Georgia Long-Term Care Ombudsman Program 1998 annual report [1998]

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STATE OF GEORGIA LONG-TERM CARE OMBUDSMAN
PROGRAM
STATE LONG-TERM CARE OMBUDSMAN
Becky A. Kurtz
OFFICE OF STATE LONG-TERM CARE OMBUDSMAN PROGRAM STAFF
Barbara Fraser - Ombudsman Program Manager Marsha Bond - Ombudsman Program Manager
Andrea Hamilton - Project Coordinator
Division of Aging Services 2 Peachtree St., NW, 36th Floor
Atlanta, Georgia 30303-3176 (404) 657-5319

TABLE OF CONTENTS

INTRODUCTION ...........................................................;

~............3

ORGANIZATION

3

WHAT DO OMBUDSMEN DO? ...............................................................................................4

HELP RESIDENTS ESCAPE ABUSIVE SITUATIONS

.4

HELP RESIDENTS LIVE HApPIER LIVES

5

HELP RESIDENTS RESOLVE DISPUTES

6

OMBUDSMAN PROGRAM HIGHLIGHTS ............................................................~................................6

HEALTH CARE FRAUD PROJECT

;

PROMOTING HUMAN ENVIRONMENTS IN NURSING HOMES

,

6

6

OMBUDSMAN PROGRAM SERVICES

7

COMPLAINT PROCESSING

8

ISSUES ADVOCACy

:

9

INFORMATION AND ASSISTANCE

9

CONSULTATION TO FACILITIES

10

ROUTINE VISITATIONS TO FACILITIES,

10

COMMUNITY' EDUCATION

10

OMBUDSMAN ADVISORY COUNCILS

11

INTERAGENCY COORDINATION

11

RESIDENTIFAMILY COUNCILS ;

12

IN-SERVICE EDUCATION TO FACILITY STAFF

12

I VOLUNTEER MANAGEMENT

12

COMPLAINT PROCESSING

12

WHO MAKES COMPLAINTS?

12

COMPLAINT CATEGORIES

13

TYPES OF COMPLAINTS BY COMPLAINT CATEGORY

,

13

Resident Rights

13

Resident Care

:

14

Quality ofLife

,

14

Administration

15

Problems With Outside Agency, System or People

15

MOST FREQUENT SPECIFIC COMPLAINTS

16

COMPLAINT MANAGEMENT

17

COMPLAINT INVESTIGATION RESULTS

17

COMPLAINT RESOLUTION

18

COMPLAINT REFERRAL

18

FUNDING

,

19

TRAINING ACTIVITIES

;

20

RECOMMENDATIONS FOR LONG -TERM, CARE ISSUES
LONG-TERM CARE SERVICES SHOULD BE AVAILABLE AND AFFORDABLE COMBAT MALNOURISHMENT IN NURSING HOMES DECREASE MEDICAID DISCRIMINATION IN NURSING HOME ADMISSIONS INCREASE STAFFING IN NURSING HOMES

.

;...20

20 21 21 22

1

RETAIN ENFORCEMENT IN MHIM:R, PERsONALCARE HOMES
PREVENT AND COMBAT HEALTH CARE FRAUD:

SUCCESSES IN OMBUDSMAN ADVOCACy

IMPROVED MONITORING OF-PERSONAL CARE HOMES
FUNDING FOR EMERGENCY P.LACEMENTS
OMBuDSMAN PROGRAM CHALLENGES

STRENGTHENING OMBUDSMAN SERVICES TO RESIDENTS

:

Needfor sufficient resources .. ,

Needfor ombudsmen to be independentadvocates

THE DEMAND FOR NEW SERVICES BY OMBUDSMAN PROGRAM

APPENDIX A

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APPENDIX B



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APPENDIX C
LONG-TERM CARE OMBUDSMAN PROGRAM ORGANIZATION CHART STAFF PHONE NUMBERS AND MAP
APPENDIXD

APPENDIX E

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22 22 ; 23
23 23
23
23
23 24
24
25
32
38 38 39 .40
41

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Georgia Long-Tenn Care
Otnbudsman Progratn ,'
Fiscal Year 1998 Annual
Report

The Long-Tenn Care Ombudsman (LTCO) Program improves the quality of life of residents of nursing homes and personal care homes by investigating and resolving complaints and acting as an independent advocate for residents. Ombudsmen provide education regarding long-tenn care issues, identify long-tenn care concerns and advocate for change.
Ombudsmen routinely visit long-tenn care facilities to give residents access to their ombudsman and to monitor conditions.

Nursing Homes ijlntermedi~te:;CaretMenta,. i~~: r~t- t', ~ '~:~:"'~'''I,'t~''I~tI'tt~i~lP''',:r;ttJ~'''frjl~V!,F.\'
~aetardati(<). i:1'iEaCilitiesJ;;i:~i;;.i I"': ,,"';';,:.'<" ''':'''j,';,'''{l ~,,;,,': ,,<:'';-:F ;;~f'H::'i'Hf
... ..... '...~,...,I,:,.....""'... -.:"",,,,,.:,,.-<..~; .... ';. " ...._';.'"y~i..<I."" I.
,Personal: Care 'Homes

<:,;:;",:2'1;:927,

Table 1. The Number ofFacilities and Beds by Facility Type.

The Long-Tenn Care Ombudsman Program is authorized by the federal Older Americans Ace and Georgia law2 The Division of Aging Services in the Department of Human Resources administers the program statewide. The Director of the Division appoints the State Ombudsman, who has responsibility for directing the state program.
Fifteen (15) community programs are located throughout the state in the 12 Planning and Service Areas. In most areas, the administration of these community programs is through the Area Agencies on Aging (AAA's), who in turn contract with an
'42 U.S.c. 3001 ~~. A copy of relevant sections is attached as Appendix A. 2 a.c.G.A. 31-8-50 ~~. A copy is attached as Appendix B.
3

appropriate provider agency to manage the program. In one area the AAA directly manages the community program. These provider agencies employ a total of 42 full and part-time staff. A full-time staff person serves as LTCO coordinator in each community program. -Volunteers are also an integral part of the ombudsman program. In Fiscal Year 1998 (FY98), 75 volunteers--17 certified, 46 volunteer visitors and 12 who perform other services-- assisted the Ombudsman Program.

An organization chart and a listing of AAA and LTCO staff for each community

program are listed in Appendix C.

.

The following are but a few examples of residents that ombudsmen have assisted. Names and some-details have been changed to preserve confidentiality.
Help residents escape abusive situations
-When the ombudsman was contacted, Jim was already in the emergency room. A resident of a personal care home with mental retardation, Jim was unable to communicate verbally. Through gestures, Jim cominunicated that the bruises on his wrists were caused by handcuffs and the ones on his head were from being sla.mrned against a wall. -Hospital lab tests revealed that Jim had been given a _toxic level of antidepressants.
Upon visiting the personal care home, the ombudsman found Perry, a resident with his hands tied behind his back with a leather belt. The ombudsman was concerned for the safety of the residents remaining in this home. The resources of several agencies - including the Office of Regulatory Services, law enforcement, and adult protective services - were brought in to address the care of these residents, who were quickly relocated to other personal care homes. Since then, the Office of Regulatory Services has taken legal action to revoke the home provider's permit.
. Ms. Smith claimed to be a personal care home provider in order to receive referrals of individuals released from the hospital. But when a hospital worker thought it was odd that Ms. Smith's two residents missed their clinic appointments, she asked for the ombudsman's help:"
When the ombudsman went to Ms. Smith's home to investigate, she discovered an unlicensed home with deplorable conditions. No one was present to provide services to the residents, there was no food in the cupboards, and the refrigerator contained only coffee creamer. Roaches were crawling in the paper bag full of medicine and on the stove and kitchen walls. On the dining room table, the ombudsman spotted a disconnect notice from the gas company. .
4

