Georgia Long-Term Care Ombudsman Program 1999 annual report [1999]

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GEORGIA LONG-TERM CARE OMBUDSMAN PROGRAM

1999 ANNUAL REPORT

DEPARTMENT OF HUMAN RESOURCES. DIVISION OF AGING SERVICES

Improving the Lives of older Georgians.

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 Tracey Williams - Administrative Assistant

TABLE OF CONTEMrS

ORGANIZATION

WAYS Ol\ffiUDSl\1EN IlELP :RESIDENTS

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Ol\ffiUDSMAN PROGRAM HIGHLIGHTS

Ol\ffiUDSMAN PROGRAM SERVICES

COMPLAINT PROCESSING

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ISSUES ADVOCACy

INFORMATION AND ASSISTANCE

CONSULTATION TO FACILITIES

ROUTINE VISITATIONS TO FACILITIES

COMMUNITY EDUCATION

OMBUDSMAN ADVISORY COUNCILS

INTERAGENCY COORDINATION

RESIDENT/FAMILY COUNCILS

IN-SERVICE EDUCATION TO FACILITY STAFF

VOLUNTEER MANAGEMENT

COMPLAINT PROCESSING IN-DEPTH

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FUNDING

TRAINING ACTIVITIES AND CERTIFICATION OF OMBUDSl\1EN

RECOl\WENDATIONS FOR LONG -TERM CARE ISSUES

SUCCESSES IN OMBUDSMAN ADVOCACy

Ol\ffiUDSMAN PROGRAM CHALLENGES

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2
5
6
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8 8 8 9 9 9 10 11 11 11 12
16
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17
:. 20
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APPENDIX A: OLDER AmRICANS ACT SECTION 712

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APPE~DIX B: GEORGIA LONG-TERM CARE Ol\ffiUDSMAN PROGRAM ACT

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APPENDIX C: COl\1l\fUNITY Ol\ffiUDSMAN PROGRAM

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APPENDIX D: GEORGIA LONG-TERM CARE Ol\ffiUDSMAN TRAINING REQUIREl\1ENTS

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The Long-Tenn Care Ombudsman (LTCO) Program improves the quality oflife of residents of nursing homes and personal care homes by investigating and resolving complaints. Ombudsmen routinely visit long-tenn care facilities to talk with residents and monitor conditions. Ombudsmen also provide education regarding long-tenn care issues, identify lop.g-tenn care concerns and advocate for change.

.., 23530 ,';. '. '., ' ~;'- ",

,,

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Table 1. The Number of Facilities and Beds by Facility Type (June 30, 1999).

Organization
The Long-Tenn Care Ombudsman Program is authorized by the federal Older Americans Ace and Georgia law. 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 program.
Thirteen (13) 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 tum contract with an appropriate provider agency to manage the program. In one area the AAA houses the program. These provider agencies employ 43 full and part-time staff. Within each community program, a LTCO coordinator is responsible for implementing all program components. Volunteers are also an integral part of the Ombudsman Program. In FY99, 80 volunteers -- 12 certified, 49 volunteer visitors and 19 who perfonn other services -- assisted the Ombudsman Program.
A listing of community ombudsman progr~s is attached as Appendix C.

142 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.
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Ways Ombudsmen Help Residents
The following are but a few examples of ways that ombudsmen assisted residents during FY99. Names and some details have been changed to preserve confidentialitY.
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Helping residents escape abusive situations,
When Mary called from Texas to speak to her mother, Mrs. Bradley, who lived in a personal care home, the home owner had no idea who Mary was talking about. The home owner had recently purchased the home and suggested that Mary call the longterm care ombudsman and ask for help in locating her mother who had lived in the home with the previous owner. Not only did the ombudsman discover Mrs. Bradley's location (in the previous owner's new home), she also feared that the previous owner, was financially exploiting Mrs. Bradley. She was receiving Mrs. Bradley's Social Security and pension checks and had made herself financial power of attorney. She had sold Mrs. Bradley's home but could not account for the money from the sale. A few dayS later, Mary traveled' from Texas to visit her mother, but Mrs. Bradley was again missing. Mary again contacted the ombudsman. The ombudsman provided all the information she had about the previous owner to the police who, based on this information, were able to locate Mrs. Bradley once more. Today, Mrs. Bradley, no longer the victim of financial exploitation, is living in Texas with Mary.
Helping residents live happier lives
,. When Mr. Parker entered a nursing facility in South Georgia, he was so debilitated that none of his family expected he Would ever be able to come home again. Some family members then moved into his home. After a few months, Mr. Parker became considerably stronger and wanted to return home, but he had a new 'problem. His farriily members were unwilling to move out. Mr. Parker contacted the ombudsman.asking for assistance in returning to his home. 'Together with an Elderly Legal Assistance Program attorneY,:the ombudsman helped Mr. Parker gain access to his own home and to the community-based services he needs to remain safely at home.
Jerry had lived nearly half of his 40 years in an intermediate care faCility for the mentally retarded (ICF/MR). He repeatedly expressed his wishes to live at home, but his family did not feel able to provide for his needs. Although his family did not live close to the facility, Jerry was able to leave and visit his family on occasion. JerrY did very well dUring the home visits, but became highly agitated whenever he returned to the facility, harming hims~lf, threatening other residents, artd damaging facility property, After visiting his home for the Christmas holidays, Jerrywas again highly agitated and was discharged to a state hospital for
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stabilization. The ICFIMR. staffinfonned the ombudsman that they would not readmit him. The ombudsman advocated for an appropriate cOrnIilunity placement for Jerry with the Mental Health/Mental Retardation Regional Board in the area where Jerry's family lives. Today Jerry is much happier and more stable in a personal care home. The home's location makes it easier for Jerry to have frequent contact with his family.

