The L.A. Times had an article about options when a loved one gets injured at a nursing home or hospital.  The California Department of Aging received 43,000 nursing home complaints in 2009. Some alleged patient abuse or neglect; others reported missing items. And some commented on the quality of the food.

"There is growing public awareness, people are feeling more empowered, and they have tools at their disposal to make a complaint," said Ralph Montano, spokesman for the California Department of Public Health, which regulates hospitals and long-term care facilities in the state.

Here’s how to complain.

In-houseMost patient advocates recommend first talking with providers within the nursing homes.  If that doesn’t work, you can talk with other people higher in the chain of command, up to the administrator.

Insurers  Another option is to file with your insurance company. The California Department of Managed Health Care requires that insurers in the state have a written process for patient complaints about hospitals and nursing homes.

Joint commission  The Joint Commission on Accreditation of Healthcare Organizations is a not-for-profit agency that accredits and certifies more than 17,000 healthcare organizations and institutions such as hospitals, nursing homes, behavioral health facilities and clinical laboratories nationwide. The commission’s Office of Quality Monitoring evaluates complaints filed against accredited organizations relating to care and safety issues.

Complaints can be faxed, phoned, e-mailed or mailed to the Joint Commission. When filing a complaint, briefly summarize the issues and provide the name and address of the facility. The agency takes one of four actions, depending on the complaint’s severity. The healthcare facility may be asked to provide a written response to the allegation. The complaint may be reviewed and considered during a coming survey. It may be placed in a database used to track performance. And if there is a serious threat to patient safety, a staff member will conduct a surprise visit to the organization.

Ombudsman   The California State Long Term Care Ombudsman Program can help resolve problems at nursing homes. It’s the arm of the state’s Department of Aging that investigates complaints made against long-term care facilities. There are 35 offices in the state, staffed with ombudsman representatives who advocate for residents of the 1,200 nursing homes and almost 8,000 residential homes in California.

When a complaint is received, an ombudsman from a nearby office goes to the facility to investigate within two to three days, said Joe Rodrigues, the state long-term care ombudsman. If the facility takes action, the case is considered resolved.  If there is no resolution or if the problem is about neglect or abuse, the ombudsman will bring it to the attention of the California Department of Public Health, which regulates nursing homes and hospitals.

State regulators   If you are filing a complaint with your local ombudsman, file one with the Department of Public Health for good measure, recommends Pat McGinnis, executive director of California Advocates for Nursing Home Reform.

The department’s staff responds within 24 hours to severe complaints and within 10 business days for minor complaints. When a facility is found to be at fault, the department can issue fines, deficiencies or revoke Medicare and Medi-Cal funding.

"If this is something that happens a lot, it is something that may be going on with everyone," she said. "We want people to look at systemic problems, because it is not just your mom, but it is probably happening to others who don’t have advocates as well."

 

This guest post is contributed by Kitty Holman, who writes on the topics of Nursing Degrees . She welcomes your comments at her email Id: kitty.holman20@gmail.com.

The New York Times had an article about the process of choosing a nursing home for your loved one. This can be a long and difficult process for people, and there are certain things to remember as you work to find a home that fits your needs.

1. Collect the data. The Centers for Medicare and Medicaid Services collect data annually on nursing homes across the country, assembling information about everything from health inspection rankings to staffing reports on more than 15,000 institutions. A great way to get started in this is by using the Nursing Home Compare tool at Medicare.gov.  However, it’s important to remember that federally issued rankings of nursing homes only reflect the home’s performance during a very brief period, so the quality might have changed since the report was issued. Additionally, Medicare’s grading system stipulates that only 10 percent of a state’s nursing homes can receive the top rating of five stars, so a high-quality home might get four stars for no reason other than that it missed the arbitrary cutoff point.

2. Visit repeatedly. It’s impossible to get a sense of what a nursing home is like from just one visit. In order to better understand life at a particular home, it pays to visit several times, over different days and at different times of the day. This way, you can get an overall feel for the place. Medicare.gov also provides a helpful PDF checklist  you can take on visits to record what you see, hear, and smell. For instance, are staff and residents busy interacting, or is the place quiet and reserved? Does it smell like food, or cleaning supplies? Are there noticeable stains or broken fixtures? This is also your chance to talk directly with the nursing home’s management, including the head physicians. If they can’t make time to speak with you, it might be a good idea to move on and look at another home.

