Ombudsman's Conflict of Interest?

The Republic reported that advocates for the elderly are objecting with Kansas Gov. Sam Brownback's choice of Barbara Hickert to be the state's long-term care ombudsman, raising concerns that consumers' best interests will be ignored, and abuse and neglect will be covered up.  This is the third person coming from the nursing home industry to hold the post.  Brownback has appointed several people with nursing home ties, including Aging Secretary Shawn Sullivan and Joe Ewert as commissioner for licensure, certification and evaluation. Sullivan was a Wichita nursing home administrator and Ewert worked for LeadingAge Kansas.

"I'm not overstating it, it's life or death," said Mitzi McFatrich, executive director of Kansas Advocates for Better Care. "Right now, there's a heavy weight on the provider side. The concern is that consumer needs will be second to industry."

It's extremely rare for someone from the nursing home industry to be appointed as state ombudsman.  Mark Miller, the ombudsman for New York and vice president of the National Association of State Long-Term Care Ombudsman Programs, said "I can't think of a single colleague. I think that's something the average person would have a question about," Miller said. "'Where do this person's allegiances lie?'"

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No Supervision in Iowa

Critics and health care experts fear that Iowa Governor Terry Branstad's relationship to the nursing home industry will cause premature deaths of vulnerable and disabled elderly.  Disability Rights Iowa, which is part of a national network of advocacy groups established by Congress in the 1970s, published a scathing, open letter to Branstad, questioning the governor’s lax supervision of Iowa’s nursing homes.

Sylvia Piper, executive director, Disability Rights Iowa, Des Moines recently wrote "Terry Branstad believes nursing home residents, many who have witnessed or experienced abuse or neglect, no longer need anyone to protect them. Rod Roberts, director of the Iowa Department of Inspections and Appeals, gets his marching orders directly from Branstad. They both agree that no inspectors are needed; the nursing homes should be left to police themselves."  Sylvia Piper told Branstad in the letter that because of his “political choices, people are suffering and dying on a regular basis in Iowa’s nursing homes.”  In March, Roberts who has no prior management experience, eliminated the positions of 10 nursing home inspectors and two abuse prosecutors, citing budget constraints. After lawmakers restored funding for the positions, the department opted to spend the money elsewhere, saying the inspectors were not needed.

"Branstad has a lucrative arrangement with the nursing home lobby. They give his campaign tens of thousands of dollars, he helps them run under the radar by removing those who would hold them accountable. Under this egregious arrangement, nursing home residents are left alone and helpless in an environment historically notorious for abuse and neglect."

The (Republican) state auditor, long-term care ombudsman, and Iowa citizen’s aid ombudsman cited him for failing to adequately regulate nursing homes. Clearly, he wants to protect his campaign contributors. There has been an increase in complaints regarding nursing homes and other types of care facilities in Iowa.

Piper said her organization has investigated specific cases in which residents have died or been injured as a result of negligent care that could have been prevented through more aggressive action by the inspections department. 

 

See articles at Des Moines Register, here and here.

 

 

Public Outcry Can Prevent Abuse and Neglect

Jim Patterson wrote an enlightening commentary for The Register-Guard in Eugene, Oregon about the widespread abuse and neglect in long term care facilities.  Below are excerpts:

Every day an elderly resident in an assisted living facility or nursing home in Oregon is neglected or abused. Usually little is done to stop it.

If a resident or family member reports neglect or abuse to their local Adult and Protective Services agency, chances are the facility won’t be fined, as allowed by law. If a fine is levied by the state Department of Human Services, it is usually only a few hundred dollars, which most for-profit long-term care companies have written into their budgets as one of the costs of doing business.

In short, the system for protecting some of our most vulnerable citizens isn’t working well due to bureaucratic inertia, profit-driven long-term care facilities, and legislators who care more about other issues.

While sexual assaults are one of the worst kinds of senior abuse, countless other abuses occur in facilities on a daily basis. I was a volunteer certified long-term care ombudsman for 2½ years, and on almost every visit to facilities in Lane County observed problems such as residents with bedsores, unchanged sanitary underwear, and colorless and tasteless meals. I learned about theft of residents’ personal property, occasional dirty kitchens, well-meaning but poorly trained staff (and a few who weren’t well-meaning), underpaid young facility directors who had little experience in the business, and medication mistakes — which can lead to death.

In three facilities I saw demented, sexually predatory male residents, and missed by a day seeing one of these residents shot to death by an offended fellow resident who then killed his wife and himself. This happened at the Alpine Court Memory Care Facility in Eugene.

