Ombudsmen deal with problems in nursing homes, assisted living facilities

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.

Host Amber Smith: Our topic today is the rights of people living in skilled nursing and assisted living facilities in Central New York. My guest is Rebecca Alder. She's the regional long-term care ombudsman manager at Arise Child and Family Services.

Welcome back to "The Informed Patient," Ms. Alder.

Rebecca Alder: Thank you for having me.

Can you describe what a long-term care ombudsman is and what they do?

Rebecca Alder: Yes. So a long-term care ombudsman is an advocate, first and foremost. What long-term care ombudsmen do is help people that live in residential facilities, such as skilled nursing and assisted living.

We help them work through any issues or grievances they have with their care.

Host Amber Smith: So what types of facilities? You said long-term care and assisted living. What is the difference between those, and then, what geographic area do you cover?

Rebecca Alder: Well, the difference between long-term care and assisted living is that basically assisted living, supports residents in a community setting with their activities of daily living. So, for example, assisting with the resident in getting dressed, or maybe preparing their meals.

Whereas skilled nursing, that's a higher level of care. It's actually considered custodial care, and it's in a more complex medical environment to meet those needs.

Host Amber Smith: So it's not independent living?

Rebecca Alder: No, it is not. That's another whole category that the ombudsman program does not cover.

Host Amber Smith: And then the geographic area, are you throughout Central New York or just Onondaga County?

We are Region 10, and we cover Onondaga, Cayuga, Cortland and Oswego counties. That's about 7,000 residents within both the skilled and the assisted living facilities.

Host Amber Smith: New York state famously has a lot of regulations. Are ombudsmen expected to be familiar with the regulations for nursing homes and assisted living facilities?

Rebecca Alder: Well, yes and no. We're not required to know every single federal or state regulation. However, there are many regulations that relate to quality of care, so we train our ombudsman staff to learn the regulations that relate to how many showers a resident gets a week or how many snacks they should be served, how many activities, things like that. We may focus sometimes: If a resident complains about the temperature of their room, I can certainly look and see what that regulation is.

We don't necessarily need to know the specifics, just enough to know when resident rights are potentially being violated.

Host Amber Smith: So a practical familiarity with those things, it sounds like, is important. Now, what are the rights of residents if they're living in skilled nursing or assisted living? What do you hear about most often having problems with?

Rebecca Alder: Well, I feel like a lot of times we get the complaint that residents feel that they do not have the right to voice a concern or air a grievance without fear of retaliation, so that is absolutely a basic right that everyone in that residential facility has.

Another right is the right to a safe discharge. A facility cannot send a resident to a homeless shelter just because the bill has not been paid. Let's see here ... another right would be the right to participate in your own care, your own care planning, so that the facility is not putting out care plans that don't involve your thoughts and your goals.

Host Amber Smith: So do the rights deal with the quality of care, making sure that you have a comfortable living environment. That you don't feel discriminated against, is that covered as well?

Rebecca Alder: Yes, absolutely. And of course, you know, the right to be free from abuse, whether that be verbal, mental, financial, physical.

Host Amber Smith: So a person who's living in one of these facilities, would they have a say about whether they're going to be transferred to another one or if they're going to be discharged?

Rebecca Alder: Absolutely. Yes. A resident should be aware of what their discharge plan is, and if they don't agree with it, they can certainly appeal and hope for a different outcome.

Host Amber Smith: Do they have a right to privacy? Because I know some of these facilities. It's not a private room necessarily, so does a resident have a right to privacy?

Rebecca Alder: They have a right to privacy within the, realm of, yes, having to have a roommate. Basically, what staff really should be doing, what I instruct my staff and my volunteers to do, is when you enter a room, knock on the door: You know, Mrs. Smith, it's Rebecca from the ombudsman program, may I please enter? You know, showing that respect. When you're in the room, making sure that curtain is closed so that your roommate could not see you getting bathed or washed. So, it's difficult, but yes, that still is a right, right to privacy.

It just looks a little differently when you have a roommate.

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 Child and Family Services. She's the long-term care ombudsman program regional manager, and we're talking about the rights of people who live in nursing homes and assisted living facilities

So are the rights the same for assisted living versus nursing homes?

Rebecca Alder: Yes, they are.

Host Amber Smith: And do residents of these facilities have the right to come and go?

Rebecca Alder: That's a great question. It really depends on the facility. For assisted living facilities, yes. Many residents at assisted living facilities have a car, so they're able to leave the property when they want.

Now, with skilled nursing, it's a little bit different. Because of Medicaid guidelines, they cannot leave the facility for more than 24 hours. If they have another funding source, say, private pay, they can certainly do that. However, family members would have to sign them out. The facility does have a responsibility, knowing where their residents are at all times.

Host Amber Smith: Do residents have to have access to a library or to newspapers or television, or are those things only available if they can pay for them?

Rebecca Alder: Again, it depends on the facility. Some facilities do offer free cable TV, free phones. Many do not. In the regulations, when it comes to activities, it's written as "giving quality activities for the residents."

