New State Ombudsman Orientation Ombudsman 101 Louise Ryan

New State Ombudsman Orientation Ombudsman 101 Louise Ryan Administration for Community Living November 10, 2020

Welcome • Quick Overview of ACL • Assessment • Functions & Responsibilities of LTCO • Selected Topics – NORS – Coordination with other agencies, legal services • Question & Answer 2

Administration for Community Living An operating division within the Department of Health and Human Services formed in April 2012 • Administration on Aging (administers the Older Americans Act) • Administration on Disabilities, which includes the Administration on Intellectual and Developmental Disabilities (DD), Includes: § the DD Councils § Protection & Advocacy Systems § Centers for Independent Living • State Health Insurance Assistance Programs (SHIP) • National Institute on Disability and Independent Living Rehabilitation Research (NIDILRR) Programs

ACL Mission Maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers.

Reminders • Office of LTC Ombudsman Programs within the Administration on Aging – Not an Ombudsman – Anything shared in writing is subject to Freedom of Information Act – ACL does not appropriate funds – Executive Branch – meaning we have a process of communicating with Congress 5

Assessment • As a new state Ombudsman take time to assess— – Your program § Where organizationally located and implications § Centralized or Decentralized? § Volunteers? § History of Systemic Advocacy? 6

Assessment, page 2 • As a new state Ombudsman take time to assess— – Your history or experience with the Ombudsman program and Long-Term Services & Supports (LTSS) § Previous experience in the program? § Brand new to the program? New to LTSS? § Comfort with public speaking, conflict, data, budgets? 7

Assessment, page 3 • What does it all mean? – Organizational location § Barriers? § Expectations? § Conflicts of Interest? § Turn-over within organization? • How do you maneuver? 8

Assessment, page 4 • What does it all mean? – Your history & skills § New to the LTCOP world? o Expectations of others? § How do you manage conflict? § Turn-over within organization? o Is there support for you? • How do you maneuver? 9

Assessment, page 5 • What does it all mean? – Your history § From the LTCOP world? o Expectations of others? § How do you step into this new role? o Need to channel your experience in a new way o Is there support for you? • How do you maneuver? 10

Assessment, page 6 • Resources and inputs – Staff – representatives of the Office, agency support-i. e. fiscal, front office, IT, management – Legal Counsel – Money – what’s in the budget? – Data System – Training – Travel 11

Covid-19 • Thinking of the COVID-19 pandemic or any other emergency or disaster, • How does the LTCO “functions and responsibilities” support your ability to protect and promote the health, safety, welfare and rights of residents? 12

Read the Functions & Responsibilities § 1324. 13 Functions and responsibilities of the State Long-Term Care Ombudsman. The Ombudsman, as head of the Office, shall have responsibility for the leadership and management of the Office in coordination with the State agency, and, where applicable, any other agency carrying out the Ombudsman program, as follows. (a) Functions. The Ombudsman shall, personally or through representatives of the Office— Selected Functions & Responsibilities: (5) Represent the interests of residents before governmental agencies, assure that individual residents have access to, and pursue (as the Ombudsman determines as necessary and consistent with resident interests) administrative, legal, and other remedies to protect the health, safety, welfare, and rights of residents; ( (7)(i) Analyze, comment on, and monitor the development and implementation of Federal, State, and local laws, regulations, and other governmental policies and actions, that pertain to the health, safety, welfare, and rights of the residents, with respect to the adequacy of long-term care facilities and services in the State; 13

Functions & Responsibilities, page 2 As it relates to COVID-19 (8) Coordinate with and promote the development of citizen organizations consistent with the interests of residents; and (9) Promote, provide technical support for the development of, and provide ongoing support as requested by resident and family councils to protect the well-being and rights of residents; and 14

Functions & Responsibilities, page 3 (c) Designation. The Ombudsman shall determine designation, and refusal, suspension, or removal of designation, of local Ombudsman entities and representatives of the Office pursuant to section 712(a)(5) of the Act and the policies and procedures set forth in § 1324. 11(e)(6). (1) Where an Ombudsman chooses to designate local Ombudsman entities, the Ombudsman shall: (i) Designate local Ombudsman entities to be organizationally located within public or non-profit private entities; (ii) Review and approve plans or contracts governing local Ombudsman entity operations, including, where applicable, through area agency on aging plans, in coordination with the State agency; and (iii) Monitor, on a regular basis, the Ombudsman program performance of local Ombudsman entities. 15

Functions & Responsibilities, page 4 • (e) Disclosure. In making determinations regarding the disclosure of files, records and other information maintained by the Ombudsman program, the Ombudsman shall: • (1) Have the sole authority to make or delegate determinations concerning the disclosure of the files, records, and other information maintained by the Ombudsman program. The Ombudsman shall comply with section 712(d) of the Act in responding to requests for disclosure of files, records, and other information, regardless of the format of such file, record, or other information, the source of the request, and the sources of funding to the Ombudsman program; • (2) Develop and adhere to criteria to guide the Ombudsman's discretion in determining whether to disclose the files, records or other information of the Office; and • (3) Develop and adhere to a process for the appropriate disclosure of information maintained by the Office, including: 16

