Georgia Long-Term Care Ombudsman Program 2008 annual report [2008]

2008 ANNUAL REPORT
Georgia Department of Human Resources Office of the State Long-Term Care Ombudsman

Statewide Toll-Free Number

5826
8 8 8 . 4 5 4 . LT C O

COMMUNITY OMBUDSMAN PROGRAMS
ATLANTA
CENTRAL SAVANNAH RIVER AREA (CSRA)
COASTAL

COUNTIES SERVED
Cherokee, Clayton, Cobb, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry, Rockdale Burke, Columbia, Glascock, Hancock, Jefferson, Jenkins, Lincoln, McDuffie, Richmond, Screven, Taliaferro, Warren, Washington, Wilkes Bryan, Chatham

COASTAL (BAXLEY OFFICE) COASTAL (FOLKSTON OFFICE) GEORGIA MOUNTAINS
HEART OF GEORGIA ALTAMAHA HEART OF GEORGIA ALTAMAHA (BAXLEY OFFICE) LOWER CHATTAHOOCHEE
LOWER CHATTAHOOCHEE (AMERICUS OFFICE) MIDDLE GEORGIA
NORTHEAST GEORGIA
NORTHEAST GEORGIA (McINTOSH TRAIL OFFICE) NORTHWEST GEORGIA
SOUTHEAST GEORGIA (FOLKSTON OFFICE) SOUTHEAST GEORGIA (VALDOSTA OFFICE) SOUTHERN CRESCENT (CHATTAHOOCHEEFLINT OFFICE)

Bulloch, Effingham, Glynn, Liberty, Long, McIntosh
Camden
Banks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin, Rabun, Stephens, Towns, Union, White Bleckley, Dodge, Jeff Davis, Johnson, Laurens, Montgomery, Telfair, Toombs, Treutlen, Wheeler, Wilcox Appling, Candler, Emanuel, Evans, Tattnall, Wayne
Chattahoochee, Clay, Harris, Marion, Muscogee, Quitman, Randolph, Stewart, Talbot Crisp, Dooly, Macon, Schley, Sumter, Taylor, Webster
Baldwin, Bibb, Crawford, Houston, Jones, Monroe, Peach, Pulaski, Putnam, Twiggs, Wilkinson Barrow, Clarke, Elbert, Greene, Jackson, Madison, Morgan, Oconee, Oglethorpe, Walton Jasper, Newton
Bartow, Catoosa, Chattooga, Dade, Fannin, Floyd, Gilmer, Gordon, Haralson, Murray, Paulding, Pickens, Polk, Walker, Whitfield Bacon, Brantley, Charlton, Coffee, Pierce, Ware
Atkinson, Ben Hill, Berrien, Brooks, Clinch, Cook, Echols, Irwin, Lanier, Lowndes, Tift, Turner Carroll, Coweta, Heard, Meriwether, Troup

SOUTHERN CRESCENT (McINTOSH TRAIL OFFICE)
SOUTHWEST GEORGIA (SOWEGA)

Butts, Lamar, Pike, Spalding, Upson
Baker, Calhoun, Colquitt, Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas, Worth

TELEPHONE NUMBERS
(404) 371-3800
(706) 721-2327 (800) 248-6697
(912) 236-6747 (877) 236-6720 (912) 367-4866 (866) 991-9988 (912) 496-3948 (888) 531-8098 (770) 538-2685 (770) 538-2650 (478) 374-4301
(912) 367-5244
(706) 323-7243
(229) 924-8304
(478) 922-4464
(706) 549-4850
(770) 567-5951
(706) 272-2157 (866) 565-8213
(912) 496-3948 (888) 531-8098 (229) 241-1017 (888) 292-9416 (404) 563-7715
ext.1587 (404) 894-7707 (800) 822-5391 (770) 567-5951 (770) 567-5948 (229) 432-1131 (866) 463-7070

OFFICE OF THE STATE LONG-TERM CARE OMBUDSMAN
2 Peachtree Street, NW 8th Floor (Office Location) 9th Floor (Mailing Address) Atlanta, Georgia 30303-3142
(888) 454-LTCO (5826) TTY (404) 657-1929
www.georgiaombudsman.org