It doesn't specify television, books, anything like that. So it's kind of a "read between lines" for activity directors. Again, many facilities do offer television, cable, phones, but residents would have to pay for that.

Host Amber Smith: Now, medical care is part of nursing home care, right? That's covered altogether?

Rebecca Alder: Yeah.

Host Amber Smith: But now what about dental care or vision care? I'm thinking about people who are immobile in a nursing home and couldn't really take themselves to those appointments. How do they receive that type of care?

Rebecca Alder: Well, Medicaid does cover both vision and dental, and there are providers that go into the facility and see residents on a regular basis.

They bring the equipment to the facility. I just want to point out, Amber, because this is important: The resident does have a right to their own physician, their own provider; however, they may be responsible for paying for that.

Host Amber Smith: I see. Now, you touched on this a little earlier, but what does happen to someone who runs out of money and can't pay for the nursing home that they're in, but they're not able to live on their own?

What happens to that person?

Rebecca Alder: Typically, when a resident cannot pay for their care, in order to qualify for Medicaid, they must spend down their assets. but certainly they may need care in the interim. So how it works is that a resident will be in a facility and have a spend-down, a "NAMI," and what that is, is an amount paid to Medicaid every month, and that allows them to go through their assets.

But they're still receiving those medical services at the same time. They don't have to necessarily deplete all their assets before going into a facility. So it really is good for people that need that care, but maybe they have too many assets to qualify, but not enough to pay for $14,000 a year privately.

Host Amber Smith: You said "NAMI." What does that mean?

Rebecca Alder: NAMI stands for "net available monthly income."

Host Amber Smith: Now, some people are unhappy about their situation, being in a nursing home, because they're not able to live on their own, and others are cognitively impaired and may not fully understand where they are.

How do you advocate for these people?

Rebecca Alder: Well, we many times go into assisted livings that cater to people with memory impairment, or we're in nursing homes where there's a dementia wing. Typically, what we do is, if the residents cannot really articulate to us what's upsetting them, we use our senses. As ombudsman, we observe, is the resident clean? Are their breakfast trays picked up? Is there an odor in the facility? Is the resident dressed? Are they sitting up? Sometimes, sadly, I'll get calls on Monday mornings from people in facilities saying, "I was left in bed all weekend" because there just simply wasn't enough staff.

So we use our senses, observation, to assist people that really cannot necessarily speak up and tell us what they do not like about their care.

Host Amber Smith: How does a resident of a nursing home or assisted living facility reach an ombudsman?

Rebecca Alder: We try to create a regular presence in all facilities, particularly the nursing homes, just because we do see more complaints, but we are in assisted livings on a quarterly basis. We do have our posters up in every single facility. It is required to have our posters up with our hotline number. That's my direct line. And again, just going in there for those weekly visits and getting to know the residents and having them trust us and to say, "OK, well, here's an ombudsman. She doesn't work for the facility. I can open up to her."

Sometimes that takes a while, so that's why we want to establish that regular presence in their facility.

Host Amber Smith: In recent years, especially with COVID, nursing homes, like many other industries, have lost a lot of workers. Are you seeing more of a need for ombudsmen tied to staff shortages?

Rebecca Alder: Not necessarily a need for more ombudsman, but the number of complaints have increased, absolutely. And a lot of issues go back to short staffing. So if a resident is saying that they haven't received a shower in three weeks, when you start to investigate and go back to the origin, it's typically because of short staffing levels.

So yes, we have received many calls due to that. Thankfully, our program, has gotten some recognition during the pandemic for the assistance we were able to offer residents, and thankfully we do have some increased funding, so we were able to hire more staff to serve the residents of Region 10.

Host Amber Smith: Well, before we wrap up, tell us how people can become volunteer ombudsmen if they're interested. Are you recruiting for more volunteers?

Rebecca Alder: I'm always recruiting for volunteers! Ideally, I would love to have a volunteer in every single facility we cover, which is about 62 different facilities. They can call me. The number here at Arise is area code 315-671-5108, and you can go to our website, Arise Child and Family Services, and look for the ombudsman program for our information.

Host Amber Smith: And what type of person are you looking for, and how much time should they allot to devote to this, if they're interested?

Rebecca Alder: Well, we're looking for anyone that is able to give a minimum time commitment of two to four hours a week. That's so that they can go into the facility on a regular basis and get to know the residents.

So it's basically the two to four hours a week and monthly in-service meetings to earn continuing education credits, so that they can retain their ombudsman certification. That's 18 credits a year. So once you go through the training and you are established with a facility, really the time commitment is only two to four hours a week, and then that monthly two-hour meeting.

Host Amber Smith: Well, Ms. Alder, thank you so much for your time today.

Rebecca Alder: Thank you so much.

Host Amber Smith: My guest has been Rebecca Alder. She's the long-term care regional ombudsman manager at 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.

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