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Assisted Living: What to Expect From Us

Patty Ducayet, State Long-Term Care Ombudsman

Agenda

• Give background about the ombudsman program

• Explain why our services are expanded

• Let you know what to expect on a visit

• Most common complaints to ombudsmen

• Q and A

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Objectives

• Distinguish between the role of an ombudsman and surveyor

• Be prepared for an ombudsman visit

• Know how to contact an ombudsman

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LTC Ombudsman Overview

• State- and federally-mandated program

• DADS contracts with 28 area agencies on aging to operate the long-term care ombudsman program under the direction of the state ombudsman

• Texas operates its program with 68 FTEs and 675 volunteer ombudsmen, ranking 4th in the nation in program size

• Texas has 2nd most nursing facilities and 11th most assisted living facilities in the country

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Distinguishing Ombudsmen

• Medicaid services

• Waiver services

• Managed care

• Independent Ombudsman for SSLCs – State Supported Living

Centers

– Staff and volunteers

• State Long-term Care Ombudsman Program – Nursing home

– Assisted living

– Staff and volunteers

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Ombudsman Program History

• 1972, a grant program—operated as the Nursing Home

Ombudsman Program—by the Texas Department of Aging

• 1980, Texas began to operate statewide; focused on developing volunteer component

• 1981, assisted living and board and care homes added to

program responsibilities

• 1999, assisted living facilities licensed by the State of Texas

• 2000, Texas ombudsman statute updated to include AL

• 2000-2003, Unlicensed facility project

• 2003 and 2008 State performance measures of AL

• 2013, funded by the Texas Legislature to expand services in assisted living facilities

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LTC Ombudsman Overview

• Protect the health, safety, welfare, and rights of residents of nursing and assisted living facilities

• Identify, investigate, and resolve problems affecting residents

• Work with residents, family and friends, facility staff, and outside agencies to resolve problems

• Represent the interests of residents to facilities and agencies

• Make policy recommendations to government agencies and elected officials 5/6/2014 7

Ombudsmen Advocate

• Nursing facilities

• Intermediate care facilities for persons an intellectual disability

• Adult day care facilities

• Assisted living facilities

• Home health care providers

• Hospice providers

• Intellectual disabilities waiver providers

• For quality of life and care for residents in nursing homes and assisted living facilities.

• Federal and state authority mandates ombudsmen to identify, investigate and resolve complaints made by, or on behalf of, people living in nursing homes

• Provide services to help in protecting their health, safety, welfare and rights.

• Provide information and assistance in choosing the most appropriate living residence.

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There are the people who walk across the bridges as though they built them.

The bridge builders are few and far between. 5/6/2014 9

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Ombudsman History with ALFs

• 2011, 2012, 2013 ALF quarterly visits – 11% and 13% and 10%

– 5000+ total

• 2011, 2012, 2013 NH quarterly visits – 82% and 86% and 82%

– 30,000+ total

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Why Ombudsman Services Are Needed in ALFs

Proliferation of ALFs

Complexity of residents’ needs

Compared to nursing homes,

fewer standards

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Ombudsman Training on ALFs

• October 2013

• December 2013

• DADS computer based training

– Aging in Place and Retaliation (aka Annual Surveyor)

– Basic Licensure

– Desk Review Process

• March 2014 – ALF rules, specialized services

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Two-Way Education Process

• Staff may…

– Appear resistant

– Protective of information

• Educate staff…

– On ombudsman program

– Role

• Bring resources

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Two-Way Education Process

• Educate yourself

– Ask good questions

– Listen to language

• On the visit…

– Ask for a blank admission packet

– Familiarize yourself

– Request a copy of the Disclosure Statement

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ALF Fee Structures and Billing

• Ombudsmen have been educated about ALF fee structures, such as: – Private pay environment – Three main delivery approaches: – All inclusive – A la carte

• Packaged plans – Fixed service plans – Flexible service packages – Time specific packages – Other common fees

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Visit Basics

• Educate

• Request facility documents

• Collect roster

• Locate postings

• Talk with residents, staff

• Build trust, relationships

• Resident councils

• Strategize approach

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Visitation Schedule and Expectations

• Generally, quarterly visits

• Visit Schedule Exceptions:

– Large programs (100+)

• 2x/yr to small facilities (Type A,C)

– Small and Medium ombudsman programs

• 6x/yr to large facilities (Type B)

(6 di ff. mos. & 4 quarters)

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When a Complaint is Identified

• Lis ten to the resident, take time, speak privately i f res ident is willing

• Observe, Interview, Record

Review

• Determine if other people can help and whether the

res . tried to address the problem

• Col lect information

• Speak to the resident

• Observe, Interview, Record Review

• ONLY TAKE ACTION WITH PERMISSION FROM

RESIDENT or COMPLAINANT

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Most Common Complaints

1. Food service

2. Equipment and building in disrepair

3. Medications

4. Discharge process

5. Information regarding rights

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• Home kitchen

• Check food supplies

• Request menu

• Adult day lunch

• Commercial kitchen–like nurs ing home

• Vis it at mealtime to see more residents

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Food Service

• Neighborhoods

• Decaying buildings

• Fire safety in old homes

• More people at ri sk

• Multiple stories

• Wheelchairs and evacuation

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Equipment and Building Disrepair

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• Common medication s torage area

• Attendants and residents as reminders

• Common medication s torage area

• In-room storage

• Bubble packaging

• Automatic dispensing

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Medications

Questions and Answers

Contact Information

• State office

– State ombudsman – Patty Ducayet

– State office – 512-438-4265

• Local

– Statewide toll free number

• 1-800-252-2412

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Texas Resources

• S&CC 13-04 Skilled Nursing Services in ALFs • S&CC 10-03 Home and Community Support Services Agency Compliance

with Texas Human Resources Code Chapter 102, Rights of the Elderly • PL 14-01 – ALF Locked Alzheimer’s Units • PL 14-02 Changes to ALF Standards (NFPA and other) • PL 13-33 Emergency Planning for Individuals Who Require Bariatric Care • PL 13-32 Aging in Place • PL 13-16 Ashtrays of Noncombustible Material and Safe Design • PL 12-25 Annual Mandatory Training for ALFs • PL 12-09 Inappropriately Placed Residents • PL 11-37 Skilled Nursing Services in an ALF • PL 11-36 New Health and Safety Code (HSC) Chapter 260A Regarding

Reporting and Investigating Abuse, Neglect and Exploitation (ANE) • IL 13-18 Prefilling Medication Planners

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Computer-Based Training (CBT) Courses

• ALF Pre-Licensure Training – Approx. 1-2 hours – http://www.dads.state.tx.us/providers/ALF/training/cbt/in

dex.html

• Annual Mandatory Training for ALFs – Approx. 30 mins. – http://www.dads.state.tx.us/providers/ALF/training/cbt/an

nual.html

• Desk Review Compliance – Approx. 30 mins. – http://www.dads.state.tx.us/providers/ALF/training/cbt/d

eskreview.html

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