History and Role of the LTCOP: Applying History to Today's Work

1. History and Role of the LTCOP: Applying History to Today's Work February 20, 2019 3:00 – 4:30 p.m. ET

2. History and Role of the LTCOP: Applying History to Today's Work Presenters: • Cathy Hart, Idaho State Long Term Care Ombudsman • Patty Ducayet, Texas State Long Term Care Ombudsman Moderator: • Carol Scott, Ombudsman Specialist, National Ombudsman Resource Center

3. Overview Reports available in the NORC Library under LTCOP Research https://ltcombudsman.org/library/ltcop https://www.nap.edu/catalog/9059/real-people-real-problems-an-evaluation-of-the-long-term http://www.nasop.org/papers/Bader.pdf

5. Video: Advocate For Resident's Rights 1. The Role of the Long-Term Care Ombudsman (LTCO) 2. The Purpose of the Long-Term Care Ombudsman Program (LTCOP) 3. Five skills ombudsman need 4. Characteristics of the LTCO

6. Poll Question: Which of the following was NOT mentioned in the video? Advocate Educator Investigator Listener Mediator

7. SECTION 2: The LTCOP Under the Older Americans Act Job Description-Summary On behalf of residents, ombudsmen are advocates for Resolving Individual Complaints Resolving Systems Issues Laws, Regulations, Policies

8. SECTION 3: Unique Aspects of the LTCOP SECTION 4: Accountability (Code of Ethics) SECTION 5: Long-Term Care Ombudsman Program Associations SECTION 6: National Long-Term Care Ombudsman Resource Center

9. SECTION 7: Why Ombudsmen Stay with the Program Ombudsman perspective on the job: The handshake and thank you from a family member after a 2 hour care plan meeting…$500 That beautiful smile lighting up the face of the resident that you just promised to come back and chat with again real soon…$50,000 Filling out monthly reports and progress notes…$5 Carol Schmidt, Local Long-Term Care Ombudsman, Maryland

10. Module 1 Quiz Four people completed the quiz for Module 1. Thanks! One question that stumped several people: All ombudsmen work under the delegated authority of: • Residents • State Agency on Aging • State Long-Term Care Ombudsman • The Federal Law

11. Long-Term Care Ombudsman ProgramCathy Hart, Idaho State Long-Term Care Ombudsman February 2019 Institute of Medicine Study: Real People Real Problems Bader Report: Rethinking and Retooling for the Future

12. LTCO Institute of Medicine Study: Real People Real Problems1995 Both reports can be found at: www.ltcombudsman.org/library/ltcop#other At the urging of the ombudsman program, Congress requested a study of the program to determine its’ strengths and weaknesses, and to assess potential for future contributions. Many changes: • OBRA 1987 brought sweeping changes to the nursing home industry • Managed care organizations and community health care services were developing • Nursing homes began to shift from a long term residence to sub acute facility • Ombudsman program expanded to cover assisted living facilities

13. GOAL GOAL: Assess program performance and make recommendations on public policy strategies by which the program could better achieve its’ objectives. Study based on 4 issues: • Extent of compliance with federal mandates • Availability and effectiveness of the program • Adequacy of resources • Need for and feasibility of providing ombudsman services to older individuals not residing in long-term care facilities.

14. FINDINGS • Not all residents were consistently visited so did not have meaningful access to ombudsman services • Some areas didn’t reach residents in a timely manner because work was done by phone • Program implementation was not consistent across states and sporadic in board and care homes • States did not uniformly comply with the requirement to provide statewide ombudsman services • No federal monitoring or standard level of effort • No technical guidance materials • No availability of legal services

15. Recommendations:COMPLIANCE Programs should operate throughout the country in compliance with federal mandates: • Broaden the program to serve younger residents • Ensure that ombudsman services are available to veterans • Implement a federal oversight system • Develop policies and guidance detailing the expectations of the program and mechanisms to enforce state compliance with federal mandates • Require an Office of the Long-Term Care Ombudsman at the Administration on Aging

16. COMPLIANCE • Develop cooperative agreements with Legal Services Corporation, National Protection and Advocacy Organization, National Medicaid Fraud Control Units, and the Office of the Inspector General of the Department of Health and Human Services • Ensure adequate and independent legal counsel for the ombudsman program.

17. CONFLICT OF INTEREST Conflict of interest problems warranted development of a broader array of tactics to prevent, identify and correct pertinent and significant conflicts. • Amend Older Americans Act to include new policy directives regarding placement of the ombudsman program • Develop policies and procedures to: • Prohibit parties that fall within the purview of the ombudsman program from participating on policy making boards • Identify potential conflicts of interest and guidance on how to address such conflicts. • Ensure that no conflict of interest exists with legal counsel provided for program

18. EFFECTIVENESS OF THE OMBUDSMAN PROGRAM Ombudsman program was vital and recommended that Congress continue the program. • Develop an objective method to assess compliance of state programs • Refine the current information system • Develop valid and reliable measures for assessing the impact of the program • Develop a system to ensure the adequate management of volunteers.