State Office Staff

Becky A. Kurtz, Esq. State Long-Term Care Ombudsman

Andrew Hales Ombudsman Services Coordinator

Gabrielle Numair Ombudsman Services Coordinator

Tracey R. Williams Ombudsman Program Consultant

Tina Lawrence Administrative Assistant

Jeni Coyne served as Acting State Long-Term Care Ombudsman and Cheryl Harris served as Training Coordinator during FY08

1

TABLE OF CONTENTS
Contact Information for the Ombudsman Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Inside Front Cover Highlights for Fiscal Year 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Purpose and Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Ombudsmen and Residents of Nursing Homes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Ombudsmen and Residents of Intermediate Care Facilities for the Mentally Retarded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Ombudsmen and Residents of Personal Care Homes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Ombudsmen and Residents of Community Living Arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Issues Advocacy and Interagency Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Information and Outreach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Operations, Funding and Program Effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
We gratefully acknowledge the late Neil Fraser for contributing the artwork used in this report and other Georgia Ombudsman publications.
The images of long-term care facility residents appearing in this report are used by permission and do not imply any usage of Ombudsman Program services by the residents. The other images in this report are stock photos.
Names and images are not the actual names and images of the individuals described in the cases in the report. Any resemblance is coincidental.
2

Highlights for FY08
242,823 Persons Served

Facility Visits
184,454 served

Received and worked to resolve 5,881 complaints on behalf of
long-term care facility residents (see pages 5-8, 11-13, 14-17, and 18-20);

LLL

Responded to:
95% of abuse complaints where the resident was believed to be at risk within 1 working day;
98% of abuse complaints where the resident was not believed to be at risk within 3 days; and
99% of all other complaints within 7 working days (see page 23);

Achieved positive outcomes for 97 % of complaints overall
(see pages 8, 13, 17, 20, and 23);

Promoted quality
improvement in nursing homes (see page 8).

Complaint Investigation
2,781 served
Resident, Family Council
5,944 served
Facility Staff Training
7,393 served
Facility Consultation
9,816 served
Information and Assistance
15,016 served
Community Outreach and Education
17,419 served

3

Purpose and
Organization

The mission of the Long-Term Care Ombudsman Program is to seek resolution of problems and advocate for the rights of residents of longterm care facilities with the goal of enhancing the quality of life and care of residents.
View the "Ombudsman Programs" section of the Older Americans Act at www.access.gpo.gov/uscode (select Title 42, Chapter 35, Subchapter XI, Part A, Subpart II).
View the Georgia Long-Term Care Ombudsman Program Act at www.legis.state.ga.us (select "Georgia Code," read public access statement / close window, select Title 31-8, and Article 3 sections 50 through 63).

The Georgia Long-Term Care Ombudsman Program serves residents of nursing homes, personal care homes (sometimes called "assisted living," "group homes," and other terms), community living arrangements (CLAs), and intermediate care homes for the mentally retarded (ICF/MRs).
Certified ombudsman staff and volunteers informally investigate and work to resolve complaints made by or on behalf of residents. Ombudsmen regularly visit long-term care facilities to be accessible to residents and monitor conditions. In addition, ombudsmen provide education regarding long-term care issues, identify long-term care concerns, and advocate for needed change.
The Long-Term Care Ombudsman Program is authorized by the federal Older Americans Act (42 U.S.C. 3058g) and Georgia law (O.C.G.A. 31-8-50 et seq.). The Office of the State Long-Term Care Ombudsman (State Office) operates as a separate office within Georgia Department of Human Resources' Division of Aging Services.
The Division of Aging Services contracts with Area Agencies on Aging (AAAs) to provide ombudsman services throughout the state. Most AAAs contract with non-profit agencies to operate the community ombudsman program in their service area, although two community ombudsman programs are housed within AAAs. Community ombudsman programs employ 51 full and part-time LTCO staff. Most community programs utilize volunteers to enhance ombudsman services to residents.

