Georgia Long-Term Care Ombudsman Program 2000 annual report [2000]

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GEORGIA LONG-TERM CARE OMBUDSMAN PROGRAM

2000 ANNUAL REPORT

DEPARTMENT OF HUMAN RESOURCES. DIVISION OF AGING SERVICES

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Improving the Lives ofOlder 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 Andrea Hamilton - Ombudsman Program Manager
Tracey Williams - Administrative Assistant

TABLE OF CONTENTS

OMBUDSMAN PROGRAM HIGHLIGHTS

1

ORGANIZATION

2

WAYS OMBUDSMEN HELP RESiDENTS

3

OMBUDSMAN PROGRAM SERVICES

5

COMPLAINT PROCESSING

5

ISSUES ADVOCACy

7

INFORMATION AND ASSISTANCE

7

CONSULTATION TO FACILITIES

7

ROUTINE VISITATIONS TO FACILITIES

8

COMMUNITY EDUCATION

8

OMBUDSMAN ADVISORY COUNCiLS

8

INTERAGENCY COORDINATION

9

RESIDENT/FAMILY COUNCiLS

10

IN-SERVICE EDUCATION TO FACILITY STAFF

10

VOLUNTEER MANAGEMENT

10

COMPLAINT PROCESSING IN-DEPTH

11

FUNDING

15

TRAINING ACTIVITIES AND CERTIFICATION OF OMBUDSMEN

16

RECOMMENDATIONS FOR LONG -TERM CARE ISSUES

17

SUCCESSES IN OMBUDSMAN ADVOCACy

20

APPENDIX A: OLDER AMERICANS ACT SECTION 712

~

21

APPENDIX B: GEORGIA LONGTERM CARE OMBUDSMAN PROGRAM ACT

28

APPENDIX C: COMMUNITY OMBUDSMAN PROGRAM

34

APPENDIX 0: GEORGIA LONG-TERM CARE OMBUDSMAN TRAINING REQUIREMENTS

35

Long-term Care Ombudsman Program Highlights for FY2000
./ received and worked to resolve 7,342 complaints on behalf of nursing home and personal care home residents;
./ resolved 940/0 of complaints;
./ advocated for legislative action to address the staffing crisis in nursing homes and other long-term care settings;
./ received $500,000 additional state dollars from the Georgia General Assembly to enhance ombudsman services to residents;
./ completed our third and final year of "Operation Red Flag," training 1,672 aging network professionals and 1,651 beneficiaries and their families to prevent and report health care fraud, waste, and abuse; and
./ co-sponsored the Elder Rights 2000 Conference, bringing together aging and social services agencies, law enforcement, and advocates to promote and protect the rights of older Georgians.
1

Purpose
Long-Term Care Ombudsmen (LTCO) work to improve the quality of life of residents of nursing homes and personal care homes by acting as their independent advocates. Ombudsman staff and volunteers informally investigate and resolve complaints on behalf of residents and visit long-term care facilities to be accessible to residents and monitor conditions. Ombudsmen also provide education regarding long-term care issues, identify long-term care concerns and advocate for needed change.
gL_
Personal Care Honles .
Table 1. The Number of Facilities and Beds by Facility Type (Jan. 31,2001)
Organization
The. Long-Term Care Ombudsman Program is authorized by the federal Older Americans Act1 and Georgia laW!. The director of the Division of Aging Services in the Department of Human Resources 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. The administration of these community programs is through the Area Agencies on Aging (AAA's), who in turn contract with a non-profit agency to manage the program. In two areas, the AAA houses the program. These provider agencies employ 47 full and parttime 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 FYOO, 82 volunteers -- 11 certified, 45 volunteer visitors and 26 who performed other services -assisted the Ombudsman Program.
A listing of community ombudsman programs is attached as Appendix C.
142 U.S.C. 3001 et~. A copy of relevant sections is attached as AppendiX A. 2 O.C.GA 31-8-50 et~. A copy is attached as Appendix B.
2