Working to improve conditions in long-term care facilities

Bathrooms without toilet paper, bathroom doors broken, leaks in the ceiling, staff

hiding the ombudsman infonnation poster from the residents, and verbal abuse --

these were just some of the problems that residents and staff described to the

ombudsman about a West Georgia personal care home. The ombudsman worked

diligently to try to get problems corrected but the problems continued. So the

ombudsman documented her findings and asked regulators to get involved. They

verified many of the problems the ombudsmen had referred to them and cited the

facility. This regulatory action helped make the governing board of the home and the

administrator more aware of the need to focus on fixing the problems identified by the

ombudsman. Since that time, many of the problems have been corrected and the

administrator regularly contacts the ombudsman for guidanc,e on how to solve

problems. The board has also obtained additional funding to repair a number of other

problems with the building.

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Empowering residents to advocate for themselves
When the United States Senate Special Committee on Aging was seeking infonnation about the effectiveness of changes in the regulation of nursing homes, ombudsmen in
Northeast Georgia helped a resident, Mr. Baugh, have the opportunity to express his opinion. The following is an excerpt from the videotape of Mr. Baugh which was
played before the Senate Committee:
"I don't believe the nursing home has always done their job in providing quality care for the residents. Although I, along with other residents, have complained to the nursing staff and also to the administrator, and have even contacted the state Office ofRegulatory Services (ORS), the problems not only remained but got worse. The problems I'm speaking of include shortage of staff, bad odors, verbal abuse, problems with food, cleanliness, lack of privacy, and failing to contact the doctor when the circumstances called for it. When the ORS would come for their annual inspection, the nursing home would be ready for them....
The survey conducted in July of 1999 was different. It was the most thorough survey that I have ever seen, and more deficiencies- were found than ever before~ The ORS came in very early on a Sunday morning' and saw the situation clearly
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for the first time. The shortage of"staffwas very evident and the lack of care to the residents could not be denied. The result has been much improvement in the care of the residents, and has greatly increased their morale."
Assisting residents get access .to needed services
After falling and breaking her hip, Mrs. Lopez entered a West Georgia nursing home. Although she was paying privately at fIrst, after the fIrst month, her funds were running out quickly so she applied for Medicaid to help pay for her care. In order to have her doctor examine her healing hip, Mrs. Lopez needed transportation to the doctor's offIce. Because the Medicaid agency had not completed' her paperwork, the agency refused to pay for the transportation even though it was clear that Mrs. Lopez would qualify for Medicaid. Without money to pay for transportation and with more follow-up visits to her doctor scheduled, Mrs. Lopez was concemedthat she would be unable to afford to get to the doctor, so she asked the ombudsman for assistance. The ombudsman helped Mrs. Lopez fIle an appeal and met on Mrs. Lopez' behalfwith Medicaid officials. As a result, Medicaid immediately covered her transportation costs to give Mrs. Lopez access to her doctor.
Mr. Jones is 40, paraplegic as the result of an a accident, and angry at feeling forced to live in a nursing home. He had been alcoholic for many years, and he would still be drinking if given the opporturllty. He spoke sharply - often abusively - to staff and other residents. He was depressed and fearful of trying other possible living arrangements that might be more appropriate. The ombudsman suggested to the resident and to staff that it might be helpful to the resident to attend Alcoholics' Anonymous (AA), an organization that had been helpful to him in the past. The resident liked the idea, and staff told the ombudsman that there were several other alcoholics in the building who could benefit from regular AA meetings. Since there was no chapter of AA in the
, community where the nursing home was located, the ombudsman found an experienced social wor1,(er from a hospital nearby, who agreed to facilitate regular meetings of an AA group in the nursing home. Today, Mr. Jones joins three other residents for regular AA meetings for help in coping with their addiction.
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Ombudsman Program Highlights
Celebration of 20 years of service to Georgia's long-term care residents
Georgia's Ombudsman Program was implemented statewide in 1979. At the December 1999 training conference, current and former ombudsmen reminisced, celebrated accomplishments, and aclmowledged the many styles and approaches that ombudsman staff and volunteers bring to their advocacy for long-term care residents.
Improved access to the Ombudsman Program
The public has easier access to the Ombudsman Program since a toll-free phone line to the Office ofthe State Ombudsman became operational in spring of 1999. In addition, an administrative assistant position was created to improve program operations and responsiveness.
Evaluation of State Office effectiveness
A workgroup evaluated whether the placement of the Office of the State Ombudsman within the Department of Human Resources, Division of Aging Services, is sufficiently independent and free of conflicts of interest to fulfill its mandate as an independent advocate for residents of long-term care facilities. The workgroup affirmed the current placement of the Office within the Division of Aging Services, but advised that, should the Office ever find it difficult to fulfill its mandate, the most desirable alternative placement would be outside of state government in a non-profit organization.
Health care fraud prevention
Through a federally funded project, "Operation Red Flag," the Ombudsman Program educated more than 500 professionals in its work to prevent and address health care fraud, waste and abuse.
Long-term Care Ombudsman from other states visit Georgia
In April 1999, the Georgia Ombudsman hosted State Ombudsmen from across the country in Atlanta for the annual State Long-term Care Ombudsman Training Conference.
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Ombudsman Program Services
Ombudsmen provided services to 179,321 individuals in FY99. Visiting residents in facilities accounted for 70% of those . services, information and assistance to the general public accounted for 9%, and iriservice education to facility staff represented 6% of services ,- . provided.
Figure 1. The number of persons served by type of service
ColTlplaint 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 th~ resident's stated wishes. Complaints against long-term care facilities have risen steadily in recent years -- from 3,774 in FY95 to 6,897 in FY99 (see Figure 2).
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7,000 6,000 5,000 4,000 3,000 2,000 1,000
o