Long-Term Care Facilities Nursing Homes Intermediate Care Facilities for the Mentally Retarded Personal Care Homes Community Living Arrangements
4

Number of Facilities*
375 11 2,079 418

Number of Beds*
40,649 1,415 28,187 1,503
*October 2008

Ombudsmen and
Residents of Nursing Homes

FACILITY VISITS
In FY08 community ombudsmen made 5,295 visits to 135,145 nursing home residents during which they also monitored facility conditions.

COMPLAINTS HANDLED BY RESIDENTS' ADVOCATES
A principal function of the Ombudsman Program is to investigate and work to resolve complaints made by or on behalf of residents of longterm care facilities. In handling complaints, ombudsmen respect resident and complainant confidentiality and focus their complaint resolution on the resident's wishes.
Ombudsmen received 4,490 complaints by and on behalf of nursing home residents in FY08. Ombudsmen, as resident advocates, served a total of 2,685 complainants in handling these nursing home complaints.

8,000

6,000

7,321

4,000

2,000

6,563

5,425

5,211

5,183

4,676

4,490

0

FY 02

FY 03

FY 04

FY 05

FY 06

FY 07

FY 08

Total Nursing Home Complaints for FY02 Through FY08

5

OMBUDSMEN AND RESIDENTS OF NURSING HOMES

Nursing Home Complaint Groups FY08

Residents' Rights
1,320
(29%)
Problems Outside Facility
333
(7%)
Administration
269
(6%)
Resident Care
1,383
(31%)
Quality Of Life
1,185
(26%)

Most Frequent Types of Nursing Home Complaints in FY08
Type of Complaint
Dignity, respect, staff attitudes Discharge, eviction planning, notice Failure to respond to requests for assistance Personal hygiene Cleanliness, presence of pests Medications administration, organization Odors Symptoms unattended, including pain not managed Equipment disrepair, hazard, poor lighting, fire safety Accidents / unknown injuries, falls, improper handling

Number of Complaints
345 278 263 205 200 141 140 138 135 128

Percentage of All Nursing Home Complaints
8% 6% 6% 5% 4% 3% 3% 3% 3% 3%

6

Percent of all Nursing Home Complainants Percent of all Nursing Home
Complaint Investigation Results

OMBUDSMEN AND RESIDENTS OF NURSING HOMES

Types of Nursing Home Complainants FY08

35

915

(37%) 30

25

20

555 557

15

(22%) (22%)

10 5

358

(14%)

63

(3%)

22

22

2

(1%) (1%) (<1%)

0

Residents Ombudsmen Relatives, Friends

Facility Staff

General Public, Anonymous, Other

Other Agency
Staff

Physicians, Medical Personnel

Other

Nursing Home Complaint Investigation Results FY08

90

80

3,583

70

(82%)

60

50

40

30

20

410 359

10

(9%) (8%)

0

Verified; Undetermined Not

Partially

Valid

Verified

Ombudsmen Advocate to Improve Residents' Quality of Life
Mr. Jones was sitting in a common area of the nursing home when he saw that the ombudsman was visiting. He asked her if she would go with him to observe his room which was uncomfortably warm and stuffy on this summer day. Mr. Jones explained that his room had been converted from an office, but that, unlike all other resident rooms, his had no air conditioning unit. He asked for the ombudsman's help.
The ombudsman confirmed that the other rooms all had air conditioning units and were significantly cooler than Mr. Jones' room. Then she went to meet with the administrator. The administrator denied that there was a problem with the air conditioner, insisting that the renovations to Mr. Jones' room had been completed before any resident had moved in. The ombudsman urged the administrator to visit Mr. Jones in his room where she saw immediately that there was no air conditioning. While he had the attention of both the administrator and the ombudsman, Mr. Jones used the opportunity to state that, although he had been paying for cable television, the cable had never been connected, despite numerous requests.
Before leaving the facility, the ombudsman made sure that Mr. Jones had access to a fan in6 his room. Then a Volunteer Visitor visited Mr. Jones every day for ten days until he was able to report to the ombudsman that Mr. Jones finally had access to both air conditioning and cable television. Today, Mr. Jones has a much more comfortable room, improving his quality of life. I