19. ADEQUACY OF RESOURCES • Increase appropriations for the program guided by the base indicator of 1 ombudsman per every 2000 long-term care beds • Revise the interstate funding formula considering number, size and type of long-term care facilities in each state • Require that states match federal funding they receive under Title VII, Chapter 2 of the Older Americans Act at no less than 20% • Delegate fiscal responsibility for the program to the state ombudsman • Provide an audit of expenditure practices in each state to determine the extent of diversion of program funds • Provide additional resources if Congress mandates additional responsibilities.

20. EXPANDING THE OMBUDSMAN PROGRAM Before any consideration is given to expansion of the program, Older Americans Act ombudsman mandates must be fully implemented and research should be conducted to determine how ombudsman services can best be delivered to consumers of health care and long-term care services.

21. Bader Report: Rethinking and Retooling for the Future2003 A Helen Bader Foundation grant was received to review the past and plan for the future. The retreat included commissioned white papers, consensus building sessions, debates and discussions. Determined that success of the ombudsman program depends on its’ independence (placement and perceived or real conflicts of interest).

22. GOAL GOAL: Improve the Ombudsman program and the care of long-term care residents: • Review current research and knowledge about the program • Review characteristics of the long-term care population in light of the changing healthcare climate • Review how best to inform participants on relevant topics and how to coordinate services for people with Alzheimer’s disease • Develop materials to be used to provide information on the program and long-term care. (publications, testimony, speeches)

23. RecommendationsINDEPENDENCE • Prevent conflict of interest of a program being located in an agency responsible for licensure and certification of long-term care facilities • Develop remedies for conflicts of interest • Ensure programs have autonomy • Monitor program compliance with Older American Act requirements • Ensure adequate resources are provided

24. SYSTEMS ADVOCACY • Conduct oral interviews with state and local ombudsmen to get full sense of barriers, attitudes, and approaches to systems advocacy • Develop intervention strategies and remedies for programs and states that are not doing a good job of systems advocacy • Develop better communications and collaboration with the National Association of State Units on Aging, National Association of Area Agencies, state units and area agencies, National Association of Legal Services Developers, and National Association of Adult Protection Services.

25. SYSTEMS ADVOCACY • Develop national training standards to include continuing education requirements • Develop a mission statement that reflects standards • Require orientation and training of all new state ombudsmen using nationally developed curriculum • Develop ongoing systems advocacy training and interventions strategies for state ombudsmen • Develop teams of experts to offer on-site visits to educate state counterparts and state unit directors on effective systems advocacy • Develop joint policies with other agencies to support the Older Americans Act mandate for systems advocacy

26. TRAINING AND QUALIFICATIONS • Develop national training standards • Develop hiring and management tools for use by state and local programs • Expand the orientation for new ombudsmen

27. DATA AND INFORMATION • Educate program staff and volunteers on the usefulness of data and the importance of complete and reliable data collection, entry and analysis • Develop a regular method of auditing data • Plan and implement a restructured and improved national reporting system that can incorporate all kinds of data and be useful for comparisons, research, analysis, and education • Develop a funding strategy to obtain the necessary hardware and software for all programs to be up-to-date • Provide outcome measures

28. PROGRAM EFFECTIVENESS • Appoint a Director of the Office of the Long-Term Care Ombudsman • Meet the ratio of one paid FTE to 2000 beds and at least one full-time ombudsman staff person per local program • Develop a tool to manage effectiveness • Develop policies for providing ombudsman information to consumers and providers • Develop policies that outline prioritization of responses to complaints • Determine actual costs of the ombudsman program and advocate for adequate resources

29. PROGRAM EFFECTIVENESS • Develop a public awareness campaign • Work toward national standards for assisted living • Develop and promote training programs for ombudsmen that focus on mental health conditions and conditions that affect decision-making capacity

30. State Mini Tool Self-Evaluation

31. Questions?

32. resources

33. History and Role of the Long-Term Care Ombudsman Program: Curriculum Resource Material for Local Long-Term Care Ombudsmen https://ltcombudsman.org/uploads/files/support/history-and-role-updated.pdf • History and Role of the Long-Term Care Ombudsman Program: Teaching Notes https://ltcombudsman.org/uploads/files/support/Local-Teaching-Notes.pdf • Unique Characteristics of the Long-Term Care Ombudsman Program https://ltcombudsman.org/uploads/files/support/Local-Unique-Characteristics.pdf • Ethics https://ltcombudsman.org/omb_support/pm/ethics • Self Evaluation and Continuous Quality Improvement Tool for State LTCOPs https://ltcombudsman.org/uploads/files/support/sltco-mini-tool-oct-2018.pdf • Self Evaluation and Continuous Quality Improvement Tool for Local LTCOPs https://ltcombudsman.org/uploads/files/support/lltco-mini-tool.pdf

34. The National Long-Term Care Ombudsman Resource Center (NORC) www.ltcombudsman.org Connect with us: The National LTC Ombudsman Resource Center @LTCombudcenter This project was supported, in part, by grant number 90OMRC0001-01-00, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.