Then the ombudsman talked to the residents. Both of them told her they were hungry - they were not given any breakfast that morning. They both requested help moving to a better home. Ms. Brown was too weakto get out of bed and had vomited on herself. The ombudsman contacted an ambulance for her. Unfortunate1y~ Ms. Brown died in the hospital only a few days later.
Ona brighter note, today the other resident lives in another home where she receives better care. And the police have charged Ms. Smith for rimning her business without a license.
Help Residents Live Happier Lives
Ms. Baker, a resident who was being restrained due to her unsteady gait, fought the restraints with all her might, picking up the chair she was tied to and dragging it around the room. Her angry behavior seemed uncontrollable. Instead of reducing restraints, the nursing home tied her to bigger, heavier chairs. The ombudsman urged the nursing facility staff to explore alternatives to the restraints but Ms. Baker's family was convinced that the restraints were protecting Ms. Baker from falling.. Then one day the ombudsman, during a routine visit to the facility, discovered Ms. Baker on the floor of her room, choking with the restraint. wrapped around her neck. At that point, the ombudsman was able to convince the facility and family to work on alternatives and to provide physical therapy to improve Ms. Baker's gait.
Today, as a result of months of hard work at therapy, Ms. Baker is no longer restrained. She is able to walk again, she is sociable, and she feels good about herself - good enough to enter the beauty pageant in the facility. The ombudsman described Ms. Baker as a "brilliant, beautiful lady" as she watched Ms. Baker become this year's third runner-up.
Mr. Jones, 50, has a serious brain injury~ As a nursing home resident in the western part of Georgia, he was miserable and expressed to the ombudsman his dream ofliving in his own apartment again. The ombudsman encouraged nursing home staff to help Mr. Jones re-Iearn skills --like cooking and operating appliances -- that he would need to live independently. Efforts by Mr. Jones, the facility staff, and the ombudsman made it possible for Mr. Jones to move from the nursing home to his brother's house as a first step. Today, Mr. Jones receives inhome services through the Community Care Services Program and he has realized his dream: he receives those services in an apartment of his own.
John, an 85 year old man from the mountains of north Georgia, had been a resident of the nursing home foronly a few months but his behavior was becoming increasingly difficult for staff to deal with. After John struck a staff
5

person, the nursing home asked the ombudsman for help. After investigation, the .ombudsrp.an discovered that John was miserable and angry about being in the nursing home; the only thing he wanted in life was to return to his home where he could fish in a mountain pond. The.ombudsman set out to determine whether, ~th appropriate supports for his medical needs, John could indeed move back home. After several months of hard work by the ombudsman, the Community Care Services Program, and John himself, today John is c~ontentedly sitting by the pond and occasionally catching a bass..
Help Residents Resolve Disputes
Mrs. Gonzalez was on the verge of discharge from the personal care home. Her bills had not been paid for months and she asked the ombudsman for help. Mrs. Gonzalez' daughter, her guardian, had been ignoring the personal care home bills and had refused tocoopeiate with the home to work out a payment plan. At Mrs. Gonzalez'direction, the ombudsman brought the situation to the attention ofthe probate judge who .eventuallydetermined that the guardianship should be terminated. Today, Mrs. Gonzalez manages her own finances and continues to live in the personal care home of her choice.
Health Care Fraud Project
Georgia's aging network is learning when and how to "raise the red flag" on suspected health care fraud, waste and abuse due to Operation Red Flag. In FY98, the Longtertn Care Ombudsman Program: \
initiated Operation Red Flag under a grant from the federal Administration on Aging;
developed Georgia:"specific training and outreach materials; conducted its first of many trainings to aging services profe~sionals and
volunteers to identify and appropriately report suspected fraud, waste and abuse; and
coordinated with other agencies who work to eliminate fraud and abuse in health care.
.t
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Promoting Human Environments in Nursing Homes
The Long-term Care Ombudsman Program supports efforts to make nursing homes better places to live. One national strategy for accomplishing this goal, is the Eden AlternativeTM, a program that seeks to eliminate the loneliness, helplessness, and boredom that often occur in institutional settings. The Eden AlternativeTM creates warm, lively environments by incorporating pets, plants, and children into the everyday life of the facility. It fosters community connections and empowers staff. The Ombudsman Program has promoted the Eden AlternativeTM and similar approaches to better lives for Georgia residents by:
participating as founding members of the Georgia Eden AlternativeTM Coalition;
providing community ombudsmen with training and resources on the principles of the Eden AlternativeTM;
providing in-services to facility staff on the Eden AlternativeTM; and
touring nursing homes which are being "Edenized."

.. ,', ,;,"

,... :,,: ....

.,.... ,......

Ombudsmen provided services to approximately 156,865 individuals in FY98. For a complete breakdown of the amount of time, state and community, ombudsmen spent providing these services and performing other activities please see Appendix D.

Information and Assistance 14,602
9%

Cofllliaint Investigation 7,449
5%

ResidentlFarrily Council 4,677
3%

CollTllJnity Education 9,535
6%

Facility Consultation 5,195 3%

Figure 1. The Number of Persons Served by Type of Service.

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Complaint Processing

A principal function of the Ombudsman Program is to investigate and resolve . complaints made by or on behalf of long-term care residents. In their complaint handling, ombudsmen respect resident and complainant confidentiality; and focus their complaint resolution on the resident's stated wishes..
Complaints against long-term care facilities have risen steadily in recent years--from 3,774 in fiscal year 1995 to 6,346 in FY98 (see Figure 2). Because of the greater .number of nursing home beds as compared to personal care home beds (40,782 vs. 21,927 in FY98), a large majority of complaints received were made by or on behalf of nursing home residents.

7,000

6,000

5,000

4,000

3;000

2,000

1,000

0 FY93

FY94

FY95

FY96

FY97

FY98

OPersonal Care Homes Nursing Homes
Figure 2. The Number of Personal Care Home and Nursing Home Complaints FY93 Through FY98.

Ombudsman processed over 6,300 complaints in FY98. The total number of complaints received increased 10% above FY97 level.
A portion ofthe increase in the number of personal care home complaints can be attributed to the increase in the number of facilities and beds, 222 additional facilities with approximately 5,000 additional beds. However, the number of nursing home complaints increased by 9%, while there has been little change in the number of nursing home beds.
Statistics ofthe types and sources.of complaints received and the complaint handling process are recorded by the local programs and compiled and analyzed by the Office

's

of the State Long-Tenn Care Ombudsman. For a detailed analysis of complaint data see page 13.
Issues Advocacy
Issues advocacy is an important component of the Ombudsman Program at both the state and local levels. Activities relating to issue advocacy include the identification of issues that affect the health and well-being of residents of long-tenn care facilities, educating the community about these issues, and analyzing, monitoring, and commenting on the development and implementation of related federal, state, and locai laws, regulations, and policies. During FY 98, the Ombudsman Program promoted efforts to:
increase funds for home and community-based long-tenn care services to prevent premature institutionalization;
pennit limited nursing services in approved personal care homes for residents who need it; .
post staffing ratios in nursing facilities;
protect the rights of residents who have no one to consent for them and are being transferred out of hospitals into long-tenn care facilities; and
combat malnutrition of nursing home residents.
Information and Assistance
In FY98 ombudsmen answered 11,377 requests for assistance, providing infonnation and assistance to 14,602 consumers and caregivers statewide.
Requests for inforination and assistance come from a variety of persons, including residents and their friends and families, facility staff and other agency personnel (see. Figure 3). Most requests are handled by telephone or during ombudsman visits to long-tenn care facilities. Requests for infonnation and assistance cover a wide range of topics including resident care, admission and discharge procedures, abuse reporting and . reimbursement.
9

Facility Staff 1,243 11%

29% (3,269) of all requests for infonnation related to nursing facilities. 57% (1,875) of these requests related to care and policies, 31 %. (1,023) related to admissions and discharges.

