Advocate, Mediator, and Everything In Between: Long-Term Care Ombudsmen

Triangle J Council of Governments provides a number of different programs and services that benefit our member governments and communities in the Triangle J region. One of the core services of all councils of government in North Carolina is that they house the Area Agency on Aging for each region. A significant program within the Area Agency on Aging is the Regional Long Term Care Ombudsman Program. TJCOG has five full-time Regional Long Term Care Ombudsman who spend much of their time in long-term care facilities across our region. They serve as advocates for older adults and valuable resources to residents, family members, long-term care facility administrators and TJCOG staff. I asked our Ombudsmen team to take a little time to talk more about this valuable direct service that TJCOG provides to all of our members.

-Lee

What on earth is a Regional LongTerm Care Ombudsman? Good question. Some refer to us as the best-kept secret in long-term care (LTC).  Others call us fixers or troubleshooters. We see ourselves as warm-hearted, hard working, and tenacious advocates for the residents in nursing homes (24-hour nursing care), assisted livings (7 or more residents) and family care homes (6 or fewer residents). With an extremely long arm, our advocacy reach positively affects the lives of the residents in facilities across the region and their family members. We would like to give you a glimpse into what we do, but first, we would like to take you on a brief mental journey.

You spend all of your life working for and trying to achieve the things that you feel are important to get the life you want – a family, home, car, things and more things. You also try to stay healthy.  Now imagine all these things that define you are taken away– sometimes gradually, sometimes all at once. Children grow up and move away; your vision is not as sharp as it once was and you hear yourself asking people to repeat something they have said because you do not think you heard it correctly. Mobility may be affected; you are now using a walker, and cognition is not what it used to be. “They” take your car keys away with the understanding that you have memory issues and get lost while driving. (Now you feel as though you have lost your total independence.) One day, your spouse dies and “they” do not think you are safe living alone in the house you have lived in for 40 years and decide that it is time to “put you somewhere”.  You enter a LTC facility with your whole life packed into two suitcases because that is all you can bring due to the amount of space in your “new home”. You are now sharing a room with someone you do not know, and maybe do not even like. You feel that everything familiar has been taken away from you, including your voice because you really did not choose this. What a great sense of loss to find yourself in this situation. Depression is not uncommon.

This is the stark REALITY for many of the residents our Long-Term Care Ombudsmen team have the opportunity to meet.

After Medicaid and Medicare became policy, nursing homes started growing rapidly. In 1970, bad publicity about poor care and high owner profits in the homes led to congressional hearings in which it became apparent that systems in place to protect residents in LTC facilities had failed. Residents were powerless and in need of an advocate to listen and respond to specific complaints and problems. As a result, the Ombudsman Program was implemented in North Carolina in 1978 as part of the Older Americans Act with mandates to protect the rights of all LTC residents.

There are 37 Ombudsmen in NC and all work within the 16 Area Agencies on Aging (AAA) that are part of each Council of Government.  The AAAs oversee the administrative portion of our job, but we answer to the NC State Ombudsman programmatically. The five Triangle J Ombudsmen cover our seven-county region (about 12,615 beds) and operate as a self-managed team of advocates for residents’ rights. Each of us independently prioritizes resident requests based on significance and urgency. While focusing on residents’ rights and carrying out our federal mandates, we uphold the backbone of our program: confidentiality. Written consent from the resident or the Power of Attorney/Guardian is necessary before we begin any investigation.

Ombudsman
The Long-Term Care Ombudsman Team at our 2017 Elder Abuse Awareness Event on May 31st.

So, what do we do daily? 

We routinely work to identify and understand complex interpersonal situations involving residents and assist in resolution of issues that affect their rights. This may include issues with family members, staff, facility policies and practices, other residents, guardians and powers of attorney. Our team also develops and conducts training for facility staff, as well as presentations for community organizations and events. When a facility is cited by the state for residents’ rights deficiencies, an Ombudsman retrains the staff on residents’ rights and/or sensitivity.

Some days you may have a hard time finding us.  We are probably walking around a facility visiting residents or burying our heads in medical records analyzing them for information, such as evidence to help prevent a resident with dementia from being discharged due to uncontrollable behaviors. Someone with such behaviors is extremely difficult to place and could end up in a facility many counties away from their family. (We try to avoid this.)

Other times, you may find us in a conference room with staff, the resident and/or family members facilitating the resolution of complaints through mediation and/or negotiation. We must consistently exercise discretion and judgment in evaluation of issues encountered. (On occasion, this has required a crash course on particular personality types in order to understand all the players and ensure effective advocacy.)

We might also be working with an attorney on a guardianship case. As part of the decision process, the magistrate/judge considers our opinion in determining who would be the best guardian for a particular resident. We advocate for the resident at 30-day discharge appeal hearings, as well.

Maybe we are on the phone with the facility corporate office, expressing concerns on behalf of residents and family members about the administrator’s lack of accessibility and unresponsiveness to their needs.

Or…there is a good chance we are with one of our Community Advisory Committee (CAC) volunteers. We have 112 CAC amazing volunteers in our region. They make quarterly visits to the facilities and are our eyes and ears when we cannot be there. We are responsible for training, oversight, and guidance, and meet with them regularly to monitor the reports of their facility visits. We provide direction regarding concerns and questions that arise and are always available to discuss individual situations. We conduct leadership-training events to educate and broaden their knowledge of guidelines and rules.

Our federal mandates are many but the Ombudsmen are few, which often makes things challenging. While this is just a snapshot of the work we do, it hopefully sheds some light on the LTC Ombudsman position. If interested, you can find more information at https://www.ncdhhs.gov/assistance/adult-services/long-term-care-ombudsman. 

P.S. We’re sure it will not surprise you that many residents are “dumped” in facilities and have no one to visit them. If you are ever looking to pay it forward, visiting a resident in a LTC facility will absolutely brighten their day- and we guarantee that it will brighten yours as well!

“Our lives begin to end the day we become silent about things that matter”- Martin Luther King, Jr.

“When the whole world is silent, even one voice becomes powerful”-Malala Yousafzai

“The idea that some lives matter less is the root of all that is wrong in the world”- Paul Farmer

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