Ways Ombudsmen Help Residents
The following are but a few examples of ways that ombudsmen assisted residents during FYOO. Names and some details have been changed to preserve confidentiality.
Helping residents live more independent lives
Mary, a 34-year-old mother of a small child, was placed in a nursing home 5 years ago after a serious auto accident. She awoke from a 9-month coma with total paralysis of her left side, little use of her right side, and inability to speak. Most of the nursing home staff avoided Mary because they could not communicate with her.
The ombudsman persuaded the staff to spend more time and effort communicating with the resident and urged staff to provide physical, occupational, and speech therapies. Mary was re-assessed by the facility, and limited therapies were started. The ombudsman then worked with the nursing home administrator to have the resident transferred to a more intensive rehabilitation program. For the first time in months, Mary dared to hope she could again live at home with her child. Mary's family shared Mary's hope, and built an accessible room for her at their home.
Today Mary lives with her grandmother and her child. Although her speech has not improved, she can communicate clearly in writing. She can transfer easily and can handle most of her physical needs independently. Most importantly, she is an active part of her family and again has a life worth living.
Helping residents participate in the community
Tom, a cheerful man with developmental disabilities, has lived in the same personal care home and has participated in a sheltered workshop for more than two decades. A year ago, Tom started bagging groceries at a local store. Workshop staff notified the ombudsman that the personal care home staff had stopped Tom from working in the grocery store. Tom expressed to the ombudsman - in motions rather than words - his eagerness to return to work. The ombudsman discovered that, after Tom had suffered a seizure while at work, personal care home staff had stopped his work out of concern for his safety. The ombudsman facilitated a meeting between staff of the personal care home, the workshop staff, Tom, and the grocery store manager to discuss Tom's safety and the need for better communication between all parties.
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At the ombudsman's suggestion, the store manager agreed to have workshop staff train his employees in seizure response. As a result of the meeting, the personal care home and the workshop have a more positive relationship that benefits Tom. And Tom is happily bagging groceries, enjoying the chance to be helpful to customers and to be an active participant in the community.
Working to improve conditions in long-term care facilities
An Ombudsman making a routine personal care home visit found Lucy, a frail resident, who told her that she had no bed and slept in a chair in the living room. The resident also reported that the personal care home owner had hit her on the head with a shoe several days ago. The ombudsman investigated further and found residents unattended during the nights and locked in their rooms without access to water or to bathrooms. Residents sharing rooms were given pails for toilets. The ombudsman reported concerns to the Office of Regulatory Services (ORS). ORS responded with an investigation that found numerous serious violations of the personal care home regulations and sanctioned the facility. The ombudsman provided in-service education sessions on residents' rights to facility staff. Today, Lucy and the other residents of this home are receiving better care from the facility.
Preserving resident rights
"My mother is very upset that she has suddenly been moved from the room she has lived in for many years." This is the call that the ombudsman received concerning the nursing home's involuntary transfer of a resident to another room in the facility. The ombudsman found that the nursing home had failed to give the resident adequate notice of the move. Although the nursing home social worker insisted that the resident had agreed to the move, the resident clearly expressed that she had not wanted to move. The ombudsman discussed with nursing home staff their violation of the resident's right to notice of the transfer and the resident's right to appeal staff's decision. The ombudsman also emphasized the facility's responsibility to be aware of the stress for the resident in being suddenly uprooted. Eventually, facility staff agreed to move the grateful resident back to the room which has been her "home" in the facility.
4

Ombudsman Program Services

Ombudsmen provided services to 183,308 individuals in FYOO. Residents in facilities accounted for 71 %, information and assistance to the general public accounted for 9%, and education to community groups represented 7% of individuals served.
Figure 1. The number of persons served by type of service

Complaint Processing

A principal function of the Ombudsman Program is to investigate and work to

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 related to long-:-term care facilities have risen steadily in recent years-- from 3,774 in FY95 to 7,342 in FYOO (see Figure 2).

5

8,000 7,000 6,000 5,000 4,000 .l---r.;~~ 3,000 2,000 1,000
SFY 95 SY 96 SFY 97 SFY 98 SFY 99 SFY 00 o Personal Care Home Complaints Nursing Home Complaints
Figure 2. Personal care home and nursing home complaints FY95 through FY99.
Because of the greater number of nursing home beds (40,466) as compared to personal care home beds (25,221), the majority of complaints received are made by or on behalf of nursing home residents. Ombudsmen received 7,342 complaints in FYOO. The total number of complaints received increased 6% above the FY99 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. Complaints in personal care homes decreased by 8% during the same period. Complaints in nursing homes, however, increased by 11 % while the bed numbers remained relatively constant.
6