Figure 3. Types of People Requesting Infonnation and/or Assistance, Not Including Complaints.
.\

16% (1,807)'ofall requests related specifically to personal care homes. 43% (778) of these requests related to care, services, and policies.
9% (999) related to residents' rights.

Consultation to Facilities

Ombudsmen provided 3,638 consultations to nursing home and personal care home staff during FY98. The largest number, 20% (744), of these consultations concerned nursing home services and care issues.
Routine Visitations to Facilities'
Visits to a facility for the purpose of monitoring and assessing the general condition of residents and providing resident access to ombudsmen.
Community ombudsmen made 9,901 routine visits, spending over 11,000 hours. visiting nursing home and personal care home residents and monitoring facility
.'~ conditions during FY98.
Community Education.
Ombudsmen provide community education on the rights of residents, the services of the Ombudsman Program, facility regulations and enforcement, resident care practices, and elder abuse. Most of this community education is provided through Y' 'presentations to community groups.. Other avenues of education are through professional newsletters, the new's media, and publications.

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In FY98, ombudsmen presented 288 educational sessions to 9,220 persons in community organizations, including churches, civic club~ and agencies; ,
the Middle Georgia program provided information about ombudsman services to hundreds of seniors who attended A Carousel of Life -- Jump on It, at the annual Senior Day in the Park;
I
three programs - Coastal, Southern Crescent (McIntosh Trail) and Atlanta -initiated newsletters to keep residents, their families and friends, and others informed of resident rights and other long-term care issues;
the Heart of Georgia Altamaha program spoke on abuse reporting and resident rights at a community health forum attended by more than 800 seniors from 5 counties.

Ombudsman Advisory Councils
Ombudsmen meet regularly with representatives from their communities to determine the needs of long-term care residents and find ways to improve ombudsman responses to those needs.
Interagency Coordination
Ombudsmen,work closely with other agencies who share concerns about the wellbeing of long-term care residents. A few examples include:
Participation in state and local personal care home relocation teams where residents have needed assistance with finding other living arrangements. Usually this team effort occurred where personal care homes were being closed for failure to provide adequate services.
Collaberative efforts with the Office of Regulatory Services, Long-term Care Section (which regulates nursing facilities and personal care homes) include: a) ORS training of ombudsmen, b) ombudsman training of surveyors, c) sharing information with ORS regarding ombudsman experience with facilities before surveys or licensing, and d) complaint referrals.
Ombudsmen served as members of long-term care advisory groups, including the Long-term Care Commission, and Department of Medical Assistance Longterm Care Advisory Committee and Reimbursement Workgroup.

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. Ombudsmen served as members of aging advocacy groups, including the Coalition of Advocates for Georgia's Elderly (CO-AGE) and the National Citizens' Coalition for Nursing Home Reform (NCCNHR)..
Operation Red Flag helped the Ombudsman Program develop stronger ties to entities involved in fraud prevention and investigation including: the American Association of Retired Persons (AARP), the Department of Medical Assistance, the Health Care Finance Administration, the State Health Care Fraud Control Unit, the Georgia Consumer Fraud Task Force, the Georgia Medical Care Foundation, and Medicare intermediaries and carriers.
Resident/Family Councils
Ombudsmen participated in 256 resident and family council meetings as speakers, observers, and resource persons in FY98.
Ombudsmen help residents and family members establish resident and family councils in nursing homes. One program, Coastal, developed a community-wide family council.
. Ombudsmen provide training to facility staff on developing or maintaining productive resident /family councils.
In-Service Education to Facility Staff .
In-service training sessions cover topics ranging from quality of life, restraint reduction, advance directives, resident rights and elder abuse to stress-reducing techniques for nursing assistants.
In FY98, community ombudsmen made 286 presentations to 9,028 facility staff.
Volunteer Management
In FY98, a volunteer development consultant provided by the State Office, developed tailored plans and in-depth evaluations for each community program, as well as tools to help ombudsmen improve volunteer management and training.
In FY98, 75 volunteers--17 certified, 46 volunteer visitors and 12 who perform other services--assisted the Ombudsman Program.
State Office staff approve volunteer training curricula, provide guidance and participate in community ombudsman program volunteer trainings.
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Who makes complaints?
I Nursing Homes

IPersonal Care Homes

Other Pgency Staff 3%

Figure 4. Types of Complainants by Facility Type.

Complaint Categories

I Nursing Homes

,
\

Personal Care Homes I

Problem Outside

Facility

I---~-J

6%

Figure 5. Categories of Complaints by facility type.
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Types of Complaints by Complaint Category

Res'ident Rights Nursing Homes

IPersonal Care Homes

Access t~ Informatio
2%

Figure 6. Types of Resident Rights Complaints FY98.

Resident Care Nursing Homes

I Personal Care Homes

Rehabilitation, M aintenancQ of
Function 8%

Rehabilitation, Maintenance of
Function 6%

Figure 7. Types of Resident Care Complaints FY98.
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Quality of Life
I Nursing Homes
Activities & Social Services
12%

I Personal Care Homes I
Activities & Social Services
9%

Figure 8. TyPes of Quality of Life Complaints FY98.

Administration
I Nursing Homes

Personal Care Homes

Figure 9. Types of Administrative Complaints FY98. .
15

Problems With Outside Agency, System or People

., Nursing Homes

IPersonal Care' Homes

Certlflcatlonl Ucensing Agency 1%

Certlficationl Ucenslng Agency
2"

Figure 10. Types of Complaints With Outsi~e Agency, System or People FY98.

Most Frequent Specific Complaints
Each sub-category of complaint type is further subdivided mto 124specific categories. The ten most frequent specific complaints in nursing homes and personal care homes are listed in the following tables.

NURSING HOMES

'.'.' ~:" " ,:'.. ;.:..",:;.:";, ..,.,,.,,," .:,,un,f;';;:;;':'
1. Personal Hygiene (includes oral hygiene)

3. Call Lights, Requests for Assistance
. I ~,(;:h:" ~.'"r;~a,,-O.:ir~j:q).:l, g;'~t~i>Q';.{'f~;;,:~::~:'~:t';!:;~([t~lI};'m;~j2~li~imin~;:\'i;~J::;m;;;~:;:~;HF

205

5. Accidents, Improper Handling 6.~:;;S~~pt6ff\~\:U~~#~~dli'''i:r~:"",'

7. Dignity, Respect - Staff Attitudes
':~~~i!eh:9~i~,!IAffr,!

9. Personal Property - Lost, stolen

114

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4.4% 2.4%

16

PERSONAL CARE HOMES

1. Menu - Quantity, Quality, Variation, Choice

108

6.9%

2: Medi~tio~;;F'.A:d~!rii~~~~hW.O~~H~tib~jlf~ii]~;i[!!;gi[a;;ji~f,~:i~'Oj;i;,"~;;f:::~~;f:~t:~i~i~ '~~ifJ;J1ri~,0':

