Advocacy from Individual Complaint to Culture Change

1. Advocacy from Individual Complaint to Culture Change Ombudsman Certification Training Module 6 State LTC Ombudsman Office Department of Aging and Disability Services

2. Module 5 Recap Forgot to Knock Between Daughter and Staff • Review cases • Possible Explanations – Potential Actions Module 5 Review Answers

3. Advocating for an Individual Two Primary Responsibilities • Investigate and resolve complaints on behalf of long-term care residents • Help residents protect their health, safety, welfare, and rights

4. Across the Nation To accomplish responsibilities, staff trains volunteers and other staff about • Regulations • Good care practices The Institute of Medicine recognized knowledgeable LTCO as a hallmark of an exemplary Ombudsman Program. “The LTCOP maintains a reputation as one staffed by well-prepared, knowledgeable workers familiar with the latest developments and trends and generously able to help others learn its knowledge and skills.”

5. LTC Ombudsman Role Persuader not Enforcer ~ ~ ~ Advocate not Regulator LTCO persuade others to fulfill their responsibilities to residents so that residents benefit from the full intent and protection of laws and regulations.

6. Ombudsman Role For EMPOWERMENT, LTCO • Support and encourage residents and family members to resolve their problems • Seek to help individuals identify their own solutions. • Seek to leave residents, family members and facility staff with an improved ability to work out problems in the future • Encourage staff to listen to residents and be more responsive to their needs

7. Instead of telling residents and family members what must be done and how to do it, LTCO seek to help individuals identify their own solutions.

8. Issues about Resident Care • LTCO may also be nurses, social workers, activities professionals, dieticians, physical therapists or other health care specialists. • Perceived conflict in the responsibility • To share his or her knowledge with others • To resolve complaints using empowerment as much as possible

9. Core Principles • Begin with the resident • Confidentiality • Empowerment When a complaint is referred by someone else, the LTCO determines what the resident wants before intervening.

10. Resident-Centered Care • LTCO approach - always resident-centered • Quality of Life - NFR 19.701 • Quality of Care - NFR 19.901 • Facility is required “to provide care to each resident to help attain or maintain the highest practicable physical, mental, and psychosocial well-being, as defined by and in accordance with the comprehensive assessment and plan of care.”

11. Residents don’t live in our Facility. We work in their Home! SOURCE: San Antonio nursing home poster

12. Each Resident? I am … • Minimum Data Set • Centers for Medicare and Medicaid Services (CMS) • “For the New Resident and Family” • Texas Ombudsman Nursing Home Quality Initiative

13. Resolution Strategies • Resolution based on resident perspective has the greatest impact on quality of care and quality of life • Challenge • Resolutions with lasting effects • Frustration with the “yo-yo” effect of facility compliance

14. Follow-Up LTCO are • More frequently in the nursing homes than surveyors • Certified individuals who • Help residents receive optimal care • Advocate for staff compliance with the Nursing Facility Requirements

15. Advocating for Culture Change

16. Efforts directed toward long-range changes in the culture are important because: Improved care for all residents is a major reason Culture change is better than a "band-aid approach" of individual problems resolution. Working on issues can be more satisfying at times and can avoid "burnout” Achieving Long-Range Goals

17. LTCO Encounter Repeat complaints in the same nursing home Similar complaints recur in multiple homes Such repetitive or system-wide problems may indicate there is a need to • Seek improved state legislation or enforcement of existing legislation • Pursue other remedies that seem likely to protect the rights of all residents

18. IMPORTANT Identify issues that affect All residents Consider steps that can be taken to change the culture for the benefit of all

19. Advocacy Solvingindividual problems,LTCO roles • Investigation • Resolution • Follow-up Workingon system issues,LTCO role • Use our voice on behalf of some person(s) in favor of some cause

20. “Issues” Advocates Skills are much like those used to solve complaints: • Gather facts and information • Plan and carry out actions

21. “Issues” Advocates • Involve individuals and groups of the local community. • By getting them involved, interest in solving problems in LTC facilities should increase. • When public interest is focused on facilities, they tend to exhibit “good behavior.”

22. Legislation • Effective way to address problems in long-term care facilities • Patience and dedication • Active coalitions

23. LTC Ombudsmen • Are a part of such a network of advocates • Should stay informed about state and national issues that affect LTC facilities • Be aware of extensive advocacy network

24. Advocates Should Know • Nursing homes in immediate community • Regulations for nursing homes • Regulatory agencies • Difference between Medicare and Medicaid programs • Local community resources

25. Texas LTCO Advocate ~ Certified Ombudsman Assignment ~ General Information Basic Duties Minimum Requirements

26. Best Practices & Resources • Resident-centered approach and empowerment www.bathingwithoutabattle.unc.edu www.dads.state.tx.us/news_info/ombudsman/bestpractices/index.html • Resources • General • Internet

27. Module 6 Review • Answer several items related to information in this module. • Recall the content or use the manual to find the appropriate answers. • Use this activity to realize your understanding of the material and ability to use it in your advocacy service to residents.

28. Transfer – No Readmission Due to combative behavior, staff sends Mr. Simpson to City Hospital ER for a psychological evaluation. Social worker tells his family, ambulance driver and hospital staff that they will not take him back. Facility says it can’t meet his needs because he refuses to follow physician orders. Mr. S wants to go to the hospital and doesn’t want to return to any nursing home. Hospital does evaluation and is ready to return Mr. S, but nursing home refuses his readmission. City Hospital files a complaint with DADS. His family says they cannot care for him and wants the nursing home to readmit him. Family complains to local ombudsman. Possible Reasons and Potential Actions?

29. Module 6 Recap Transfer – No Readmission • Review case • Possible Explanations – Potential Actions Module 6 Review Answers

30. A WINNING CASE Mr. D’s Race in Honor of his 100th Birthday!