Issues Advocacy
The Ombudsman Program advocates for changes in long-term 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 and comment on the development and implementation of related federal, state, and local laws, regulations, and policies. During FYOO, the Ombudsman Program advocacy efforts included:
increased staffing in long-term care facilities and services
increased funds for services to residents by the Long-term Care Ombudsman Program
strengthened elder abuse laws
limited nursing services in approved personal care homes for residents who need it (also known as assisted living levels of care)
a consumer-centered system for access to long-term care services
increased funds for home and community-based long-term care services to provide alternatives to nursing home placement
identifying health care fraud trends -- Operation Red Flag shared findings of these trends through education and interagency collaboration.
Information and Assistance
In FYOO ombudsmen answered 13,087 requests for information, serving 17,086 consumers and caregivers statewide. Ombudsmen provided information regarding resident care, admission and discharge procedures, abuse reporting, and many other long-term care issues.
Consultation to Facilities
Ombudsmen provided 4,510 consultations to nursing home and personal care home staff during FYOO. The largest number of consultations (946) concerned resident rights. Consultations regarding nursing home services and care issues comprised the second largest number at 929.
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Routine Visitations to Facilities
Community ombudsmen made 9,753 routine visits, spending over 13,939 hours visiting nursing home and personal care home residents and monitoring facility conditions during FYOO.
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 FYOO, ombudsmen presented 374 educational sessions to 13,500
persons in community organizations, including churches, civic clubs and public and private agencies. Through "Operation Red Flag," funded by a federal grant, the Ombudsman Program trained 970 aging network professionals and 1,552 beneficiaries and their families on how to prevent, detect, and report health care fraud, waste, and abuse.
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.
8

Interagency Coordination
Ombudsmen work closely with other agencies that share concerns about the well-being of long-term care residents. During FYOO, activities included: co-sponsoring the forum "Staffing Crisis ... Staffing Solutions,"
developing recommendations for adequate long-term staffing in all settings.
co-sponsoring the Elder Rights 2000 Conference, bringing together aging and social service agencies, law enforcement, and advocates to promote and protect the rights of older Georgians. Several areas have developed or strengthened local Elder Rights teams as a result.
participation in state and local personal care home and nursing home relocation teams, helping residents find other living arrangements when the facilities cease operation.
attendance at the U.S. Department of Justice Nursing Home Abuse and Neglect Prevention Conference for the Southeast Region.
collaborative efforts with ORS Long-term Care Section (which regulates nursing facilities and personal care homes) through:
>- training -- surveyor training of ombudsmen and ombudsmen training of
surveyors;
>- sharing information with DRS regarding ombudsman experience with
facilities prior to nursing facility surveys and personal care home licensing;
>- referring complaints appropriate for investigation by a regulatory
agency; and
>- making recommendations to improve nursing home complaint handling
processes.
serving as members of long-term care advisory groups, including:
>- the Eden Alternative Coalition - advocating for best practices in long-
term care facilities; and
>- the Legislative Long-term Care Industry Study Committee -
developing recommendations on staffing.
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 (NCCNHR).
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developing stronger ties, through "Operation Red Flag," to entities involved in fraud prevention and investigation including: AARP, Department of Community Health, Health Care Financing Administration, State Health Care Fraud Control Unit, Georgia Consumer Fraud Task Force, Georgia Medical Care Foundation, and Medicare intermediaries and carriers.
Resident and Family Councils
Ombudsmen participated in 246 resident and family council meetings as speakers, observers, and resource persons in FYOO. They helped residents and family members establish resident and family councils in nursing homes and larger personal care homes.
Resident Council members from several long term care facilities in the Southern Crescent - Mcintosh Trail service area have initiated a "shoebox project." Each shoebox is filled with various necessity and gift items, including lap robes made by the residents, and is given to battered women's shelters, homebound seniors, and special needs students at a local elementary school.
Family Council members at one nursing home in the GA Mountains service area have become very interested in the issues supported by the Coalition of Advocates for Georgia's Elderly (CO-AGE), including increased staffing levels for nursing homes.
In-Service Education to Facility Staff
Ombudsmen trained facility staff on topics such as restraint reduction, resident rights and elder abuse. In FYOO, community ombudsmen made 324 presentations to 7,932 facility staff.
In an effort to improve retention of Certified Nursing Assistants (CNAs) in nursing homes, the Southern Crescent - Mcintosh Trail Ombudsman Coordinator offered training classes for CNAs to become Geriatric Technicians or Senior Geriatric Technicians. The graduates were then eligible for pay increases depending on which level of training was completed.
Volunteer Management
In FYOO, 82 volunteers --11 certified, 45 volunteer visitors and 26 who perform other services -- assisted the Ombudsman Program. State Office staff approved volunteer training curricula, administered the certification examination, provided guidance, and participated in community ombudsman program volunteer training.
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Complaint Processing In-Depth