3. Verbal Abuse, Psychological Abuse (punishment)
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58

3.7%

5. Discharge/Eviction - Planning, Notice
6,: ~~~~id~ft~ w~h~rl~i:'L~\J~~~~b,r,~;~~;~
7. Cleanliness, Pests
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9. Physical Abuse
~'1 oi~ offij~~,~iri~~pf6pri1it~ttlt~v~ii~f;!~

41

2.6%

Complaint Management
Complaint Investigation Results
I ,I Nursing Homes

I Personal Care Homes

Figure 11. Complaint Investigation Results by Facility Type FY98.
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Complaint Resolution3
1 Nursing Homes

Personal Care Homes

Figure 12. Complaint Resolution Results by Facility Type FY98.
Sometimes ombudsmen make referrals to other agencies that have the responsibility or capability to investigate or take other action to further assist the resident. In complaints referred to other agencies the ombudsman remains involved by maintaining contact with the resident and following up to determine whether the problem has been resolved. In FY98, 655 complaints -- 357 nursing home complaints and 298 personal care home complaints -- were referred to other agencies. Ombudsmen referred 10% of all complaints. Figure 13 shows the breakdown of types complaints that were referred to other agencies by ombudsmen.
3 "Other" category in Figure 12 includes the following categories: "Disposition Not Obtained," "Other Agency Failed to Act," "No Action Needed," and "LegislativelRegulatory Action Required."
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Nursing Homes

Personal Care Homes

Figure 13. Percentage of Referred Ombudsmen Complaints by Referral Agency.

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Expenditures for the Long-Term Care Ombudsman Program totaled $1,566,959 in fiscal year 1998. Figure 14 shows a breakdown of total expenditures by fund source.

Federal Bder Abuse Prevention 2%

Figure 14. Breakdown ofLTCOP Expenditures by Fund Source.
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Because state and community ombudsmen work with many complex issues and
a provide training arid information to variety of individuals and groups, they need up-
to-date information on regulations, changes in the law, and on other topics relevant to long-term care residents and their care. They also need training in the skills necessary to investigate complaints and to be successful advocates for facility residents. State law authorizes the State Ombudsman to certify community ombudsmen and requires that community ombudsmen receive appropriate training prior to certification. Community ombudsmen must be re-certified every two years.

State Certification Requirements for Community Ombudsmen ensure that community ombudsmen meet minimal standards for qualifications, training, knowledge and competence. Training requirements specify requisite training topics, minimum hours and types of instruction, examination procedures, and mandatory continuing education (see Appendix E).

During FY98, State Office staff conducted one certification training for new staff

ombudsmen and two statewide training conferences for community ombudsmen

and other persons interested in issues relating to the quality of care and life for

residents.

.

Based on the experience and knowledge of ombudsmen in Georgia, the State Ombudsman makes the following recommendations to improve the quality of life for residents of Georgia's nursing homes and personal care homes.
Long-Term Care Services Should Be Available and Affordable
.Problem: An ever-increasing population of individuals need some assistance due to their. disabilities, but do not require'or want nursing home care. The long-term care . services cUrrently available in Georgia are not sufficient -- or sufficiently affordable -to provide for the needs of many persons who seek alternatives to nursing home care -whether those options are in one's own home or in a residential facility. This is particularly true for individuals with dementia who may need constant supervision but do not need intensive nursing services.
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Recommendations:
Georgia should develop additional residential options for long-tenn care, including adding the provision of limited nursing services in qualified personal care homes. The Ombudsman"Program supports S.B. 131 and H.B. 758 (1999) in the Georgia General Assembly.
Georgia should continue to allocate resources to community-based long-term care services to meet the needs of older and disabled persons and "unlock the waiting list."
Georgia should develop a consumer-centered system for access to long-tenn care services. Consumers and caregivers need to have infonnation and assessments that can assist them access appropriate services for their needs. The Ombudsman Program supports S.B. 144 (1999) in the Georgia General Assembly.
Combat Malnourishment in Nursing Homes
Problem: According to recent scientific studies, malnutrition is a persistent and critical problem among many nursing home residents. These residents are at risk for infection, weight loss, skin breakdown, impaired immunity, weakness that results in falls, and sometimes even death. Lack of needed assistance with eating contributes greatly to this problem.
Recommendation: Nursing facilities, the Office of Regulatory Services, and the Ombudsman Program should provide increased attention to the need to reduce malnutrition and dehydration of nursing home residents.
Decrease Medicaid Discrimination in Nursing Home Admissions
Problem: Ombudsmen find that many applicants who are Medicaid-eligible have a much more difficult time gaining admission to nursing homes than do other residents who pay privately or who receive Medicare payments. This is particularly true in some geographical areas of the state. In addition, some facilities fail to notify residents of their right to apply for Medicaid when their Medjcare benefits are exhausted. Because the Medicaid reimbursement rate is lower than either the Medicare or privatepay rate, facilities have little incentive to admit Medicaid-eligible residents.
Recommendation: The Georgia Department of Medical Assistance and the federal Health Care Finance Admininstration should prohibit discrimination against the recipients of Medicaid benefits. The Ombudsman Program will continue its current efforts to counter individual instances of Medicaid discrimination.
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Increase Staffing in Nursing Homes



e

.. Problem: Inadequate staffing in nursing homes is a continuing problem - and one

that is the basis for many of the serious complaints ombudsmen receive. In order for

residents of nursing homes to receive quality care, the facility in which they live must

provide sufficient, well-trained and well-supervised staff. When staffing is inadequate,

residents may develop serious and avoidable medical problems, including

malnutrition, dehydration, and pressure sores.

Recommendation: Georgia and federal laws and regulations should require .minimum direct care staff to resident ratios and should require facilities to provide consumers with information regarding staffing ratios in every facility.

Retain Enforcement in MH/MR Personal Care Homes

Problem: Enforcement in pe~sonal care homes will be weakened if current proposals

are adopted to remove personal care homes contracted with the Division of Mental

. HealthlMental Retardation! Substance Abuse (MHlMR/SA) from the jurisdiction of

. ORS. Under this proposal, only MHIMR/SA would have the authority to monitor

contracting with that agency. Residents with mental health disabilities deserve the

same protections and oversight from an outside agency as residents with other

disabilities.

.

Recommendation: The Ombudsman Program supports continued authority of ORS to enforce regulations in personal care homes, including those contracted with MHlMR/SA. The Ombudsman.Program does not support this provision in S.B. 131 (1999) in the Georgia General Assembly.

Prevent and Combat Health Care Fraud

Problem: A few health"care providers' are defrauding Medicaid and Medicare by filing

false and fraudulent claims. Services are being billed that have not been provided or

are not necessary. These practices not only misuse taxpayers' dollars, but also rob

older adults and others of needed resources for health care.

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Recommendation: The Long Term Care Ombudsman Program is educating the aging

network; caregivers, and beneficiaries about health care fraud and abuse. The

education is aimed at prevention as well as identifying fraud.