3. Ask the right questions. If you’re placing a loved one in a nursing home, make sure to ask the facility’s staff about "person-centered care" and "consistent assignment." The former is a term that means residents will be able to set their own schedules, including meal times and when they wake up. The latter means that the same team of physicians and assistants will deal with the same patients in each shift. This provides a feeling of continuity for residents and allows them to develop relationships with their caregivers.

4. Check their reputation. Every state in the country has a federally funded ombudsman overseeing long-term care who works as an advocate for nursing home patients. Your state’s ombudsman will be able to help you find out more about nursing homes in your area and whether there is additional survey information on the facility in question. They can also tell you if any complaints have been filed against the nursing home. The National Long-Term Care Ombudsman Resource Center can help you learn more about your local ombudsman.

 

I was reading an article in the Herald Democrat about the importance of ombudsman in advocating for nursing home residents.  Unfortunately, the ombudsman in South Carolina are understaffed, underbudgeted, and without any power and authority.  It is rare they get involved when a family complains and it is very rare that they conduct a proper investigation.  The article discusses how in Texas each facility is assigned an ombudsman who visits at least once a month.   At the heart of the program is patient advocacy.   For example, if a resident is complaining about not getting enough water, the ombudsman would discuss this with the staff, and correct any substantiated issue.

Many issues revolve around the staff.  The high turnover rate, low pay, understaffing, and minimal training harms the overall care level.  Though ombudsmen focus on patient advocacy, they also work closely with the nursing home staff.   The ombudsmen can sit in on care meetings between patients and administrators. 

Interestingly, the Illinois State Register-journal had an article recently about how the budget of the Ombudsman’s program was being cut  reducing the number of trained advocates who visit nursing homes to expose and prevent abuse and neglect.  Petrone said the 19 percent funding cut will result in layoffs and reductions in staff hours for people who regularly visit facilities, talk with residents and act as frontline watchdogs over an industry that serves more than 100,000 residents in 1,500 Illinois nursing homes, assisted-living and supportive-living centers.

 

BakersfieldNow had an interesting article on the prevalence of elder abuse in nursing homes.  The article cites an investigator and ombudsman for the elderly.  They stated elder abuse in the nursing home industry happens more often than people know.

Nona Tolentino is an ombudsman for the elderly.   Tolentino’s job is to investigate cases of suspected elder abuse in the nursing home industry.   Trying to verify it, however, can prove elusive, because people refuse to talk about it for a number of reasons.

"I call it the conspiracy of silence, (because) no one is able to talk for them," said Tolentino.

Under California law and in most states, nursing home employees are mandated to report any cases of suspected elder abuse. Tolentino finds that’s not always happening, though, as employees keep quiet out of fear of losing their jobs.

Tolentino is adamant about patients’ rights to a safe environment.   It was only back in 1987 when the Older Americans Act established a legislative framework for reform to better protect the elderly in nursing homes.   It is based on the premise that it is a resident’s right to be free of verbal, mental, sexual and physical abuse, unnecessary physical and chemical restraints, and involuntary seclusion in a nursing or residential care facility.

 

The Dallas News had an article about the role that Ombudsman’s office has in advocating for nursing home residents.  The article stresses the importance of their role and the breadth of their power and responsibility. However, it all depends on the State’s funding and the specific Ombudsman’s knowledge of the regulations and standard of care.

The article revolves around Jennelle Dixson who is a nursing home ombudsman who looks out for residents too frail or too afraid to speak up about problems such as inattentive caregivers, dirty bedding and long delays in getting medication.   Ombudsmen are among the most important watchdogs of the nursing home industry.  The frequent prods and nudges they give nursing home administrators can have almost as much influence on the quality of care as the annual inspections that government regulators make.

The Senior Source, the nonprofit agency that runs the state’s long-term ombudsman program in Dallas County, sends ombudsmen to 63 nursing homes at least once a month and 160 assisted-living communities at least twice a year.  Dixson checks on more than 1,000 residents in 17 nursing homes throughout Dallas. She visits most of the homes weekly. 

Forty-three percent of Americans who reach 65 can expect to spend time in one of the nation’s 15,281 nursing homes. The average stay is almost 2 ½ years.