SFY 95 SFY 96 SFY 97 SFY 98 SFY 99

Personal Care Home Complaints
II Nursing Home Complaints

Figure 2. Personal care homes and nursing home complaints FY95 through FY99.
Because of the greater number of nursing home beds as compared to personal care home beds (40,922 vs. 23,530 in SFY99), a large majority of complaints received are made by or on behalf of nursing home residents.
Ombudsmen processed 6,897 complaints in FY99. The total number of complaints received increased 9% above the FY98 level. The number of personal care home beds increased by 7%, reflecting the trend toward larger assisted living facilities being built in urban and suburban areas of Georgia. Ombudsman complaints in personal care homes increased by 7% during the same period. Complaints in nursing homes increased by 7% while the bed numbers remained relatively constant.

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Issues Advocacy

The Ombudsman Program advocates for changes in long-tenn care to improve the
lives of residents. Both state and community ombudsmen identify issues that require
changes in laws, resources, policies or processes. They educate the community about these issues, and analyze ~d comment on the development and implementation of related federal, state, and local laws, regulations, and policies. During FY99, the
Ombudsman Program promoted efforts to:

pennit limited nursing services in approved personai care homes for residents who need it (also known as assisted living levels of care)

increase funds for home and community-based long-term care services to provide alternatives to nursing home placement

post staffmg ratios in nursing facilities

combat malnutrition and dehydration in nursing facilities

protect the rights of individuals transferred from hospitals into long-term care facilities with no one to consent for them

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identify unlicensed personal care homes arid encotrragetheir licensure

identify health care fraud trends - Operation Red Flag shared findings ofthese trends through education and interagencyc6Uaborations.

Information and Assistance

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In FY99 ombudsmen answered 12,819 requests for assistance, providing
infonnation and assistance to 1.5,527 ..consumers and caregivers statewide.
Ombudsmen provid~d infonnation regarding resident care, admission and discharge procedures, abuse reporting, and many other .long-tenn care issues.

Consultation to Facilities
Ombudsmen provided 4,409 consultations to nursing home and personal care home staff during FY99. The largest number of consultations (801) concerned nursing home services and care issues. Consultations regarding resident rights comprised the second largest number at 737.

