24. Contact Information • State office – State ombudsman – Patty Ducayet – State office – 512-438-4265 • Local – Statewide toll free number • 1-800-252-2412 5/6/2014 24
  • 25. Texas Resources • S&CC 13-04 Skilled Nursing Services in ALFs • S&CC 10-03 Home and Community Support Services Agency Compliance with Texas Human Resources Code Chapter 102, Rights of the Elderly • PL 14-01 – ALF Locked Alzheimer’s Units • PL 14-02 Changes to ALF Standards (NFPA and other) • PL 13-33 Emergency Planning for Individuals Who Require Bariatric Care • PL 13-32 Aging in Place • PL 13-16 Ashtrays of Noncombustible Material and Safe Design • PL 12-25 Annual Mandatory Training for ALFs • PL 12-09 Inappropriately Placed Residents • PL 11-37 Skilled Nursing Services in an ALF • PL 11-36 New Health and Safety Code (HSC) Chapter 260A Regarding Reporting and Investigating Abuse, Neglect and Exploitation (ANE) • IL 13-18 Prefilling Medication Planners 5/6/2014 25
  • 26. Computer-Based Training (CBT) Courses • ALF Pre-Licensure Training – Approx. 1-2 hours – http://www.dads.state.tx.us/providers/ALF/training/cbt/in dex.html • Annual Mandatory Training for ALFs – Approx. 30 mins. – http://www.dads.state.tx.us/providers/ALF/training/cbt/an nual.html • Desk Review Compliance – Approx. 30 mins. – http://www.dads.state.tx.us/providers/ALF/training/cbt/d eskreview.html 5/6/2014 26