Who makes complaints?

INursing Homes
General Public/Anonymous 2%
Physician, Medical Personnel 1%

I Personal Care Homes
General Public/Anonymous 2%

Figure 3. Types of complainants by facility type

What kind of complaints do ombudsmen receive?

I Nursing Homes

I Personal Care Homes

Figure 4. Categories of complaints by facility type 11

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 12

Complaint Investigation Results Nursing Homes

Personal Care Homes

Figure 5. Complaint investigation results by facility type
Complaint Resolution

Nursing Homes

Personal Care Homes

Figure 6. Complaint resolution by facility type 13

Complaint Referral

Sometimes the complaint resolution process requires that ombudsmen make referrals to other agencies which 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 FYOO, 1,074 complaints were referred to other agencies (665 regarding

nursing homes and 409 regarding personal care homes). This number

represented 15% 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 14

Funding
The budget for the Long-term Care Ombudsman Program totaled $2,018,211
in FYOO. The largest portion of funds supporting the Ombudsman Program
was federal (54%). State sources made up 27%, while local funds and grants from other sources made up 20% of Ombudsman Program funding. Figure 8 shows a. breakdown of total expenditures by fund source.
State Supplemental Funds
for PCHs $381,365
19%
Federal Title VII Elder Abuse Prevention $30,973 2%
Figure 8. Total expenditures by fund source.
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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 authorizes the State Ombudsman to certify community ombudsmen.
In FYOO, the State Office:
certified twelve (12) new staff and volunteer ombudsman;
conducted two (2) certification trainings for new ombudsmen (July 1999 and February 2000);
conducted one (1) statewide training conference (December 1999) attended by community ombudsmen and representatives of Area Agencies on Aging, subcontract agencies, and the Division of Aging Services; and
combined its spring conference with the Elder Rights 2000 Conference (May 2000).
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 (NCCNHR) annual conference. 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.
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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.
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 wellsupervised 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 - and the Medicaid budget should support - adequate direct care staff to meet residents' needs.
Long-term care services should be available and affordable
Problem: An ever-increasing population of individuals needs some assistance due to their disabilities, but do not require nursing home care. Long-term care services currently available in Georgia are not sufficient - or sufficiently affordable - to provide for many persons who need them.
Recommendations:
Georgia should develop additional residential options for long-term care, including adding the provision of limited nursing services in qualified personal care homes (Le., assisted living levels of care) with appropriate. protections for residents.
Georgia should continue to allocate resources to community-based longterm care services to meet the needs of persons who are older or who have disabilities.
Georgia should develop a consumer-centered system for access to longterm care services. Consumers and caregivers should have information and assessments that can help them access appropriate services for their needs.
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Improve complaint investigations in nursing homes
Problem: A study by the Atlanta Long-term Care Ombudsman Program, funded by the Administration on Aging, identified serious problems in the nursing home complaint investigation process. Recommendations: The Office of Regulatory Services should continue to improve the
timeliness and thoroughness of its complaint investigations. Complainants should have an opportunity to seek review of a complaint
investigation if they are dissatisfied with an ORS investigation. The General Assembly and the federal Health Care Finance
Administration should adequately fund ORS to enable them to meet these goals.
The criminal justice system should improve its responsiveness to elder abuse
Problem: Law enforcement and prosecutors are often unaware of problems of elder abuse in their communities, including in long-term care facilities. Sometimes they mistakenly believe that such problems should only be a regulatory concern but never a criminal matter. Recommendations: Training and resources should be available to enable law enforcement
officers and prosecutors to adequately respond to criminal activity against elders and long-term care facility residents. Ombudsmen should collaborate with those in the criminal justice system to help raise their awareness of long-term care issues.
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Improve mental health services for nursing home residents
Problem: With state-run psychiatric facilities down-sizing, and insufficient resources in the mental health system, individuals with severe mental illness often reside in nursing homes because there are no other options. While some individuals' needs can be met in the nursing home setting, others need more appropriate placements that can provide more intensive treatment and services. Despite the existence of the PASARR (Preadmission Screening and Annual Resident Review) system for nursing home residents, residents with mental illness have critical needs which are not being met. Recommendations: In order to make the mental health needs of nursing home residents a higher priority both in state government and in nursing homes, the Ombudsman Program recommends: Coordination between the PASARR system and the Division of
MH/MR/SA (Mental Health, Mental Retardation, and Substance Abuse of the Department of Human Resources) in serving the needs of nursing home residents with mental illness. DCH (the Department of Community Health) evaluation of the effectiveness of the current PASARR system. Nursing facilities more adequately assess the mental health needs of their residents and provide appropriate treatment.
