The document provides an overview of the role and services of state long-term care ombudsmen in Texas. Ombudsmen advocate for residents of nursing homes and assisted living facilities, identifying and resolving complaints regarding quality of care and quality of life. They educate facility staff and residents on residents' rights and investigate issues like food service, building maintenance, medication management, and discharge processes. Ombudsmen make regular quarterly visits to facilities to monitor conditions and be available for residents, expanding services in recent years to more comprehensively cover the growing number of assisted living facilities in the state.

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
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3. Objectives
• Distinguish between the role of an
ombudsman and surveyor
• Be prepared for an ombudsman visit
• Know how to contact an ombudsman
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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
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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
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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
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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
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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.
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9. There are the people who walk across the
bridges as though they built them.
The bridge builders are few and far between.
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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
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11. Why Ombudsman Services Are
Needed in ALFs
Proliferation of
ALFs
Complexity of
residents’ needs
Compared to
nursing
homes, fewer
standards
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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
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13. Two-Way Education Process
• Staff may…
– Appear resistant
– Protective of information
• Educate staff…
– On ombudsman program
– Role
• Bring resources
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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
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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
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16. Visit Basics
• Educate
• Request facility documents
• Collect roster
• Locate postings
• Talk with residents, staff
• Build trust, relationships
• Resident councils
• Strategize approach
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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)
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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
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19. Most Common Complaints
1. Food service
2. Equipment and building in disrepair
3. Medications
4. Discharge process
5. Information regarding rights
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20. • Home kitchen
• Check food supplies
• Request menu
• Adult day lunch
• Commercial kitchen–like
nursing home
• Visit at mealtime to see
more residents
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Food Service

21. • Neighborhoods
• Decaying buildings
• Fire safety in old homes
• More people at risk
• Multiple stories
• Wheelchairs and evacuation
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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
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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
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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
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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
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