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After years of advocacy by ombudsmen and others, the following improvements have been made to long-term care in Georgia:
Improved Monitoring of Personal Care Homes
Beginning in FY 2000, annual inspections ofpersonal care homes will be handled by ORS, rather than by comity health departments. The Ombudsman Program believes that this move will generate a less fragment~d approach to monitoring the quality of personal care homes.
Funding for Emergency Placements
For the first time, Georgia's General Assembly has appropriated funds in FY 2000 for emergency placements of older or disabled adults who have been subject to abuse or neglect and need short-term interventions. These funds will be available to personal care home residents who have been relocated from their residences due to neglect or abuse, regulatory actions, a provider emergency, or similar circumstances. While the responsibility for relocation usually falls on the county Department of Family and Children Services (DFCS), that agency had been without resources to assist in emergency, temporary placement of residents. We are optimistic that with this new funding, residents will no longer be relocated to situations that are undesirable or be forced to leave their communities due to the lack of available resources.
',,'
Strengthening Ombudsman Services to Residents
Need for sufficient resources
Resources for the Ombudsman Program have not kept pace with the demand for ombudsman services. The number of complaints ombudsmen are requested to resolve has increased by
10% in the past year. The number of personal care home residents is rapidly increasing in Georgia. The
number of personal care home beds has increased 52% to 21,927 since 1995.
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Without adequate funding, ombudsmen cannot make regular visits to facilities or provide other necessary services to residents in a timely manner. In planning for FY 1999, four (4) community ombudsman programs had to request approval to make fewer visits to facilities than required by the Ombudsman Program standards because resources were not adequate to provide that minimal level of service.

Need for ombudsmen to be independent advocates
The Ombudsman Program can only be an effective voice for residents if it is . independent of conflicts of interest and free to focus on resident concerns. Therefore,
the Office ofthe State Ombudsman has convened an Ombudsman Structure Workgroup to evaluate the ability of the Office to effectively serve long-term care residents.

Demand for New Services by the Ombudsman Program

Currently, the Ombudsman Program in Georgia provides services to residents of

nursing facilities and personal care homes. However, there is increasing discussion of

the need to expand these services into new areas -- such as in-home long-term care

services and managed health care plans.

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Concerns about expansions include:

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the need for adequate resources for new services without diminishing current

services to residents of personal care homes and nursing homes;

the shift in focus from residents who live in residential settings and may have different advocacy needs and issues; and

potential conflicts of interest with agencies providing both ombudsman services and in-home services.

On tHe other hand, as a program of hands-on advocates with a wealth of experience,

the Ombudsman Program could be the ideal program to advocate for these

populations. Many of these consumers in the community would likely have been

ombudsman clients living in nursing facilities or personal care homes if not for the

increased options for in-home services today. This raises the question: should the

Ombudsman Program follow the setting or the client?

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Title'Vll, Chapter 2, Section 712 1992 Amendments to the Older Americans Act
SEC. 712. STATE LONG-TERM CARE OMBUDSMAN PROGRAM.
(a) Establishment.--
(1) In general.--In order to be eligible to receive an allotment under section 703 from funds appropriated under section 702(a), a State agency shall, in accordance with this section--
(A) establish and operate an Office of the State Long-Term Care Ombudsman; and
(B) carry out through the Office a State Long-Term Care Ombudsman program.
(2) Ombudsman.--The Office shall be headed by an individual, to be known as the State Long-Term Care Ombudsman,. who shall be selected from among individuals with expertise and experience in the fields oflong-term care and advocacy.
(3) Functions.--The Ombudsman shall serve on a full-time basis, and shall, personally or through representatives of the Office--
(A) identify, investigate, and resolve complaints that--
(i) are made by, or on behalf of, residents; and (ii) relate to action, inaction, or decisions, that may adversely affect the
health, safety, welfare, or rights of the residents (including the weifare and rights of the residents with respect to the appointment and activities of guardians and representative payees), of--
(I) providers, or representatives of providers, of long-term care services;
(II) public agencies; or (III) health and social service agencies;
(B) provide services to assist the residents in protecting the health, safety, welfare, and rights of the residents;
(C) inform the residents about means of obtaining services provided by providers or agencies described in subparagraph (A)(ii) or services described in subparagraph (B);
(D) ensure that the residents have regular and timely access to the services provided through the Office and that the residents and complainants receive timely responses from representatives of the Office to complaints;
(E) represent the interests of the residents before governmental agencies and seek administrative, legal, and other remedies to protect the health, safety, welfare, and rights of the residents;
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(F) provide administrative and technical assistance to entities designated under paragraph (5) to assist the entities in participating in the program;
(G) (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 oflong-term care facilities and services in the State; (ii) recommend any changes in such laws, regulations, policies, and actions as the Office determines to be appropriate; and (iii) facilitate public comment on the laws, regulations, policies, and actions;

(H) (i) provide for training representatives of the Office; (ii) promote the development of citizen organizations, to.participate in the program; and (iii) provide technical support for the development of resident and family councils to protect the well-being and rights of residents; and

(I) carry out such other activities as the Commissioner determines to be appropriate.

(4) Contracts and arrangements.--

(A) In general.--Except as provided in subparagraph (B), the State agency may establish and operate the Office, and carry out the program, directly, or by contract or other arrangement with any public agency or nonprofit private organization.

(B) Licensing and certification organizations; associations.--The State agency may not enter into the contractor other arrangement described in subparagraph (A) with-"'-

(i) an agency or organization that is responsible for licensing or certifying. long-term care services in the State; or
(ii) an association (or an affiliate of such an association) oflong-term care facilities, or of any other residential facilities for older individuals,

(5) Designation oflocal ombudsman entities and representatives.--

(A) Designation.--In carrying out the duties of the Office, the Ombudsman may designate an entity as a local Ombudsman entity, and may designate an employee or volunteer to represent the entity..

(B) Duties.--An individual so designated shall, in accordance with the policies and . procedures established by the Office and the State agency--

(i) provide services to protect the health, safety, welfare and rights of

residents;

- (ii) ensure that residents in the service area of the entity have regular, timely

. access to representatives of the program and timely responses to

..

complaints and requests for assistance; (iii) -. identify, investigate, and resolve complaints made by or on behalf of

residents that relate to action, inaction, or decisions, that may adversely

affect the health, safety, welfare, or rights of the residents;

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".;1", ...

(iv) ,represent the interests ofresld~nts before government agencies and seek administrative, legal, and other remedies to protect the health, safety, welfare, and rights of the residents;
(v) (1) review, and if necessary, comment on any existing and proposed laws, regulations, and other government policies and actions, that pertain to the rights and well-being of residents; and
(II) facilitate the ability of the public to comment on the laws, regulations, policies, and actions;
(vi) support the development of resident and family councils; and (vii) carry out other activities that the Ombudsman determines to be
appropriate.

(C) Eligibility for designation.--Entities eligible to be designated as local Ombudsman entities, and individuals eligible to be designated as representatives of such entities, shall--

(i) have demonstrated capability to carry out the responsibilities of the Office;
(ii) be free of conflicts of interest; (iii) in the case of the entities, be public or nonprofit private entities; and (iv) meet such additional requirements as the Ombudsman may specify.

(D) Policies and procedures.--

(i) In general.--The State agency shall establish,in accordance with the Office, policies and procedures for monitoring local Ombudsman entities designated to carry out the duties of the Office.
(ii) Policies.--In a case in which the entities are grantees, or the representatives are employees, of area agencies on aging, the State agency shall develop the policies in consultation with the area agencies on aging. The policies shall provide for participation and comment by the agencies and for resolution of concerns with respect to case activity.
(iii) Confidentiality and disc1osure.--The State agency shall develop the . policies and procedures in accordance with all provisions of this subtitle regarding confidentiality and conflict of interest.

(b) Procedures for Access.--

1) In general.--The State shall ensure that representatives of the Office shall have--

(A) access to long-term care facilities and residents;

(B) (i) appropriate access to review the medical and social records of a

resident, if--

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(1) the representative has the permission of the resident, or the legal representative of the resident; or (II) the resident is unable to consent to the review and has no legal representative; or

(ii) access to the records as is necessary to investigate a complaint if--

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(C) -:

(I) a legal guardian of the resident refuses to give the pennission; (II) a representative of the Office has reasonable cause to believe (III) the representative obtains. the approval of the Ombudsman; access to the administrative records, policies, and documents, to which the . residents have, or the general public has access, oflong-tenn care facilities; and

(D). . access to and, on request, copies of all licensing and certification records maintained by the State with respect to long-tenn care facilities.

