Ombudsman program for nursing homes seeks volunteers

Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Arise Child and Family Services has a long term care ombudsman program with opportunities for volunteers. We're going to learn more about the role of the ombudsman program from my guest, regional ombudsman manager Rebecca Alder. Welcome to "The Informed Patient" Ms. Alder.

Rebecca Alder: Hi Amber. Thank you for having me.

Host Amber Smith: Ombudsmen typically are people who look into complaints people have with an agency or an institution of some sort. Is your group the same type of ombudsman?

Rebecca Alder: It is. It's a little bit different. So yes, you're absolutely right. There's different kinds of ombudsman. A long term care ombudsman is an advocate and a resource for people living in residential facilities. We cover not only skilled nursing facilities, but also assisted living, family style homes and adult homes.

Host Amber Smith: And what geographic area do you cover? Onondaga county, where Syracuse is, but do you cover other counties as well?

Rebecca Alder: Yes. Our program is regionalized, so we are region 10. I'm responsible for Onondaga, Cortland Cayuga and Oswego counties. That's about 7,000 residents.

Host Amber Smith: There's a lot of long term care options and skilled nursing facilities, assisted living. There's a lot within that region, and you're one person.

Rebecca Alder: That is correct. I do have amazing program staff. I have a full-time and a part-time coordinator that do assist me. And then, of course, we depend on volunteers to fill the holes. And with only two and a half program staff, there certainly are holes.

Host Amber Smith: So tell me more about the volunteers. I'm interested in the opportunities and what sort of person you look for to volunteer.

Rebecca Alder: Well, to be a volunteer long term care ombudsman, we look for people who have a passion for helping residents and working with residents in residential facilities.

We look for someone who is assertive, a volunteer that could go in and speak with the CEO or the director of nursing and work hard through the investigation process to resolve any complaints or issues that a resident may have. Ombudsmen may also file complaints on behalf of ourselves. If we go into a facility and, say, for example, there's an odor, or we notice that several residents aren't properly groomed, we can bring on a complaint as the ombudsman and investigate it that way. So it's helping several residents, not just one.

It sounds like a good volunteer would be someone who maybe worked in the industry, in nursing or nursing homes...? Not necessarily. Actually, we do have very strict conflict of interest guidelines. So to become a volunteer, you must not have worked at a residential or any other type of adult residential facility within the last 12 months. The current volunteers I have come from all walks of life. Some are former RNs. I have someone who in his past life was a HR (human resources) executive. He had fantastic mediation skills, so he is absolutely a wonderful ombudsman. I have a former state psychologist. I actually have someone who was a CNA (certified nurses aide.) So, really, it's all walks of life.

There is not an educational requirement. It's someone that simply has the passion and drive, and again, to be assertive to get resolution for resident complaints.

Host Amber Smith: Now CNA, that's certified nursing assistant?

Rebecca Alder: Yes. Long-term care facilities must have certified nurses aids to assist with the nurses.

Host Amber Smith: I see. Now, what is a typical week for a volunteer? What does it look like?

Rebecca Alder: Well, generally what our program does require is a 2- to 4- hour commitment in a week with the facility that was chosen for them. And I actually do have some ombudsman that cover more than one facility. So that would be a minimum of two hours to each facility covered. Generally what someone would do as a volunteer ombudsman, we ask that they do not come the same time every single week or the same day. We definitely want to keep staff, for lack of a better word, on their toes and not expect us every Tuesday at four o'clock, because things look a little bit differently when they're expecting an ombudsman or the Department of Health, versus a normal day.

When a volunteer omdubsman enters the facility, the first thing we ask is that they get a new roster of residents from the front desk. We do have access to that information. And when we have that, we actually go and visit the new residents. We explain our program, we give them a brochure, tell them how we could be a resource and advocate for them while they're there for their stay. Typically after they meet with the new residents, they go just door to door and hit up the residents, maybe they weren't available the week prior, or then they follow up with any concerns or request for assistance as well. Some of the neat things that volunteer ombudsman can also participate in is a monthly residential council meeting. All skilled nursing facilities are required to have a resident council. That's when the residents come together and talk about the bigger issues that affect more than one person. So that's always a pleasure to sit in on these meetings.