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Routine Visitations to Facilities
Community ombudsmen made 10,797 routine visits, spending over 12,000 hours visiting nursing home and personal care and monitoring facility conditions during FY99.
Community Education
Ombudsmen provided community education on the rights of residents, the services of the Ombudsman Program, facility regulations and enforcement, resident care practices, and elder abuse; For the most part ombudsmen provided education through presentations to community groups. Other avenues of education were through professional newsletters,the news media, and publications. In FY99, ombudsmen presented 425 educational sessions to 10,023 persons in
community organizations, including churches, civic clubs and public and private agencies. The Ombudsman Program; through Operation Red Flag, helped plan the first Consumer University in Georgia, held in Macon in September 1999. Over 750 . people attended to learn how to prevent consumer fraud, including health care fraud, and were addressed by Governor Roy Barnes, Secretary of State Cathy Cox, and Attorney General Thurbert Baker.
Ombudsman Advisory Councils
Ombudsmen met regularly with representatives from their communities to determine the needs of the Ombudsman Program, discuss long-term care issues, and network in order to resolve identified problems.
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Interagency Coordination

Ombudsmen work closely with other agencies that share concerns about the wellbeing of long-term care residents. Dunng'FY99, activities included:

implementing the Emergency Relocation Fund: The Ombudsman Program, worked together with Adult Protective Services (APS), theDivision of Aging
Services, and the Office of Regulatory Services (ORS), developing protocols to
help victims of abuse or neglect who need emergency relocation to a safer
environment. APS workers, ombudsmen, and others who may be involved in
implementing the Fund received training on the new protocols in September 1999.

participation in state and local p~rsonal care home relocation teams, helping residents find other living arrangements when the personal care homes they have lived in have ceased operation.

",
coll~borative efforts with ORS Long-'term Care Secti9n (which regulates

nursing facilities and personal care homes) through:'

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trainirig -- surveyor training of ombudsmen and ombudsmen training of surveyors;

,

,

sharing information with ORS regarding ombudsman experi~nce with

facilities before nursing f~cility surveys and personal care home licensing; and

referring complaints appropriate for investigation by a regulatory agency.

serving as members oflong-term care advisory groups, including:

the Long-term Care Commission (a Georgia Mountains ombudsman);

- th~ ,Eden Alternative Coalition;

the Beneficiary Partnership Council of the Health Care Finance Administration (a Northwest Georgia ombudsman and the State Ombudsman);

State Health Planning Agency's Residential Resources Workgroup (which reviewed personal care home certificate of need);

the Long-term Care Advisory committee of the Department of Medical , Assistance (DMA) (a Northwest Georgia ombudsman); and

the Reimbursement Workgroup ofDMA.

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participating in aging advocacy groups, including the Coalition of Advocates for Georgia's Elderly (CO-AGE) and the National Citizens' Coalition for Nursing Home Reform.
developing stronger ties, through Operation Red Flag, to entities involved in fraud prevention and investigation including: AARP, DMA, HCFA, the State Health Care Fraud Control Unit, the Georgia Consumer Fraud Task Force, the Georgia Medical Care Foundation, and Medicare intermediaries and carriers.
Resident and Family Councils
Ombudsmen participated in 285 resident and family council meetings as speakers, observers, and resource persons in FY99. They helped residents and family members establish resident and family councils in nursing homes and larger personal care homes. Several community ombudsman programs helped organize family support groups serving residents of several nursing homes in a region.
In-Service Education to Facility Staff
Ombudsmen trained facility staff on topics such as restraint reduction, resident rights and elder abuse. In FY99, community ombudsmen made 385 presentations to 10,152 facility staff.
Volunteer Management
In FY99, 80 volunteers --12 certified, 49 volunteer visitors and 19 who perform other services -- assisted the Ombudsman Program. State Office staff approved volunteer training curricula, provided guidance and participated in community ombud~man program volunteer training. The Ombudsman Program, with the aid of consultant Leigh Anne Clark, completed its Volunteer Development Project resulting in:
a 57% increase in the number of individuals in volunteer training;
a comprehensive training manual, enthusiastically received by community ombudsmen and used as a model by Ombudsman Programs in many other states;
customized plans to assist each community ombudsman program in volunteer development; and
an evaluation of the barriers to and possibilities for volunteer development.
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Complaint Processing' In-Depth

'Who makes complaints?
INursing Homes

Personal Care Homes

Figure 3. Types of complainants by facility type

What kind of complaints do ombudsmen' receive?

I Nursing Homes

IPersonal Care Homes

Figure 4. Categories of complaints by facility type ,
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Most Frequent Specific Complaints
The ten most frequent specific complaints in nursing homes and personal care homes are listed in the following tables. NURSING HOMES
Table 2. The most frequent complaints in nursing homes
PERSONAL CARE HOMES
Table 3. The most frequent complaints in personal care homes
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Complaint Investigation Results

I Nursing Homes

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'Il-:__P_er_s_o_n_a_I_C_a_r_e_H_o_m_e_s_----J

Figure 5. Complaint investigation results by facility type

Complaint Resolution

Nursing Homes

Personal 'Care Homes

Figure 6. Complaint resolution by facility type
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Complaint Referral
Sometimes the complaint resolution process requires that ombudsmen make referrals to other agencies that have the responsibility to regulate facilities 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 FY99, 780 complaints were referred to other agencies. This number represented 11 % of all complaints received by ombudsmen. Figure 7 shows the breakdown of ombudsman complaints that were referred to other agencies.