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Successes in Ombudsman Advocacy
After years of advocacy by ombudsmen and others, we can celebrate the following successes:
Attention to the staffing crisis in long-term care
Ombudsmen's concerns about staffing are beginning to be heard: The 2000 General Assembly passed HR 850 to create the Long-term
Care Industry Study Committee, which made recommendations to improve staffing in long-term care. The State Ombudsman was appointed as a member. The Georgia Council on Aging, the Long-term Care Ombudsman Program, and other organizations co-sponsored a "Staffing Crisis: Staffing Solutions" forum in December 2000. Efforts to implement the recommendations that emerged from the forum are continuing, with state and community ombudsman involvement. The Coalition of Advocates for Georgia's Elderly (CO-AGE) again chose "Staffing in Nursing Homes" as a priority issue for the 2001 General Assembly.
Strengthening ombudsman services to residents
Because resources for the Ombudsman Program have not kept pace with the demand for ombudsman services, the 2000 General Assembly provided an increase of $500,000 for FY 2001. The Ombudsman Program is very appreciative of these critically needed funds and thanks CO-AGE for choosing this issue as one of its priorities.
One hundred percent (100%) of the funding increase has been distributed among community programs to enable them to meet the growing number of complaints (an increase of 81 % in the last six years) and to respond to the demands of personal care home residents. (The number of residents has increased by 84% in the last six years.)
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Appendix A
Title VII, Chapter 2, Section 712 2000 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 and made available to carry out this chapter, a State agency shall, in accordance with this section-(A) establish and operate an Office of the State Long-Term Care Ombudsman; and (8) 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 of long-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 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, of long-term care services; (II) public agencies; or (III) health and social service agencies; (8) 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 (8); . (0) 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
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(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 Assistant Secretary 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) of long-
term care facilities, or of any other residential facilities for older individuals. (5) Designation of local 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; (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 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-
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(i) have demonstrated capability to carry out the responsibilities of the Office; (ii) be free of conflicts of interest and not stand to gain financially through an action or potential action brought on behalf of individuals the Ombudsman serves; (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 disclosure.--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; (8) (i) appropriate access to review the medical and social records of a resident, if-(I) 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(I) a legal guardian of the. resident refuses to give the permission; (II) a representative of the Office has reasonable cause to believe that the guardian is not acting in the best interests of the resident; and (III) 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-term care facilities; and (D) access to and, on request, copies of all licensing and certification records maintained by the State with respect to long-term care facilities. (2) Procedures.--The State agency shall establish procedures to ensure the access described in paragraph (1).
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(c) Reporting System.--The State agency shall establish a statewide uniform reporting system to--
(1) collect and analyze data relating to complaints and conditions in long-term 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-term care facilities in the State; (8) other State and Federal entities that the Ombudsman determines to be appropriate; (C) the Assistant Secretary; 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)(1 )or (c). (2) Identity of complainant or resident.--The procedures described in paragraph (1) shall-(A) provide that, subject to subparagraph (8),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 (8) 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 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;
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(8) 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 described in subparagraphs (A)through (O)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 (8) 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 (8) 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; (8) 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; (0) 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 (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;
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(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 Assistant Secretary, 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) strengthen and update procedures for the training of the representatives of the

Office, including unpaid volunteers, based on model standards established by the

Director of the Office of Long-Term Care Ombudsman Programs, in consultation

with representatives of citizen groups, long-term care providers, and the Office,

that-

(A ) specify a minimum number of hours of initial training;

(B ) 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

(C) specify an annual number of hours of in-service training for all designated

representatives;

(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 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;

(8) coordinate services with State and local law enforcement agencies and courts of

competent jurisdiction; and

.