(2) Procedures.--The State agency. shall establish procedures to ensure the access described in paragraph (1).

(c). Reporting Syste.m.--The State agency shall establish a statewide unifonn reporting. system to--

(1) collect and analyze data relating to complaints and conditions in Jong-tenn care facilities and to residents for the purpose of identifying and resolving significant problems; and

(2) submit the data, on a regular basis, to--

(A) the agency of the State responsible for licensing or certifying long-tenn care facilities in the State;

(B) other State and Federal entities that the ombudsman detennines to be appropriate;

(C) the Commissioner; and

(D) the National Ombudsman Resource Center established in section 202(a)(21).

(d) Disclosure...;

(1) In generaL..-The State agency shall establish procedures for the disclosure by the Ombudsman Of local Ombudsman entities of files maintained by the program, including records described in subsection (b)(l) or (c)..

.1

(2) Identity of complainant or resident.--The procedures described in paragraph (1)

shall--

(A) provide that, subject to subparagraph (B), the files and records described

<

in.paragraph

(1) may be disclosed only at the discretion of the Ombudsman (or the

person designated by the Ombudsman to disclose the files and records); and

(B) prohibit the disclosure of the identity of any complainant or resident with respect to whom the Office maintains such files or records unless--

(i) the complainant or resident, or the legal representative of the complainant or resident, consents to the disclosure and the consent is given in writing;

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(ii) (1) the complainant or resident gives consent orally; and (IT) the consent is documented contemporaneously in a writing made by a representative of the Office in accordance with such requirements as the State agency shall establish; or (III) the disclosure is required by court order.
(e) Consultation.--In planning and operating the program, the State agency shall consider the views of area agencies on aging, older individuals, and providers of long-term care.
(f) Conflict of Interest.--The State agency shall--
(1) ensure that no individual, or member of the immediate family of an individual, involved in the designation of the Ombudsman (whether by appointment or otherwise) or the designation of an entity designated under subsection (a)(5), is subject to a conflict of interest;
(2) ensure that no officer or employee of the Office, representative of a local Ombudsman entity, or member of the immediate family of the officer, employee, or representative, is. subject to a conflict of interest;
(3) ensure that the Ombudsman--
(A) does not have a direct involvement in the licensing or certification of a long-term' care facility or of a provider of a long-term care service;
(B) does not have an ownership or investment interest (represented by equity, .debt, or other financial relationship) in a long-term care facility or a long-term care service;
(C) is not employed by, or participating in the management of, a long-term care facility; and
(D) does not receive, or have the right to receive, directly or indirectly, remuneration (in cash or in kind) under a compensation arrangement with an owner or operator of a long-term care facility; and
(4) establish, and specify in writing, mechanisms to identify and remove conflicts of interest referred to in paragraphs (1) and (2), and to identify and eliminate the relationships described in subparagraphs (A) through (D) of paragraph (3), including such mechanisms as--
(A) the methods by which the State agency will examine individuals, and immediate family members, to identify the conflicts; and
(B) the actions that the State agency will require the individuals and such family members to take to remove such conflicts.
(g) Legal Counsel.--The State agency shall ensure that--
(1) (A) adequate legal counsel is available, and is able, without conflict of interest, to--
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(i) provide advice and consultation needed to protect the health, safety, welfare, and rights ofresidents; and
(ii) assist the Ombudsman and representatives of the Office in the performance ofthe official duties of the Ombudsman and representatives; and
(B) legal representation is provided to any representative of the Office against whom suit or other legal action is brought or threatened to be brought in connection with the performance of the official duties of the Ombudsman or such a representative; and
(2) the Office pursues administrative,Jegal, and other appropriate remedies on behalf of residents.
(h) Administration.--The State agency shall require the Office to--
(I) prepare an annual report--
(A) describing the activities carried out by the Office in the year for which the report is prepared;
(B) containing and analyzing the data collected under subsection (c);
(C) evaluating the problems experienced by, and the complaints made by or on behalf of, residents;
(D) containing recommendations for--
(i) improving quality of the care and life of the residents; and (ii) protecting the health, safety, welfare, and rights of the residents;
(E) (i) analyzing the success of the program including success in providing services to.residents of board and care facilities and other similaradult care facilities; and
(ii) identifying barriers that prevent the optimal operation of the program; and
.I
(F) providing policy, regulatory, and legislative recommendations to solve identified problems, to resolve the complaints, to improve the quality of care and life of residents, to protect the health, safety, welfare; and rights of residents, and to remove the barriers;
(2) analyze, comment on, and monitor the development and implementation of Federal, State, and local laws, regulations, and other government policies and actions that pertain to long-term.care facilities and services, and to the health, safety, welfare, and rights of residents, in the State, and recommend any changes in such laws, regulations, and policies as the Office determines to be appropriate;
(3) (A) provide such information as the Office determines to be necessary to public and private agencies, legislators, and other persons, regarding-- ~ .
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(i) the problems and concerns of older individuals residing in long-term care facilities; and

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(ii) recommendations related to the problems and concerns; and

(B) make available to the public, and submit to the Commissioner, the chief executive officer of the State, the State legislature, the State agency responsible for licensing or certifying long-term care facilities, and other appropriate governmental entities, each report prepared under paragraph (1);

(4) (A) not later than 1 year after the date of the enactment of this title, establish procedures for the training of the representatives of the Office, including unpaid volunteers, based on model standards established by the Associate Commissioner for Ombudsman Programs, in consultation with representatives of citizen groups, long-term care providers, and the Office, that--

(i) specify a minimum number of hours of initial training; , (ii) specify the content of the training, including training relating to--

(1) Federal, State, and local laws, regulations, and policies, with respect to long-term care facilities in the State;
(II) investigative techniques; and (III) such other matters as the State determines to be appropriate; and

(iii) specify an annual number of hours of in-service training for all designated representatives; and'

(B) require implementation of the procedures not later than 21 months after the date

of the enactment of this title;

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(5) prohibit any representative of the Office (other than the Ombudsman) from carrying out any activity described in subparagraphs (A) through (G) of subsection (a)(3) unless the representative--

(A) has received the training required under paragraph (4); and

(B) has been approved by the Ombudsman as qua:lified to carry out the activity on behalf of the Office;

(6) coordinate ombudsman services with the protection and advocacy systems for individuals with developmental disabilities and mental illnesses established under--

, (A) (B)

part A of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6001 et seq.); and
the Protection and Adv<;lcacy for Mentally III Individuals Act of 1986 (42 U.S.C. 10801 et seq.);

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(7) .co.ordinate,tothe.greatest,extent possible; ombudsman services with legal assistance

provided under section 306(a)(2)(C), through adoption of memoranda of understanding

and other means; and

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(8) permit any local Ombudsman entity to carry out the responsibilities described in "paragr~pn(,l), (2;), (3),,(6), or (7).
(i) Liability.--TheSta1e s.hall:ens.urethatno,representativeofthe Office will be liable under State law for the go.odfaith performance ofofficial duties..

(j) Noninterference.--The State shall--

(1) ensurethl!,t willfuhnterfero:ence :with representatives of the Office in the performance of the official duties of the representatives (as:defined by the Commissioner) shall be
unh.lwful', .