Though ombudsmen often meet an uncooperative administrator, their visits sometimes produce results because most nursing homes prefer to resolve issues before they escalate into black marks during state inspections. Last year, the Senior Source’s ombudsmen received 8,600 complaints about nursing homes and 600 complaints about assisted-living communities in Dallas County.

Swanson says complaints involving abuse or serious neglect go to the Texas Department of Aging and Disability Services, the state agency that inspects and regulates nursing homes and assisted-living communities. "The most common complaint we receive is that caregivers take too long to answer residents’ call buttons," Swanson said. "Patients may wait an hour for aides to escort them to the bathroom."   This lack of response often results in falls when residents attempt to make it to the bathroom without assistance.

I don’t doubt that Mrs. Dixson is a caring ombudsman who benefits residents under her jurisdiction but the Ombudsman in South Carolina do absolutely nothing for the residents.  They do not act like advocates and often defend the actions or inactions of the nursing homes all the time stating "that is what my boss tells me to do."  The ombudsmen in South Carolina do not feel they have any power or right to tell the nursing homes how to provide care to the residents. If that is true, what is the point of their existence?  South Carolina needs to train the ombudsmen and give them the power and authority to challenge the nursing homes to prevent neglect and abuse.

The Hartford Courant has an article about proposed reforms in nursing homes by the Connecticut Ombudsman’s office.  I wish the South Carolina Ombudsman’s office would play a proactive role in protecting resident’s care and preventing neglect.  Below is a summary of the article.

Connecticut’s long-term care ombudsman is proposing reforms in oversight that would protect residents who complain about poor care from retaliation and encourage state agencies to monitor and evaluate the performance of chains, rather than just individual homes.

The program outlined a dozen reforms, including protections for residents who complain about poor care such as preventing nursing homes from issuing involuntary discharges to people who file complaints for at least a year following the complaint.

The ombudsman’s office also wants the Department of Public Health to impose "significant sanctions" when patient-care deficiencies result in death, and to weigh "common ownership and management" as a factor in imposing penalties against corporate operators. 

The recommendations were prompted by revelations about the troubled record of one of the state’s largest nursing-home chains, Haven Healthcare, which filed for bankruptcy in November and faces a federal fraud investigation. Some of the chain’s 15 Connecticut homes had escaped severe sanctions despite repeated citations for serious patient-care deficiencies resulting in death. The chain also defaulted on millions of dollars in bills for supplies and services, while its owner used corporate assets for personal profit.

Democratic state senators proposed strengthening state oversight of nursing homes and boosting staff levels. 

The ombudsman’s office wants to require more financial "transparency" from nursing-home corporations, including disclosures of detailed information about related business entities. Owners shield excessive profits by diverting money to related ventures without detailing those transactions.

Other proposals call on the state to more carefully review the public-health and financial records of any new owners or managers of nursing homes or assisted-living facilities, and for "improved communication" among state agencies charged with overseeing elderly care.

Description of Federal Requirements

The federal regulation (483.12) articulates rights that the resident has related to admission, transfer, or discharge, some of the procedures facilities must follow, and records they must keep. The definition of transfer and discharge here applies to movement to a bed outside the certified facility (including differently licensed beds in the same physical plant), but does not apply to movement to a different bed in the certified facility. (Those Intra-facility transfers are discussed under 483.10, Resident Rights.)

The rules regarding transfer or discharge (a) establish the conditions under which a resident may be transferred involuntarily, including that the facility is closing, the resident has improved so that he/she no longer needs the care, the facility is unable to provide the resident with the necessary care, the resident is a danger to self or others, and the resident has failed to pay for care or (if supported by third parties, including Medicaid) has failed to have the care paid for.

The federal rule establishes expectations for documentation regarding transfers (including the reason), and written notice to the residents of at least 30 days, unless the reason for transfer is related to urgent medical needs of the resident or health and safety of others.

 The written notice must include the reasons for the transfer/discharge, the effective date, the location of discharge or transfer, the right of appeal, and notification of how to reach the long-term care ombudsman and/or the appropriate Protection and Advocacy agency in the case of individuals with developmental disabilities or persons who are mentally ill. Further, the facility “must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.”

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