Nursing Homes

Personal Care Homes

Figure 7. Percentage of referred ombudsman complaints by referral agency
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Funding
.. J'he budget for the Long-term C~e O~budsman Program totaled $1,768,773 in , FY99. The largest portion of funds supporting the Ombudsman Program were federal (59%). State sources made up 29%, while local funds and grants from other sources made up 12% of Ombudsman Program funding. Figure 8 shows a breakdown of total expenditures by fund source.

Federal nUe VII LTCO AcUvlly
7,.. $120,554

Figure8. Total expenditures by fund source..

Training Activities and Certification of Ombudsmen

Because state and community ombudsmen work with many complex issues, offer

training and provide information to a variety of individuals and groups, they need up-

to-date information on changes in laws and regulations and on other topics relevant to

long-term care residents. They also need skills to investigate complaints and to be

successful advocates. State law requires that community ombudsmen receive

appropriate training prior to certification (see Appendix D) and 3;uthorizes the State

Ombudsman to certify community ombudsmen.

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In FY99, the State Office:
certified seven (7) new staff and volunteer ombudsman;
conducted a certification training for new ombudsmen (June 1999); and
conducted two (2) statewide training conferences (December 1998 and April 1999) attended by community ombudsmen and representatives of Area Agencies on Aging, subcontract agencies, and the Division of Aging Services. The April training conference was held in conjunction with the National State Ombudsman Training Conference, affording Georgia ombudsmen the opportunity to meet state ombudsmen from across the country.
In addition, coordinators of community programs provide training on a regular basis to community program staff and volunteers. Some ombudsmen attend the National Citizens Coalition for Nursing Home Reform annual conference, and State Office staff attend the annual National State Ombudsman Training Conference, receiving current information about long-term care issues. Many ombudsmen also participate in a variety of professional training events such as those sponsored by the Georgia Gerontological Society, the American Society on Aging, the Gerontological Society of America, and the Southeast Area Agency on Aging Association.
Recommendations for Long -Term Care Issues
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 needs som~ assistance due to their disabilities, but do not require or want nursing home care. 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-term care,

including adding the provision of limited nursing services in qualified personal

care homes (i.e., assisted liviIig levels of care). The Ombudsman Program

supports S.B. 131 and H.B. 758 (introduced in 1999) in the Georgia General

J\ssembly.

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Georgia should continu~ to allocate resources to 'community~based long-term care
services to meet the needs of persons who are older or who have a disability. Efforts should continue to "unlock the waiting list" so that more individuals can
be served.

Georgia should develop a consumer-centered system for access to long-term care

. services. Consumers and caregivers need to have information and assessments

that can assist the~ to access appropriate services for their needs. The

Ombudsman Program supports S.B. 144 (introduced in 1999) in the Georgia

General J\ssembly.

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Increase staffing' in nursing homes

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

.maI1lUtrition, dehydration, and pressure sores.

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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.

Combat malnutrition in nursing homes

Problem: Malnutrition and dehydration are persistent and critical problems among many nursing home residents. These residents are at risk for infection, weight loss, skin breakdown, impairedirrtmunity, and weakness that results in falls. Lack of 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.

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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 payment. In addition, some facilities fail to notify residents of their right to apply for Medicaid when their Medicare skilled nursing benefits are exhausted. Because the Medicaid reimbursement rate is lower than either the Medicare or private-pay rate, facilities have little incentive to admit or retain Medicaid-eligible residents.
Recommendation: The Georgia Department of Medical Assistance and the federal Health Care Finance Administration should prohibit discrimination against the recipients of Medicaid benefits. The Ombudsman Program will continue its current efforts to counter individual instances of Medicaid discrimination.
Retain enforcement in MH/MR personal care homes
Problem: Enforcement in personal care homes will be weakened if current proposals are adopted to remove personal care homes contracted with the Division of Mental HealthJMental Retardation/Substance Abuse (MHIMRJSA) from the jurisdiction of the Office of Regulatory Services. Under this proposal, only MHIMRISA would have authority to monitor homes contracting with that agency. Residents with mental health disabilities deserve the same protections and oversight as residents with other disabilities.
Recommendation: The Ombudsman Program supports continued authority ofORS to enforce regulations in personal care homes, including those contracted with MH/MR/SA. The Ombudsman Program does not support this provision in S.B. 131 or H.B. 758, introduced in the 1999 Georgia GeneralAssembly. .
Prevent and combat health care fraud
Problem: A few health care providers are defrauding Medicaid and Medicare by billing for services not provided; billing services at a higher rate than allowed, and other fraudulent or abusive practices.
Recommendation: Seniors and people who serve seriiors should recognize signs of health care fraud and abuse so they can report suspected problems and prevent fraud from occurring. The Long-term Care Ombudsman Program, through Operation Red Flag, is working to educate Georgians to accomplish these goals.
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"Successes in Ombudsman Advocacy

After years of advocacy by ombud~Dfenand others, we can celebrate the following

successes:

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Funding for emergency placement~

The Emergency Relocation Fund was created in 1999 by Georgia's General Assembly to enable elders and disabled adults, wpo have been, abused or neglected to relocate to safer environments. The General Assembly considered infonnation from ombudsmen in creating this Fund.' Weare optirilistic that with this new funding (administered by the Department of Family and Children's Services), residents will rio longer be relocated to situations that' are undesirable or be forced to leave their communities due to the lack of availa1:?le resources.