(2) prohibit retaliation and reprisals by a long-term care facility or other entity with respect to any resident,. employee,i or; othenperson for fihng a'complaint with, providing information .to, or otherwise coo'per-atingwith any representative of, the Office; and

(3) . provide for. appropriate: sanctions with respect to the interference, retaliation, and reprisals.

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Georgia Long-Term Care Ombudsman Program Act
O.C.G.A. 31-8-50 et seq
31-8-50. Declaration of policy.
The general assembly finds that a significant number of older citizens of this state reside in long-term care facilities in this state and, because of their isolated and vulnerable condition, are more dependent on others for their protection and care. It is the intent of the General Assembly to protect and improve the quality of care and life for residents through the promotion of community involvement in long-term care facilities and by establishment of a process to resolve complaints and problems of residents. It is the further intent of the General Assembly that the department, within the available resources and pursuant to its duties under the Older Americans Act of 1965, as amended, ensure that the quality of care and life for such residents is maintained, that necessary reports are made and that, where necessary, corrective action is taken at the departmental level.
31-8-51. Definitions.
As used in this article, the term:
(1) "Community ombudsman" means a person certified as a'community ombudsman pursuant to Code Section 31-8-52.
(2) "Long-term care facility" means any skilled nursing home, intermediate care home, or personal care home now or hereafter subject to regulation and licensure by the department.
(3) "Resident" means any person who is receiving treatment or care in a long-term care facility who seeks admission to such facility or who has been discharged or transferred from such a facility.
(4) "State ombudsman" means the state ombudsman established under Code Section 31"8-52.
31-8-52. Establishment of long-term care ombudsman program.
Pursuant to the Older American Act of 1965 (p. L. 89-73,79 Stat. 219), as amended, and as a condition of receiving funds under that act for various programs for older citizens of this state, the Department of Human Resources has been required to establish and operate a longterm care ombudsman program. In order to receive such funds, the department has already established a position of state ombudsman within the state Office of Special Programs. The state ombudsman shall be under the direct supervision of the commissioner or his or her designee and shall be given the powers and duties hereafter provided by this article. The state ombudsman shall be a person qualified by training and experience in the field of aging or long-term care or both. The state ombudsman shall promote the well-being and quality of life of residents in long-term care facilities and encourage the development of community ombudsman activities at the local level. The state ombudsman may certify community ombudsman and such certified ombudsman shall have the powers and duties set forth in Code Sections 31-8-54 and 31-8-55. The state ombudsman shall :require such community
33

ombudsman to receive appropriate training as determined and approved by the department

prior to certification. Such training shall include an internship of at least seven, working days

in a nursing home and at-least three working days in a personal care home. Upon .

certification, the state ombudsman shall issue an identification card which shall be presented

upon request by community ombudsman whenever needed to carry, out the purposes of this
article. Two years after first being certified and every two years thereafter, each such

community ombudsman, in order to carry out his or her duties under this article, shall be

recertified by the state ombudsman as continuing to meet the department's standards as

" community ombudsman.

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31-8-53. Duties o(the state ombudsman.

The state ombudsman shall:

. (1) Establish policies' and procedures, subject to approval by the commissioner of human .:; resources, for'receiving, investigating, referring, and attempting to resolve complaints
made by or on behalf ofresidents oflong-term care facilities concerning any act, omission to act, practice, policy, procedure that may adversely affect the health, safety, or welfare of any resident;

(2) Investigate and make reports and recommendations to the department and other

appropriate agencies concerning any act or failure to act by any government agency

with respect to its responsibilities and duties in connection with long-term care or

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residents 'bflong-termcare facilities;

,

(3) Establish a uniform ,state-:wide reporting system to record data about complaints and conditions in' long-term care facilities' and shall collect and analyze such data in order to identify significant problems affecting the residents of such facilities;

(4) Promote the development of community ombudsmen activities and provide

,' . technical assistance as necessary;' an~

""

,.

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(5) Make an annual written report, documenting the types of complaints and problems ,, 'reported by residents; to the director of the Office of Special Programs for his
recommendations to the commissioner concerning needed policy and regulatory and legislative changes.

31-8-54. Duties of community ombudsman.

,

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Pursuant to poiicies and procedUres established by 'the state ombudsm:an, rhe community

ombudsman shall:'

, :'" .

(1) Learp. about the gene;al conditions affecting residents oflong-term care' facilities and work ~or the best interest ofthese residents;

(2) Receive, investigate, and. attempt to resolve complaints made by or on behalf of ',' residents of long-term care facilities; ,
(3)' Collect data about the number ~d types of complaints handled; and

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(4) Report regularly to the state ombudsman about the data collected and the activities of the community ombudsman.
31-8-55. Entry and investigative authority; cooperation of government agencies; communication with residents.
(a) The state ombudsman or community ombudsman, on his or her initiative or in response to complaints made by or on behalf of residents of long-term care facilities, may conduct investigations in matters within his or her powers and duties as provided by this article.
(b) The state ombudsman or community ombudsman shall have the authority to enter any long-term care facility and shall use his or her best efforts to enter such facilities during normal visiting hours. Upon entering the long-term care facility, the ombudsman shall notify the administrator or, in the absence of the administrator, the person in charge of the facility, before speaking to any residents. After notifying the administrator or the person in charge of the facility, the ombudsman may communicate privately and confidentially with residents ofthe facility, individually or in groups. The ombudsman shall have access to the medical and social records of any resident if:
(1) The ombudsman has the permission of the resident or the legal representative or guardian of the resident;
(2) The resident is unable to consent to the review and has no legal representative or guardian; or
(3) There is a guardian of the person of the resident and that guardian refuses to permit access to the records necessary to investigate a complaint, and;
(A) There is reasonable cause to believe that the guardian is not acting in the best interests of the resident; and
(B) A community ombudsman obtains the approval of the state ombudsman.
As used in this Code section, the term "legal representative" means an agent under a valid power of attorney, provided that the agent is acting within the scope of his or her agency; an agent under a durable power of attorney for health care; or an executor, executrix, administrator, or administratrix of the estate of a deceased resident. The ombudsman shall have the authority to inspect the physical plant and have access to the administrative records, policies, and documents of the facility to which the residents have or the general public has access. Entry and investigation provided by this Code section shall be conducted in a manner which will not significantly disrupt the provision of nursing or other care to residents.
(c) The state ombudsman or community ombudsman shall identify himself or herself as such to the resident, and the resident shall have the right to communicate or refuse to communicate with the ombudsman.
(d) The resident shall have the right to participate in planning any course of action to be taken on his or her behalf by the state ombudsman or community ombudsman, and the resident shall have the right to approve or disapprove any proposed action to be taken on his or her behalf by such ombudsman.
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(e) The state ombudsman and community ombudsman shall have authority to obtain from any government agency, and such agency shall provide, such cooperation and assistance, services, data, and access to files and records as will enable the ombudsman properly to perform his or her duties and exercise his or her powers, provided such information is not privileged under any law.
(f) Where the subject of the investigation involves suspected abuse, neglect, or exploitation of a resident by his or her guardian, the state ombudsman or community ombudsman shall have the authority to communicate with the resident in a private and confidential setting not withstanding any objection by the guardian to such meeting and communication.
. 31-8-56. Resolution of complaints.
(a) Following an investigation, the state ombudsman or community ombudsman shall report his opinions or recoriunendations to the party or parties affected thereby and shall attempt to resolve the complaint using, whenever possible, informal techniques of mediation, conciliation, and persuasion. With respect to a complaint against a long-term care facility, the ombudsman shall first notify the administrator of the facility in writing and give such administrator a reasonable opportunity to correct any alleged defect. lfthe administrator fails to take corrective'action after a reasonable amount of time or if the defect seriously threatens the safety or well-being of the residents, the state ombudsman or community ombudsman may refer the complaint to the appropriate agency.
(b) Complaints or conditions adversely affecting residents of long-term care facilities which cannot be resolved in the manner described in subsection (a) of this Code shall, whenever possible, be referred by the state ombudsman or community ombudsman to an appropriate agency,
(c) The community ombudsman shall not disclose to the public, either directly or indirectly, the identity of any long-term care facility which is the subject of an investigation unless and until the matter has been reviewed by the office of the state ombudsman and the matter has been referred to'an appropriate governmental agency for action.
31-8-57. Reporting abuse.
Any person who has reasonable cause to believe that a resident of a long-term care facility is being, or has been, abused, neglected, exploited, or abandoned or is in the condition which is the result of abuse, neglect, exploitation, or abandonment may report such information or cause a report to be made in any reasonable manner to the state ombudsman or community ombudsman, if any.
31-8-58. Confidentiality.
The identity of any complainant, resident on whose behalf a complaint is made, or individual providing information on behalf of the resident or complainant relevant to the investigation of a complaint shall be confidential and may be disclosed only with the express permission of such person. The information produced by an investigation'may be disclosed by the state ombudsman or community ombudsman only if the identity of any such person is not disclosed by name or inference in such information, the information may be disclosed only with express permission. If the complaint becomes the subject for judicial proceeding, such investigative information may be disclosed for the purpose of the proceeding.
36

