Long-Term Care For Someone You Are Caring For? You Need To Know About The Ombudsman.
If you are like many Americans, you have experienced having someone you know temporarily or permanently placed in a long-term care facility.
With people requiring long-term care being in the millions in the United States, there is a pretty good chance that you are someone you know is navigating this world, with some level of frustration, anxiety and difficulty.
As a nurse practitioner who has worked in the long-term care world all of my career (visiting patients wherever they call home), I can tell you that things have not improved in the last 2 years with all of the chaos of the pandemic, health-care staffing shortages and the increasing aging population.
For many, the choice to place a person you are caring for into a long-term care setting, including a nursing home, assisted living, group home or residential care setting, is often difficult and very emotional.
While the goal for most is to keep someone at home after health issues, decline in function and an increased need for assistance with activities of daily living, such as bathing, dressing, cooking, many times that is not a reasonable option for many reasons.
My professional and personal experience with patients and my own family members has brought to light that often, the expectations of care and the delivery of care often have gaping holes in them.
This is generally not due to the lack of effort on both the patient’s family or the facility staff part, but a logistical nightmare that is often fueled by insurance, lack of resources, differences in culture, values and goals.
Trying to find a middle ground can become frustrating and a family and patient can often be feeling defeated and the facility staff can often feel defensive about issues and concerns.
So how can we find a way to make improvements in this communication, planning and goals of care? Is there a way to methodically bring the family/patient and facility staff together into an understanding and plan of care that is agreeable to both sides?
Here’s something that I have found that most family members are not aware of, the long-term care ombudsman.
What is that ombudsman?
This program is nationwide and is a public official who has the responsibility to advocate for those individuals who are in a long-term care facility.
What qualifies as a long-term care facility?
Skilled nursing or nursing home setting (SNF)
Group home
Residential care setting (RCAC)
Assisted living facility (ALF)
Memory care unit
How can the Ombudsman assist?
Families can benefit from services including:
Support
Education
Problem resolution
Investigation of suspected neglect or abuse
Referrals to resources
In my own experience, most of the licensed facilities I work in, there are posters throughout the facility with the name and number for the local ombudsman, but when I speak to families about it, they generally have never noticed the posters and have no idea this is a free service available to them.
That’s right. These services are provided 100% at no cost to the family or patient.
Many ombudsman make it part of their practice to visit residents of long-term care facilities in person. So even if you do not need help right now, you could contact your local ombudsman and find out if they are planning an upcoming visit. Getting to know this individual might provide you with a piece of mind that if you were to ever need their services, you could put a face to a name.
I have personally attended family care conferences with an ombudsman present in my nurse practitioner role. The family and facility both benefit from these services because the ombudsman is a neutral party, who genuinely has the patient’s best interest at heart.
Some areas the ombudsman focuses on include issues of:
Privacy
Abuse/neglect
Physical/chemical restraints (chemical restraints generally include psychiatric medications)
Appeals and grievances
Denial of services
To find a local ombudsman in your area, click on the link below:
https://theconsumervoice.org/get_help
The purpose of the ombudsman program is to ensure that individuals over the age of 60 years old, are treated with dignity, safety and that their rights remain honored during their time in long-term care. This is for someone who is staying a week or until end-of-life.
What are considered “rights” of a resident in long-term care:
The right of citizenship.
The right to dignity.
The right to privacy.
The right to personal property.
The right to information.
The right of freedom.
The right to care.
The right of residence.
One of the biggest barriers that I have observed in my 16 years working with patients in long-term care, is the fear of retaliation if they make a complaint, ask for changes or even ask for help with taking someone to the restroom while they are visiting the facility.
Trust me, I understand where this comes from and why if you are a caregiver you can worry about what is happening while you are not present.
I ensured someone was in the hospital with my husband 24/7, if I had to go to work, just for fear that something would go sideways or someone would not take his care seriously.
Often we don’t want to “bother” people, be a problem or create bad feelings. I also have trouble asking for help. Read more about that topic here:
https://familycaregiverlanding.com/help-why-is-it-so-hard-to-ask-for/
On the other hand, if you are responsible for the care someone is receiving, you do have a duty to speak up and advocate for the care. Remember, the people who are working generally want to help. While they are very busy, they are also responsible for the care of that individual while they are residing in that facility. So you asking for help should not be seen as a “bother.”
If you are continually noting staff ignoring the needs you or the resident is verbalizing, blatant bad or rude attitude and treatment, my first recommendation is to speak with management. That may include:
Nurse managers
Director of nursing
Social worker
Administrator
If you have not had your issues resolved, you do have the right to request a “care conference” in which all the key players should be present. This includes:
The resident
Health care power of attorney if needed/activated
Care team, including anyone from an agency including home care, hospice, wound care, psychiatry
When you have made this request, the meeting should be held within 14 days at the most. If your request is not met, either because there was not a meeting or because your agreed upon requests were not met, my recommendation would be to contact your local ombudsman.
Here are some other tips I recommend you do prior to any meeting requests or calls to the ombudsman.
Document your concerns:
Write down what you observe
Names of staff involved
Time and place of incident
Be as specific as you can. For example, saying something like “My husband is constantly sitting in a wet brief needing to be changed.” You might document:
Wet brief soaked through clothes 8/10/22 2pm
Requested brief to be changed on 8/10/22 at 2:05pm to Lisa CNA
Brief still not changed at 4pm on 8/10/22
This is an example and generally I would not lodge a formal complaint about one isolated incident. They could be short staffed. There could have been another resident who fell down and needed emergency care. However if you document this and you see this happening daily, or always with the same staff members, then you have solid evidence of the issues and it’s more likely to be resolved.
I see daily, first hand how hard long-term care facility staff work and there are many great professionals who provide exceptional care. So this post is not to generalize all long-term care as poor.
The chances you will need to contact your local ombudsman may be slim, however, it is important to me that families know that if they are unable to get issues resolved, they have another layer of help and protection to ensure that the person they are responsible for is getting the best possible care.
As always, I am a real person and read all the emails I receive. If you have specific questions or issues, please feel free to reach out to me at:
hello@familycaregiverlanding.com