N,ational attention to inadequate staffing in nursing homes

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While continuing to advocate for improved staffing in Georgia, ombudsmen's

concerns are b'eginning to be heard by federal government <;>fficials:' ,

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In July 1999, aNorthwest Ge<;>rgiaombudsman was invitedto'a WaShington, D.C.
press conference regarding the Older Americans Act and used the opportunity to
educate the press about nursing home staffing problems.

The State Ombudsman was invited to testify before the United States Senate "Special Committee, on Aging forum on nursing home staffing in November 1999.

0r:nbudsman Program Challenges
,Strengthening ombudsman serVices tor~sidents,
Resources for the Ombudsman Program have not kept pace with the demand for ombudsman services. This is especially true due to growth in the number of residents in personal care ho~es but .also due to increased complaints ,in nursing facilities.
The 'number of complaints received by ombudsmen has increased by 70% in the past five years.

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The number ofpersonal care home residents has increased to 23,530, an increase of more than 72% since 1995. Since the General Assembly appropriated funds for ombudsmen to serve personal care home residents in 1986, the number of residents has increased by 432%.
Ombudsmen must have sufficient funding to make regular visits to facilities and respond to complaints in a timely manner. Recognizing this need, the Coalition of Advocates for Georgia's Elderly (CO-AGE) has chosen increased funding for the Ombudsman Program as one of its budget priorities for the FY 2001 state budget.
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 for additional populations such as individuals receiving long-term care in their own homes or in senior apartments. Concerns about expansions include: the need for adequate resources for new services without diminishing current
services to residents of personal care homes and nursing homes; a shift in focus from residents who live in congregate settings and may have
different advocacy needs and issues; and conflicts of interest within 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 the individuals would have been living in nursing facilities or personal care homes in the past and would have access to ombudsman services, but are now able to receive long-term care without entering a facility.
Implementation of a new reporting system
The Ombudsman Program is developing a new reporting system within the Aging Information Management System (AIMS) of the Division of Aging Services. Adapting to this new system has taken enormous amounts of staff time and adjustments at all levels of the Program. The full implementation of AIMS should improve Ombudsman Program management and effectiveness.
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AQpendixA

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Title VII, Chapter 2, Section 712 1992 Aniendments to the Older Americans Act

, SEC. 712. STATE LONG-TERM CARE OMBUDSMAN PROGRAM.

(a) E.stablishrnent.--

(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) i establish and operate an Office ofthe 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 peaded by an individual, to be mown as the State Long-T~rm Care Ombuds~an,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 Of:f1ce--

'.

,

(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 welfare and rights of the residents with respect to the appointment and activities of guardians and representative payees), of--'

(I) providers, or representatives of providers, oflong-term care seTVlpes;
(II) public agencies; or (III) health ~nd 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
I
agencies described in subparagraph (A)(ii) or services described in subparagraph
(B);

22

(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;

(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 of long-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 contract or 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--

23

.;-

(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;

(iv). ' represent the interests of residents before government agencies and seek

administrative, legal, and other remedies to protect the health, safety,

welfare, and rights of the residents;

(v) " (I) .' 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 ahd family councils; and

, (vii) . carry out other activities thai the Ombudsman determines to be

appropriate.

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

(i)
(ii) (iii) . (iv)

have demonstrated capability to carry outthe responsibilities of the

Office;

,

be free of conflicts of interest;

in the case of the entities, be public or nonprofit private' entities; and

meet suchadditional requirements as the Ombudsman may specify.

(D) Policies and procedures.--

. (i) (ii)
(iii)

-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. 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 pol~cies 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. Confidentiality and disclosure.--:The State agency shall develop the policies and procedures in accordance with all provisions of this subtitle regarding confidentiality and conflict of interest.

24

" ...

(b) Procedures for Access.--

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

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

(B) (i)

appropriate access to review the medical and social records of a resident, if--

(I) the representative has the pennission 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--

(I)

alegal guardian of the resident refuses to give the pennission;

(II) a representative of the Office has reasonable cause to believe

(ill) the representative obtains the approval of the Ombudsman;

(C) access to the administrative records, policies, and documents, to which the

residents have, or the general public has access, of long-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 System.--The State agency shall establish a statewide unifonn reporting system to--

(1) collect and analyze data relating to complaints and conditions in long-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 or local Ombudsman entities of files maintained by the program, including records described in subsection (b)(I) or (c).