Functions & Responsibilities, page 5 • (f) Fiscal management. The Ombudsman shall determine the use of the fiscal resources appropriated or otherwise available for the operation of the Office. Where local Ombudsman entities are designated, the Ombudsman shall approve the allocations of Federal and State funds provided to such entities, subject to applicable Federal and State laws and policies. The Ombudsman shall determine that program budgets and expenditures of the Office and local Ombudsman entities are consistent with laws, policies and procedures governing the Ombudsman program. • (g) Annual report. The Ombudsman shall independently develop and provide final approval of an annual report as set forth in section 712(h)(1) of the Act and as otherwise required by the Assistant Secretary. 17

Office of Ombudsman • You are the statewide leader of a very important program – Power in your authority and duties § Access to residents & their records, Disclosure, Designation, Systems Advocacy… – However you also need to be aware of barriers and how to remedy – It’s a process 18

NORS • National Ombudsman Reporting System (NORS) – Only data collection that describes the experiences of residents – Essential that your program have regimented practices to: § Collect and enter data § Review for quality (monthly is ideal) § Use your program’s data to inform the public, policy makers and other entities. 19

NORS • Getting lost in the weeds of NORS – Don’t get stuck in the “what if’s” – Focus on consistent and routine data entry – Hold routine meetings to discuss coding and to review NORS training – Run monthly reports – Expect at a minimum quarterly reports 20

How to tell your state’s story • Have a story • Include a picture • Share the data • If advocating to address a problem, have a solution 21

Admission, Transfer, Discharge, Eviction Admission, Transfer, Discharge Chart 2013 -2017 22. Room assignment/room change/interfaculty transfer 21. Discrimination in admission due to Medicaid status 20. Discrimination in admission due to condition, disability 19. Discharge/eviction - planning, notice, procedure, implementation, inc. abandonment 18. Bed hold - written notice, refusal to admit 17. Appeal Process - absent, not followed 16. Admission contract and/or procedure 0 2017 2016 2 000 2015 22 4 000 2014 2013 6 000 8 000 10 000 12 000 14 000 16 000

Individual advocacy • The Ombudsman program was able to assist a resident to contest an eviction notice. The resident is living with Alzheimer’s disease and the facility was not providing the individualized care that she needed. The persistence of the volunteer was instrumental in obtaining the needed staffing changes, ensuring shower safety, lowering the dosage of medications which caused sleepiness, and providing assistance at meal times. Her (volunteer) advocacy helped the resident and made a positive impact for all resident’s living in this facility. 23

Creative way to share data 24

Functions & Responsibilities § 1324. 13 (h) Through adoption of memoranda of understanding and other means, the Ombudsman shall lead state-level coordination, and support appropriate local Ombudsman entity coordination, between the Ombudsman program and other entities with responsibilities relevant to the health, safety, well-being or rights of residents of long-term care facilities including, but not limited to: (1) Area agency on aging programs; (2) Aging and disability resource centers; (3) Adult protective services programs; (4) Protection and advocacy systems, as designated by the State, and as established under the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 U. S. C. 15001 et seq. ); (5) Facility and long-term care provider licensure and certification programs; (6) The State Medicaid fraud control unit, as defined in section 1903(q) of the Social Security Act (42 U. S. C. 1396 b(q)); (7) Victim assistance programs; (8) State and local law enforcement agencies; (9) Courts of competent jurisdiction; and (10) The State legal assistance developer and legal assistance programs, including those provided under section 306(a)(2)(C) of the Act. 25

Mo. U – Legal Assistance • Older Americans Act Section 712(h)(8) – Requires the Ombudsman to: “coordinate, to the greatest extent possible, ombudsman services with legal assistance provided under section 306(a)(2)(C), through adoption of memoranda of understanding and other means; ” 26

LTCOP Rule - Mo. U (10) The State legal assistance developer (LAD) and legal assistance programs, including those provided under section 306(a)(2)(C) of the Act. • A Mo. U with state legal assistance developer and legal assistance programs is required • ACL also factors in the language “and other means, ” which adds flexibility • NORC website has examples. • One approach is to consider that with the LAD you may focus on systems advocacy coordination and training, while legal services is more relevant for making referrals, and training at the local level See Frequently Asked Questions: https: //www. acl. gov/node/68 • 27

How do Ombudsman programs access to legal support for residents? • There are many ways that LTCOP’s and legal services work together depending on a states’ organizational structure: – Ombudsman programs and legal services are frequently in separate organizations and successful collaborations are supported through program policies and procedures that describe how to refer residents to legal services; – Memoranda of understanding support these referral processes and working relationships; – Programs that are co-located often develop formalized referral processes and protocols to keep ombudsman work and recordkeeping distinct from the legal services functions of the entity. 28

Benefits of Coordination • Individual Residents: Strength of the LTC Ombudsman program is the ongoing support for residents — before, during, and after legal actions, ombudsmen are an important resource for and support to residents. • Examples of Systems Collaboration: – Strengthening state policy on financial exploitation; – Long-term care consumer protections, i. e. increased protections from evictions in residential care settings; – Participation on statewide task forces; i. e. WINGS; Elder Abuse Prevention workgroups, etc. 29

Best Job Ever • Hopefully you will embrace the uniqueness of this responsibility and authority • You will always learn • Never get bored • Be sure to pace yourself • Celebrate successes – both large & small 30

Discussion Question& Answer 31