Long Term Care Division

1. Long Term Care Division Alabama Medicaid Agency Long Term Care Division Outreach and Education Unit February 2004

2. P R E S E N T SAn Overview of The Long Term Care (LTC) Ombudsman Program

3. What is an Ombudsman? • A Swedish word, Ombudsman (pronounced om-budz-man) is a specially trained advocate who is given authority under federal and state law to investigate and resolve complaints made by, or on behalf of, long term care consumers.

4. Activities Performed by the LTC Ombudsman: • Investigate and resolve complaints of poor patient care; • Investigate complaints referred by the Medicaid Program regarding quality of care or issues about a facility’s structure;

5. Activities Performed by the LTC Ombudsman..continued • Provide direct client advocacy; • Make quarterly client visitation to each facility;

6. Activities Performed by the LTC Ombudsman..continued • Make presentations to nursing facility residents and staff; • Guide clients/families through the long term care system;

7. Activities Performed by the LTC Ombudsman..continued • Represent clients’ interest before state government officials by working to change laws, regulations and policies that affect those receiving long term care services; and • Report to the administering and operating agencies all cases under investigation that involve Medicaid residents or Medicaid facilities.

8. Administering State Agency • The Alabama Medicaid Agency has administrative authority over the Ombudsman Program.

9. Operating State Agency • The Alabama Department of Senior Services (ADSS) has the responsibility of operating the day-to-day activities of the LTC Ombudsman Program.

10. When did the LTC Ombudsman program establish collaboration began with the Alabama Medicaid Agency? • The LTC Ombudsman Program started on August 1, 2002.

11. Target Population Individuals residing in: • Nursing Homes; • Institutions for Mental Disease (IMD); • Intermediate Care Facilities for the Mentally Retarded (ICF/MR); • Specialty Care Assisted Living Facilities (SCALF); • Other long term care facilities where Medicaid funding is approved.

12. State Ombudsman • There is one State Ombudsman located at ADSS; • There are currently 13 Lead Ombudsman in 13 Area Agencies on Aging. • There are 57 certified Ombudsman in the State of Alabama.

13. Who can ask for assistance? • Any person interested in improving the quality of care for consumers; • A resident of a long term care facility; • A friend or relative of a resident; or • Representatives of public agencies and community groups.

14. Residents Have the Right to Express their Complaints... • State Regulations for long term care facilities indicate that individuals may voice their grievances to anyone outside of the facility. • All communication is confidential.

15. What is the cost to receive Ombudsman services? • All LTC Ombudsman services are free of charge.

16. Additional Information If you have further questions regarding Alabama Medicaid Agency, Long Term Care Programs, please contact: • Wanda Davis, Assistant Director, Long Term Care Division, 334-242-5018, wdavis@medicaid.state.al.us