(9 ) 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 good faith performance of official duties.

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(j) Noninterference.--The State shall-(1) ensure that willful interference with representatives of the Office in the performance of the official duties ofthe representatives (as defined by the Assistant Secretary) 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.
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APPENDIXB
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 long-term 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 longterm care facilities and encourage the development of community ombudsman activities at the local level. The state ombudsman may certify community ombudsman and such
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certified ombudsman shall have the powers and duties-set forth in Code Sections 31-854 and 31-8-55. The state ombudsman shall require such community 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 re-certified by the state ombudsman as continuing to meet the department's standards as community ombudsman.
31853. 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 of residents of long-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 residents of long-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 technical assistance as necessary; and
(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.
31854. Duties of community ombudsman.
Pursuant to policies and procedures established by the state ombudsman, the community ombudsman shall:
(1) Learn about the general conditions affecting residents of long-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 of residents of long-term care facilities;
(3) Collect data about the number and 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.
31855. 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 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
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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. (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 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.
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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.
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 fait~ 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 31-2-6 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 of law, 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.
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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 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.
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APPENDIX e
Statewide Toll-free Number: 888/454-LTeO (5826)

COMMUNITY OMBUDSMAN PROGRAMS ATLANTA
CENTRAL SAVANNAH RIVER AREA (CSRA) COASTAL
GEORGIA MOUNTAINS
HEART OF GEORGIA ALTAMAHA
MIDDLE GEORGIA
NORTHEAST GEORGIA
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)

COUNTIES SERVED
Cobb , Cherokee, Clayton, Dekalb, Douglas, Fayette, Fulton, Gwinnett, Henry, Rockdale Burke, McDuffie, Columbia, Richmond, Screven, Glascock, Taliaferro, Hancock, Warren, Jefferson, Washington, Jenkins, Wilkes, Lincoln Bulloch, Bryan, Camden, Chatham, Effingham, Glynn, Libertv, Lona, Mcintosh Banks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin, Rabun, Stephens, Towns, Union, White Appling, Bleckley, Candler, Dodge, Emanuel, Evans, Jeff Davis, Johnson, Laurens, Montgomery, Pulaski, Tattnall, Telfair, Toombs, Treutlen, Wayne, Wheeler, Wilcox Baldwin, Bibb, Crawford, Houston, Jones, Monroe, Peach, Pulaski, Putnam, Twiggs, Wilkinson
Barrow, Clarke, Elbert, Greene, Jackson, Madison, Morgan, Oconee, Oglethorpe, Walton
Bartow, Haralson, Paulding, Polk
Catoosa, Chattooga, Dade, Fannin, Floyd, Gilmer, Gordon, Murray, Pickens, 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, Jasper, Lamar, Newton, Pike, Spaulding, Upson

TELEPHONE NUMBER
(404) 371-3800 (706) 826-4480
(912) 651-2180 (770) 538-2685
(912) 374-4301
(912) 922-4464 (706) 549-4850 (404) 894-7728 (800) 822-5391* (706) 272-2158 (800) 822-5391 * (912) 496-3948
(229) 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
Crisp, Dooley, Macon, Marion, Schley, Sumter, Taylor, Webster

(229) 432-1131 (706) 323-7243 (229) 924-8304

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,-~~~~~~~~~~~~~~~~~--~~------"-~~~~~~~-'---------------------.-----

APPENDIX D

Georgia Long-term Care Ombudsman Training Re-quirements

INITIAL TRAINING AND EXAMINATIONS - OVER 120 HOURS

Classroom Training

Minimum of 24 Hours

Training topics include: Federal, state and local laws, regulations, and policies with respect to long-term care
facilities The aging process Long-term care facilities Effects of institutionalization Resident rights Long-term care reimbursement Role of government agencies Complaint investigation and resolution 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

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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