Also, volunteer ombudsmen are invited to participate in the survey process. So every skilled nursing facility and adult home that's licensed and accepts Medicare and Medicaid must have a 12- to 18- month recertification survey from the Department of Health. So how ombudsmen get involved is that the surveyor may ask the volunteer what their experience has been in the past year, what are they seeing, any systematic issues?

We also participate with the resident council meeting that the survey team holds while doing their inspection. And then lastly, we are invited to the what's called exit interview survey. That's what the Department of Health does, prior to leaving the facility. They give the facility staff a list of potential deficiencies. So really it's a wonderful opportunity to go into facilities, assist residents, work with other entities, such as Department of Health and work together to, again, make sure that the resident has the very best quality of life.

Host Amber Smith: So does every nursing home or assisted living facility have an ombudsman volunteer assigned to it?

Rebecca Alder: No, unfortunately not. My region, region 10, has 64 facilities. Currently we only have six active volunteers. We have eight, but right now, two are on medical leave. And, that is why our program is always recruiting volunteers, because we simply as program staff cannot be in the facilities every week. We try very hard. We, make sure that we hit certain facilities at a minimum, quarterly, but we really do try for monthly. For skilled nursing facilities, we do our best to make a visit weekly, but it has not been feasible lately just due to the lack of volunteers.

Prior to COVID, we had about 25 volunteers, and it was great. We had a lot of coverage, but unfortunately, during the pandemic, many volunteers decided that because they're older and some are retired that it really was not in their best interest to be going into facilities during COVID.

Host Amber Smith: How would someone who's listening to this interview and is interested in volunteering, how would they go about applying?

Rebecca Alder: Well, first thing is to call me at the office. My number is (3 1 5) 6 7 1 - 5 1 0 8. If you don't remember that number, remember the name Arise. Arise is our host agency. So you would call Arise, and the receptionist would connect the potential volunteer with myself. I chat a little bit about what the program requirements are and the process for being certified. All volunteer ombudsmen must go through a very thorough certification process which involves pre and post classroom shadowing. And then, of course, the classroom component, which is about 36 hours. The next step is to fill out a volunteer application. We do a very basic background check. Once the background check comes back, then we can start the pre-class shadowing, which is four hours, is the requirement. And what that pre-class shadowing does is it gives potential volunteers the opportunity to see exactly what their time and facilities would look like. I've had, sometimes, potential volunteers shadow me, and after one or two visits, they say, "you know what? This is fantastic. However, it's just not for me." And that's fine. It's not for everybody. And, I actually have a volunteer last year that went through the certification who decided, you know, it's really not for me to be in the facilities, however, I'm gonna come help you in the office. And so we certainly can use volunteers for not only being in facilities, but at the office. That would free program staff up to go out and make more visits.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Rebecca Alder from arise. She's the regional long term care ombudsman manager.

We've all read news accounts from time to time about poor conditions in nursing homes. How much can ombudsman help someone who is living in one of those troubled nursing homes or who has a family member living in one of those troubled nursing homes?

Rebecca Alder: Well, the main things that ombudsmen do is that we educate, empower and advocate. So when we receive phone calls from people in the facilities that maybe are more in the news than others, not only do we go and investigate calls that come in, but we also do our very best to have several visits that are considered routine. We call them routine visits, and that's where we go and just observe staff, observe the residents, is there an odor in the facility, et cetera.

And we work very hard to make sure that residents know their rights and how to advocate for those rights. And if they're not successful, then of course we would come in and then we would be the advocate. Because the program again, is volunteer-based, and at the moment, there's not a lot of volunteers, again, a big component of what we do is education, not only educating the resident, but also their representatives, for example, their daughter or an aunt who has the power of attorney / health care proxy. We also educate staff. It's very common for administrators to have us come in and speak with their new incoming employees at orientation to talk about resident rights and how they can best serve the residents while working in the facility.