25

(2) Id~ntity 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 record~); 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;
(ii) (I) the complainant or resident gives consent orally; and (II) the consent is documented contemporaneously in a writing made by a representative ofthe Office in accordance with such requirements as the State agency shall establish; or (ill) 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-~ermcare. '

(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 d;signated 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;

i

(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

(0) 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

26

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--
(i) provide advice and consultation needed to protect the health, safety, welfare, and rights of residents; and
(ii) assist the Ombudsman and representatives of the Office in the performance of the 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, legal, and other appropriate remedies on behalf of residents.
(h) Administration.--The State agency shall require the Office to--
(1) 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 similar adult care facilities; and
(ii) identifying barriers that prevent the optimal operation of the program; and
27

(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--

(i) the problems and concerns of older individuals residing in long-term care facilities; and

(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--

(I) 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 ~nnual 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;

(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

28

(B) has been approved by the Ombudsman as qualified 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) part A of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6001 et seq.); and
(B) the Protection and Advocacy for Mentally III Individuals Act of 1986 (42 U.S.C. 10801 et seq.);
(7) 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; and
(8) permit any local Ombudsman entity to carry out the responsibilities described in paragraph (1), (2), (3), (6), or (7).
(i) Liability.--The State shall ensure that no representative of the Office will be liable under State law for the ~ood faith performance of official duties.
(j) Noninterference.--The State shall-(1) ensure that willful interference with representatives of the Office in the performance of the official duties of the representatives (as defmed by the Commissioner) shall be unlawful; (2) prohibit retaliation and reprisals by a long-term care facility or other entity with respect to any resident, employee, or other person for filing a complaint with, providing . information to, or otherwise cooperating with any representative of, the Office; and (3) provide for appropriate sanctions with respect to the interference, retaliation, and reprisals.
29

APPENDIXB
"
Long-Term Care Ombudsman Program Act
O.C.G.A. 31-8-50 et seq

31-8-50. Declaration of policy.

The gener~l assembly finds that ~ significant number of older citizens of this state reside in longtenn care facilities in this state and, because of their isolat~:d 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 arid life for residents through the promotion of

community involvement in long-tenn 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 t.he

department, within the available resources and pursuant to its duties under the Older Americans

Act, of 1965, a,~ amended, ensure that the quality of care and life for such residents is maintained,

thatnecessary reports are made and that, where necessary, corrective action is taken at the

departmental level. , J

'

31-8-51. Definitions.

As used in this article, the tenn:

(1) "Community ombudsman" means a person certified as acommunity ombudsman pursuant to Code Section 31-8-52.

(2) "Long-tenn care facility" means any skilled nursing home,. intennediate 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-tenn 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. 1. 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 long-tenn 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-tenn care or both. The state ombudsman shall promote the well-being and quality of life of residents in long-tenn 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

30

have the powers and duties set forth in Code Sections 31-8-54 and 31-8-55. The state ombudsman shall require such community ombudsman to receive appropriate training as
an determined and approved by the department prior to certification. Such training shall include
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 ombud;sman.

31-8-53. Duties of 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 gov~ent agency with respect to its responsibilities and duties in connection with long-term care or residents oflong-term care 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 assistance as necessary; and

technical

(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 comrirunity ombudsman.
Pursuant to policies and procedures established by the state ombudsman, the community ombudsman shall:
(1) Learn about the general conditions affecting residents oflong-term care facilities and work for the best interest of these residents;
(2) Receive, investigate, and attempt to resolve complaints made by or on behalf ofresidents of long-term care facilities;
(3) Collect data about the number and types of complaints handled; and

31

(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 of the 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 ofthe resident or the legal representative or guardian' of the resident;

(2) Theresident is Unable to consent to the review and has no legal representatiye 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 tha~ 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 physicai 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 om. budsman .or community ombudsman, and

32

the resident shall have the right to approve or disapprove any proposed action to be taken on his or her behalfby such ombudsman. (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 recommendations 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. If the administrator fails to take corrective action after a reasonable amount oftime or if the defect seriously threatens the safety or wellbeing of the residents, the state ombudsman or community ombudsman may refer the complaint to the appropriate agency.
. (b) Complaints or conditions adversely affecting residents oflong-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 commuriity 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
33

disclosed by name or inference in such infonnation, the infonnationmay be disclosed only with express pennission. If the complaint becomes the subject for judicial proceeding, such investigative infonnation may be disclosed for the purpose.ofthe proceeding.