From November 2009 through April 2011, Lane County Adult and Protective Services received 866 complaints about incidents of neglect or abuse in long-term care facilities under its jurisdiction. Of these, 44 percent were substantiated by APS caseworkers and passed on to the state DHS, which contracts with APS to do the investigations in the facilities. Of those reviewed by the state during this 18-month period, 28 percent of the 44 percent sent on to the state were upheld by DHS. Of the 28 percent substantiated by the state, 20 percent resulted in fines.

Thus, out of a total of 866 complaints, only 22 were found severe enough to incur a fine.

The Oregon Health Care Association is the main lobbying group for the for-profit long-term care industry in Oregon. It has already convinced our legislators this year that increasing those penalties would be bad for business.

One bright spot in this depressing picture is the state Office of the Long-Term Care Ombudsman. The office’s staff of deputies and its volunteers across the state are committed to advocating for seniors and their rights. But at a meeting in May with DHS officials, the ombudsman’s office was told that imposing fines doesn’t do any good because they only amount to a few hundred dollars. Instead, DHS said it would go after the few “bad apples” in the industry. That may be why DHS regularly reverses a significant number of findings of sustainability of neglect or abuse by the Lane County agency.

What can be done about this mess? I suggest the following:

When you hear of neglect or abuse, report it to the Lane County Adult and Protective Services office in Eugene. Also call the state Office of the Long-Term Care Ombudsman. If it’s a criminal matter, call the police.

Call Gov. John Kitzhaber’s office in Salem and demand more rigorous enforcement by DHS of the existing laws against facilities that neglect or abuse their residents. The governor has recently appointed Erinn Kelley-Siel as director of the Department of Human Services.

Call your state representative and senator, and ask that they change the law in the 2012 legislative session to impose much stiffer penalties on an industry that, according to the evidence, puts profits above the well-being of the people they are supposed to serve and protect.

To grow old and have to go into a facility, and then not to feel safe or protected or well-cared for in the place where you live, is demeaning at best and terrifying at worst. Public outcry can change this.

 

GAO Report about Investigating Complaints

MCKnight's Long Term Care News had an article about the new GAO report .  The report concludes that substantial evidence mandates more oversight from the Centers for Medicare & Medicaid Servives specifically with investigating complaints.  Nursing homes self-report so the data is inherently unreliable. 

 

WSPA's State of Care

Diane Derby at WSPA did a 7 On Your Side Investigation called State of Care that reported the problems that families like the Sextons have with Magnolia Manor-Inman.   Dorothy Sexton was a resident at Magnolia Manor-Inman, a nursing home owned and operated by Sparks, Maryland based Fundamental Long Term Care Holdings, L.L.C.

Sexton's family who visited often complained about the neglect but the administrator, Dale Lyles, ignored their pleas for help.  "All Dale will ever tell you is he's looking into it," said Sexton. Some of the issues include giving the resident the wrong medication, not responding to call bells, and allowing her to sit in a dirty diaper for hours without help.

Pam Dukes is DHEC's Deputy Commissioner of Health Regulation and admitted that due to numerous complaints DHEC has inspected Magnolia Manor in Inman three times this year.  Dukes claimed DHEC would be making at least four mandatory unannounced visits each year, instead of once every two years to more than 480 facilities statewide.  DHEC will limit the focus of inspections to issues involving quality of care.  Dukes told WSAP there still is a way to check out many facilities online. (Click here to check out a facility)   The ratings are based on health inspections for topics like proper management of medications or protecting residents from abuse, staffing, and quality measures like how well the nursing home prevents and treats skin ulcers.

Magnolia Manor in Inman received 1 out of 5 stars on it's overall rating from Medicare. The Medicare website says the total number of health deficiencies for this facility is 15. In South Carolina the average is six.

Click here to make a FOIA request.   To file a complaint against a nursing home or assisted living facility contact your local Long Term Care Ombudsman's office. Click here to locate one in your area. You can also file a complaint with SC DHEC by clicking here.

 

Florida Governor Rick Scott Helps Campaign Contributors

Consumer advocates and industry experts are calling for an investigation into Republican Gov. Rick Scott’s  dismissal of Florida Ombudsman Brian Lee claiming that the governor’s “interference” was illegal.  Federal and state laws prohibit political interference with and retaliation against the ombudsman.  Lee, who had held the post for seven years, previously worked under Republican Govs. Jeb Bush and Charlie Crist and was a champion of residents’ rights.

The last straw, Lee believes, was his Jan. 31 letter to nursing homes directing them to submit information on their ownership, as permitted under the new federal health care legislation. It's a contentious issue in the industry; critics say that's because facilities are often broken into multiple businesses to make lawsuits against them more difficult.   After Lee's departure, a new letter was sent out to nursing homes telling them to disregard the order.

