New role of ombudsman in assisted living presentation slides

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New role of ombudsman in assisted living presentation slides

  1. 1. 4/28/2014 1 Assisted Living: What to Expect From Us Patty Ducayet, State Long-Term Care Ombudsman 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 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
  2. 2. 4/28/2014 2 LTC OmbudsmanOverview • State- and federally-mandatedprogram • DADS contracts with28 area agencieson aging to operate the long-termcare ombudsmanprogram under the directionof the state ombudsman • Texasoperatesitsprogram with68 FTEs and 675 volunteerombudsmen,ranking4th in the nation in program size • Texashas 2nd most nursingfacilitiesand11th most assistedlivingfacilitiesinthe country 5/6/2014 4 Distinguishing Ombudsmen • Medicaidservices • Waiver services • Managedcare • 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 Ombudsman ProgramHistory • 1972, a grant program— operated as theNursing Home Ombudsman Program—by the Texas Department ofAging • 1980, Texas began to operate statewide;focused on developing volunteer component • 1981, assisted living and board and care homes addedto program responsibilities • 1999, assisted living facilities licensedby the Stateof Texas • 2000, Texas ombudsman statuteupdated to include AL • 2000-2003, Unlicensedfacility project • 2003 and 2008State performance measures of AL • 2013, funded by the Texas Legislatureto expandservices in assisted living facilities 5/6/2014 6
  3. 3. 4/28/2014 3 LTC OmbudsmanOverview • Protect the health,safety,welfare,andrightsof residentsof nursingand assistedlivingfacilities • Identify,investigate,andresolve problems affectingresidents • Work with residents,familyandfriends,facility staff,and outside agenciesto resolve problems • Representthe interestsof residentstofacilities and agencies • Make policyrecommendationsto government agenciesand electedofficials 5/6/2014 7 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 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
  4. 4. 4/28/2014 4 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 Why Ombudsman Services Are Needed in ALFs Proliferation of ALFs Complexity of residents’ needs Compared to nursinghomes, fewer standards 5/6/2014 11 Ombudsman Training on ALFs • October 2013 • December 2013 • DADS computer based training – Aging in Place and Retaliation(aka Annual Surveyor) – Basic Licensure – Desk ReviewProcess • March 2014 – ALF rules, specialized services 5/6/2014 12
  5. 5. 4/28/2014 5 Two-Way EducationProcess • Staff may… – Appear resistant – Protective of information • Educate staff… – On ombudsman program – Role • Bring resources 5/6/2014 13 Two-Way EducationProcess • 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 ALF Fee Structuresand Billing • Ombudsmenhave beeneducatedabout ALF fee structures, such as: – Privatepay environment – Three main delivery approaches: – All inclusive – A la carte • Packagedplans – Fixed serviceplans – Flexibleservicepackages – Time specificpackages – Other common fees 5/6/2014 15
  6. 6. 4/28/2014 6 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 Visitation Schedule and Expectations • Generally, quarterly visits • Visit Schedule Exceptions: – Largeprograms (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 When a Complaint is Identified • Listen tothe resident, take time, speakprivatelyif resident is willing • Observe, Interview, Record Review • Determine if other people can helpandwhether the res. tried to address the problem • Collect information • Speakto the resident • Observe, Interview, Record Review • ONLY TAKE ACTION WITH PERMISSION FROM RESIDENT or COMPLAINANT 5/6/2014 18
  7. 7. 4/28/2014 7 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 • Home kitchen • Check foodsupplies • Request menu • Adult daylunch • Commercial kitchen–like nursing home • Visit at mealtime to see more residents 5/6/2014 20 Food Service • Neighborhoods • Decaying buildings • Fire safetyinoldhomes • More people at risk • Multiple stories • Wheelchairs andevacuation 5/6/2014 21 Equipment and Building Disrepair
  8. 8. 4/28/2014 8 • Common medication storage area • Attendants and residents as reminders • Common medication storage area • In-roomstorage • Bubble packaging • Automatic dispensing 5/6/2014 22 Medications Questions and Answers Contact Information • State office – Stateombudsman – PattyDucayet – Stateoffice – 512-438-4265 • Local – Statewide toll free number • 1-800-252-2412 5/6/2014 24
  9. 9. 4/28/2014 9 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 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 Trainingfor 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

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