31-8-59. Notice to residents.
The state ombudsman shall prepare and distribute to each long-term care facility in the state a written notice describing the long-term care ombudsman program and the procedure to follow in making a complaint, including the address and telephone number of the state ombudsman and community ombudsman, if any. The administrator shall give the written notice required by this Code section to each resident and his legally appointed guardian, if any, upon admission. The administrator shall also post such written notice in conspicuous public places in the facility in accordance with procedures provided by the state ombudsman and shall give notice to any resident and his legally appointed guardian, if any, who did not receive it upon admission. The failure to provide the notices required by this Code section shall be a ground upon which the department may revoke any permit issued to a long-term care facility under Code section 31-7-1.
31-8-60. Retaliation against resident and interference with ombudsman prohibited; provisions applicable to violations.
No person shall discriminate or retaliate in any manner against any resident or relative or guardian of a resident, any employee of a long-term care facility, or any other person because of the making of a complaint or providing information in good faith to the state ombudsman or community ombudsman. No person shall willfully interfere with the state ombudsman or community ombudsman in the performance of his or her official duties. Code Sections 31-26 and 31-5-8 shall apply fully to any violation of this article.
31-8-61. Liability for provision of information.
Notwithstanding any other provision oflaw, no person providing information, including, but not limited to, patient records, to the state ombudsman or a community ombudsman shall be held, by reason of having provided such information, to have violated any criminal law or to being civilly liable under any law unless such information is false and the person providing such information knew or had reason to believe that it was false.
31-8-62. Liability arising from complaints.
Any person who, in good faith, makes a complaint or provides information as authorized in this article shall incur no civil or criminal liability therefor. Any state or community ombudsman who, in good faith, performs his or her official duties, including but not limited to, making a statement or communication relevant to a complaint received or an investigative activity conducted pursuant to this article shall inc!JT no civil or criminal liability therefor.
31-8-63. Rules and regulations.
The department is authorized to adopt and promulgate rules and regulations to implement this article.
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Long-Term Care Ombudsman Program Organization Chart

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Community Ombudsman Programs

Northwest GA 800/822-5391

NORTHWEST Cindy Wade
7061272-2158
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NORTHWEST Aimee Zukowski 4041206-6021

GEORGIA MOU1'l"TAINS Dianne Brookins 7701538-2685

NORTHWEST Ramona Hambrick 706/272-2158
NORTHWEST Renee Sanders 4041894-7728
SOUTHERN CRESCENT Mary Woody 404/894-7727 (Chat-Flint)
SOUTHERN CRESCENT Penny Medhurst 770/358-7874 (McIntosh Trail)
WEST CENTRAL GEORGIA Linda Richbw-g KarenRahm 706/327-5208 (Lower Chat)
WEST CENTRAL GEORGIA Susan Ragan 912/924-8304 (Middle Flint)
SOUTHWEST GEORGIA Elaine Wilson Gene Hudson Rosa Malone 912/432-112'1 800/282-6612

SOUTHEAST GEORGIA Sandra Bulanow Francis Guice 912/241-1017 (South Georgia)

NORTHEAST Sally Parker Robin Miller June Hewell 7061549-4850
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ATLANTA REGION 404/221-3780 Karen Boyles (2) Monica Graham Clark (9) Roberta Collins (3) Jennie Deese (4) Kay Coppage (5) Cheryl Ewing (6) Law-a Formby (7) Valorie Williams (8) Carolyn Young (3792)

CSRA Beth Williams 'r~T------ Julie Tucker Sarah Bebzadian
Ernest Hicks :;;,;;;,.------, 706/826-4480

MIDDLE GEORGIA Nancy Hill Wanda Fitzgerald 912/922-4464

COASTAL 912/651-2180 Pam Lipsitz 9121651-2140 Jana Boggus 912/651-2817

HEART OF GEORGIA ALTA..\1AHA DeWees Evans 912/427-5882 Dorothy Middleton 9121374-4301 Rachel Hilliard 912/374-4301

SOUTHEAST GEORGIA Karla Ward 9121496-3948

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State Ombudsman Program

Certif ication Activ ities Ref erral to LTCO
In-Serv ice Education to LTCO Inter-agency Activity Community Education
Consultation to Facility Information and Assistance
Technical Assistance Issues Adv ocacy
Program Management
o

200 400 600 800 1,000 1,200 1,400 1,600 1,800 2,000

The number of hours spent in an activity for the State Ombudsman Program (This does not include the travel time associated with each activity).-

Community Ombudsman Program
Certification Activities Routine Visits to LTC Facilities In-Service Education to Facility Staff
Inter-agency Activity Community Education __r,L..-"" Consultation to Facility
Staff Management Issues Advocacy
1.000 2.000 3.000 4.000 5.000 6.000 7.000 6.000 9.000 10.000 11.000 12.000
The number of hours spent in an activity for Community Ombudsman Programs (This does not include the travel time associated with each activity).
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Georgia Long-Term Care Ombudsman Training Requirements

INITIAL TRAINING AND EXAMINATIONS - OVER 120 HOURS

Classroom Training

Minimum of 24 Hours

Training topics include: Federal, state and loeallaws, regulations, and policies with respect to long-term care
facilities Investigative techniques the aging process Long-term care facilities Effects of institutionalization Resident rights Long-term care reimbursement Role of state ager'cies Complaint investigation skills . Community resources

On-site Training

Minimum 10 Working Days

Training in Nursing Facility - 7 days

Training by facility administration and staff, interviews with residents, and observation of

departmental activities

Observation of Office of Regulatory Services survey process and complaint investigation

Training in Personal Care Homes - 3 days Training by facility staff, interviews with residents, observations of daily routines and
activities Observation of Office of Regulatory Services complaint investigation

Written reports required on each phase of on-site training.

Examinations - Written and Oral Approximately 20 Hours

Examination topics include: Issue identification and analysis Complaint resolution skills Interviewing skills Negotiating skills Laws governing long-term care facilities and the Ombudsman program

MANDATORY CONTINUING EDUCATION - MINIMUM OF 40 HOURS Two, 3-day training conferences each year provide current information on relevant long-term care issues and LTCO management and practice. All staff ombudsmen are required to attend.
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