“This is really a disaster for the residents of Florida nursing homes,” said Kate Ricks, chair of Voices for Quality Care, a Maryland-based nonprofit that supports patients’ rights.  “There are problems in nursing homes and assisted-living facilities across the country, and there are very few resources to help — but the ombudsman is one. The ombudsman’s only job is to be an advocate for those residents. He has to be independent.”

The federal Administration on Aging sent a letter to Voices for Quality Care confirming there will be a review of Florida’s long-term-care ombudsman program, “including the circumstances surrounding [the] resignation” of the former head of that program, Brian Lee.   The Administration on Aging will conduct the review into long-term care ombudsman Brian Lee's dismissal, and will take "all the steps we can to see that the law was followed," said agency spokeswoman Moya Thompson.

In a letter to Charles Corley, the secretary of the state Department of Elder Affairs, the Administration on Aging warned the job must be filled by someone with credibility among advocates for the elderly and disabled and untainted by conflicts of interest.

Governor Scott, who previously ran the Columbia/HCA hospital chain which was found guilty of Medicaid fraud, also founded Solantic, a chain of urgent care centers in Florida.  Scott took money from the nursing home industry in campaign contribution and seems to repaying their generosity now.

See articles from the Miami Herald, the Orlando Sentinel here and here.

The Termination of Ombudsman Independence

McKnight's had an article about the tragic case of Brian Lee who was fired by the infamous new governor of Florida Rick Scott.  Lee was fired as the director of Florida's Long-term Care Ombudsman Program (after seven years) for doing his job.  He requested ownership information from nursing homes that are given tax payer funds through Medicare and Medicaid.  The request was authorized under new federal healthcare legislation which will promote transparency and accountability.  Scott fired Lee after operators and industry lobbyists had complained about the request.  Rick Scott is owned by Big Insurance.

Consumer Voice Statement on Florida Ombudsman Resignation:

 

The independence and effectiveness of the Florida long-term care ombudsman program were dealt a severe blow last week by the forced resignation of state ombudsman Brian Lee. The Consumer Voice is shocked that Gov. Rick Scott forced out the ombudsman, who represents some of the state's most vulnerable residents, on the recommendation of nursing home and assisted living operators who are the subject of the ombudsman program's oversight.

 

The ombudsman is mandated under the Older Americans Act to be an independent voice for residents and free of conflicts of interest. Ombudsmen investigate resident complaints and serve as advocates to ensure that residents in nursing homes and assisted living facilities are protected under the law.

 

"Brian was recognized by his colleagues in Florida and nationally for his commitment to protecting the rights of long-term care residents and working with residents, families and providers to improve care," said Sarah F. Wells, Consumer Voice executive director. Wells said the office must be independent and free of political interference to perform its statutory functions.

 

Lee was asked to resign after he asked the state's nursing homes for names of companies and individuals with an ownership and operational interest in their facilities. State ombudsmen were given authority to request the information from Medicare and Medicaid-funded nursing homes in transparency provisions in the health care reform law. The law was the subject of congressional hearings in which witnesses testified that it is often impossible to hold nursing homes accountable for quality because of complex ownership and operating structures. In a recent report, the Government Accountability Office said, "To determine the effect of ownership on nursing home quality of care, it is necessary to have complete and accurate ownership information that provides a clear understanding of the relationship of each owner to the nursing home and any other owners."

 

Ombudsmen in some states report that nursing homes routinely provide the information when it is requested. In 2012, a summary of the ownership data will be reported on the federal government's Nursing Home Compare website, which is designed to help families choose a nursing home.

 

"We are very concerned that the governor of Florida has yielded to industry demands to dismiss an effective advocate for residents in a state that so many elderly Americans choose as their retirement home," said Wells. "As a national voice for long-term care residents, we strongly urge the governor to follow the law and allow the ombudsman program to operate without interference."

The National Consumer Voice for Quality Long-Term Care is a 501(c)(3) nonprofit organization founded as the National Citizens' Coalition for Nursing Home Reform (NCCNHR) in 1975 by Elma Holder. The organization represents the consumer voice at the national level for quality long-term care, services and supports by advocating for public policies that support quality care and quality of life responsive to consumers' needs in all long-term-care settings; empowering and educating consumers and families with the knowledge and tools they need to advocate for themselves; training and supporting individuals and groups that empower and advocate for consumers of long-term care; and promoting the critical role of direct-care workers and best practices in quality-care delivery.
 

How to file a Complaint

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."

 

Finding the Right Nursing Home

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.

 

Role of Ombudsman in Nursing Homes

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.