Host Amber Smith: You mentioned the advocacy role. Does that apply to residents who have Alzheimer's disease or dementia?

Rebecca Alder: Absolutely. If a resident does not have capacity, generally they do have someone acting as their power of attorney / health care proxy. So they may call us the representative and have us go see the resident and work on any issues they're concerned with. However, if we go into a facility and speak with the resident and the resident does not want our assistance and is able to articulate that, then we do not proceed. You may be like, "well, that's strange. Why would someone with dementia, how would they even understand?" There's various degrees of dementia. And if a resident, even with dementia, if they can still indicate their wants and needs, that still, that has to be honored. Dementia does not take away their rights to have a certain food, or want to do a certain activity.

So as we work with the representative, again, we also work with the resident with dementia.

Host Amber Smith: Having worked in this field for so long, what advice do you have for families who are just now looking into long-term care for a loved one?

Rebecca Alder: Well, the very first thing I do is I have them look up the Centers for Medicare and Medicaid. Every facility has a star rating, 1 to 5, indicating -- based on surveys, facility complaints, etcetera --where their level is. So some facilities are 1. Some facilities are 5. And what's interesting is that, it's a bell curve. So say, for example, you have five great 5-star facilities. You can't have a six. So, therefore, a facility must be a 1 with the curve.

So, that's good to start, but it doesn't always tell the picture of what's going on in the facility. I encourage families to visit, visit, visit. I always encourage families just to take every opportunity they can to visit the facility they're interested in, whether it be during the week during normal business hours, or maybe pop in on a Saturday just to see how the weekend shifts look. Ask lots of questions. Use their senses. Does the facility smell? Are residents appearing groomed? Are they out of bed? Are they doing activities? Are they eating meals that are warm? That's a dignity issue for sure. Things like that. You've just got to ask questions. Ask for staffing ratios. Ask for their contingency plan of too many staff call in sick. These are the things you want to know that will certainly indicate the quality of a facility.

Host Amber Smith: If you have a loved one in a nursing home or assisted living and problems start coming up, what do you advise the loved ones to do?

Rebecca Alder: Communication is key. Many times I have families or residents call me with their concerns, and the first question I ask is, what have you done? And if they say, "oh, gee, I haven't spoken with anyone. I'm afraid of retaliation." So what I then do is, if it's a small issue that's something that all it takes is a phone call, I encourage the resident or the family to make that phone call. And we find many times that that's all it takes is just a little communication between staff and the resident or the resident's family. If it's an issue that cannot be resolved at that level, I ask them if I can proceed with an investigation.

Now, residents and their representatives, they call the shots here. The cornerstone of our program is confidentiality. So if a resident does not want the ombudsman to look into the situation, we do not. We have to honor that confidentiality. If they give us permission, we do what's called an investigation. The investigation may include, interviewing staff or general record review. Ombudsmen do have access to a resident's records, providing we get that permission from the resident. So after we do those things, as well as possibly going in on off hours, maybe going to the facility in the evening, or... I've been to a nursing home, one time I went at 7 p.m. on a Saturday to see the second shift. So with all these things that we do that are in our toolbox, then hopefully we can come up with a plan for resolution.

And then once we have that plan, the most important part of the investigation is follow up. Follow up in two weeks. Did the facility hold true to their word that they would start providing a service or whatever the resolution may be. And if they don't, certainly we keep working, but if there is ever a time where the ombudsman can not solve the issue, then we do refer to the Department of Health.

Host Amber Smith: Well, Rebecca Alder, thank you for making time for this interview.

Thank you for having me. My guest has been Rebecca Alder. She's the regional long term care ombudsman manager from Arise Child and Family Services. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at Upstate.edu/informed. This is your host, Amber Smith, thanking you for listening.