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 q,escribing 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 shalhlso 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 pennit issued to a long-tenn 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-tenn care facility, or any other person because of the !llaking of a complaint or providing infonnation in good faith to the state ombudsman or community ombudsman. No person shall willfully interfere with the state ombudsman or community ombudsman in the perfonnance of his or her official duties. Code Sections 31-2-6 and 31-5-8 shall apply fully to any violation of this article.
31-8-61. Liability for provision of info" rmation. .:;

Notwithstandipg any other provision oflaw,.no person providing infonnation, including, but not limited to, patient records, to thestat(: orribudsman or a community ombudsman shall be held, by reason of having provided such infonnation, to have violated any criminal law or to being civilly liable under any law unless such infonnation is false and the person providing such infonnation 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 infonnation as authorized in

this article shall incur no civil or criminal liability therefor. Any state or community

.ombudsman who, in good faith, perfonns 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. incur 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.
...

34

APPENDIX C Statewide Toll-free Number: 888/454-LTeO (5826)

COMMUNITY
I OMBUDSMAN PROGRAMS

COUNTIES SERVED

~=:~NE

I

ATLANTA

Cobb, Cherokee, Clayton, Dekalb, Douglas, Fayette, Fulton, Gwinnett, Henry, Rockdale

(404) 371-3800

CENTRAL SAVANNAH
RIVER AREA (CSRA)
COASTAL GEORGIA MOUNTAINS

Burke, McDuffie, Columbia, Richmond, Emanuel, Screven, Glascock, Taliaferro, Hancock, Warren, Jefferson, Washington, Jenkins, Wilkes, Johnson, Lincoln Bulloch, Bryan, Camden, Chatham, Effingham, Glynn, Liberty, Long, McIntosh Banks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin, Rabun, Stephens, Towns, Union, White

(706) 826-4480
(912) 651-2180 (770) 538-2685

HEART OF GEORGIA ALTAMAHA

Appling, Bleckiey, Candler, Dodge, Evans, Jeff Davis, Laurens, Montgomery, Pulaski, Tattnall, Telfair, Toombs, Treutlen, Wayne, Wheeler, Wilcox

(912) 374-4301

MIDDLE GEORGIA

Baldwin, Bibb, Crawford, Houston, Jasper, Jones,. Monroe, Peach, Putnam, Twiggs, Wilkinson

(912) 922-4464

NORTHEAST GEORGIA .

Barrow, Clarke, Elbert, Greene, Jackson, Madison, Morgan, Oconee, Oglethorpe, Walton

(706) 549-4850

NORTHWEST GEORGIA (ATLANTA OFFICE) NORTHWEST GEORGIA (DALTON OFFICE) SOUTHEAST GEORGIA (FOLKSTON OFFICE) SOUTHEAST GEORGIA (VALDOSTA OFFICE) SOUTHERN CRESCENT (CHATTAHOOCHEE-FLINT OFFICE) SOUTHERN CRESCENT (McINTOSH TRAIL OFFICE)

Bartow, Fannin, Gilmer, Gordon, Haralson, Paulding, Pickens, Polk .Catoosa, Chattooga, Dade, Floyd, Murray, Walker, Whitfield Atkinson, Bacon, Brantley, Charlton, Clinch, Coffee, Pierce, Ware Ben Hill, Berrien, Brooks, Cook, Echols, Irwin, Lanier, Lowndes, Tift, Turner Carroll, Coweta, Heard, Troup, Meriwether
Butts, Lamar, Newton, Pike, Spaulding, Upson

(404) 894-7728
(800) 822-5391 *
(706) 272-2158
(800) 822-5391 *
(912) 496-3948
(912) 241-1017
(404) 894-7727
(770) 358-7874

SOUTHWEST GEORGIA (SOWEGA)
WEST CENTRAL GEORGIA (COLUMBUS OFFICE)
WEST CENTRAL GEORGIA
(AMERICUS OFFICE)

Baker, Calhoun, Colquit, Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas, Worth
Chattahoochee, Clay, Harris, Muscogee, Quitman, Randolph, Stewart, Talbot

(912) 432-1131 (706) 323-7243

Crisp, Dooley, Macon, Marion, Schley, Sumter, Taylor, Webster

(912) 924-8304

. * outside the Atlanta area only

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APPENDIX D

Georgia Long-term Care Ombudsman Training Requirements

INITIAL TRAINING AND EXAMINATIONS - OVER 120 HOURS

Classroom Training

of Minimum 24 Hours

Training topics include: Federal, state and local laws, 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 agencies .
'1
Complaint investigation skills Community resources

,On-site Training -

Minimum 10 Working Days

.Training in Nursing Facility - 7 daY$
Training by facility administration and staff, interviews with residents, and observation of. departmental activities
. Observation of Office of Regulatory Services surv~y 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 ofRegulatory Services complaint investigation

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 fhe'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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