7

3
OMBUDSMEN AND RESIDENTS OF NURSING HOMES

Percent of all Nursing Home Complaint Outcomes Percent of all Nursing Home Complaint Referrals

Outcomes FY08 (97% Positive Outcomes)

80

70

2,998

60

(71%)

50

40

30

20 10

325 (8%)

321 (8%)

248 (6%)

174 (4%)

0

Resolved* Withdrawn* Partially Resolved*
* indicates "positive outcomes"

Explained*

No Action Needed*

132 (3%)
Not Resolved

12 (<1%)
Other

Referrals to Other Agencies FY08

60

50
149 40 (50%) 128
(43%) 30

20

10

6

5

5

5

11

0

(2%) (2%)

(2%) (2%) (<1%) (<1%)

Office of Regulatory Services

Legal Adult

Mental

Law

Services Protective Health, Enforcement

Services Developmental

Disabilities,

Addictive

Diseases

Other

Centers Family for Medicare and
and Children Medicaid Services Services

Ombudsmen Promoted Quality Improvement in Nursing Homes.
Ombudsmen helped promote the Advancing Excellence in America's Nursing Homes campaign among residents, families, facility staff, and the general public. I

RESIDENT AND FAMILY COUNCILS
Ombudsmen participated in 249 resident council meetings, assisting 3,628 persons, and in 55 family council meetings, assisting 1,018 persons, in FY08, on behalf of residents and family members in all facility settings nursing homes, ICF/MRs, personal care homes, and CLAs.
IN-SERVICE EDUCATION
Ombudsmen trained facility staff on topics such as the Ombudsman Program, residents' rights, and abuse reporting. In FY08, community ombudsmen made 249 presentations to 5,989 nursing facility and ICF/MR staff.
CONSULTATIONS TO FACILITIES
Ombudsmen provided consultations involving 7,282 nursing facility and ICF/MR staff during FY08. The largest number of consultations concerned residents' rights, followed by consultations regarding nursing home services and care issues and the Ombudsman Program.

Join the Advancing Excellence in America's Nursing Homes coalition (go to www.nhqualitycampaign.org for details).

8

OMBUDSMEN AND RESIDENTS OF NURSING HOMES
Ombudsmen Advocate for Quality Care
When Mrs. Brown visited her husband in the nursing home, she discovered him sitting naked and unattended in the shower stall, while the aide was talking on her cell phone. Mrs. Brown was upset that Mr. Brown, who was confused due to Alzheimer's disease, was not receiving the assistance he needed. She noticed there was a bruise on his back and no one had provided her with an explanation of its origin. She was also frustrated because she had asked facility staff to arrange for a urinary tract infection (UTI) test, but none had been ordered. Mr. Brown frequently had UTIs and his recent changes in behavior were consistent with times he had had UTIs in the past. When she didn't receive the responses she needed from facility staff, Mrs. Brown asked the ombudsman for help. With Mrs. Brown's permission, the ombudsman reviewed Mrs. Brown's concerns with the Director of Nursing, who started to work on these issues ordering a UTI test (which was positive) and investigating the unattended shower issue and the bruising. Later that week, the Office of Regulatory Services was conducting a standard survey, so the ombudsman and Mrs. Brown described their concerns to the surveyors. The surveyors substantiated Mrs. Brown's concerns, citing several violations of federal regulations by the nursing home. The facility took disciplinary actions with staff who had failed to meet Mr. Brown's needs. Today the staff of this facility is better managed, Mrs. Brown's concerns are taken seriously by facility staff, and Mr. Brown is receiving improved care. I

Mrs. Williams, a nursing home resident, rents her home to her niece. Her niece offered to take her home for a visit, and Mrs. Williams was excited about the opportunity to see her

Ombudsmen Advocate for Residents' Rights

home again. But other family members objected to the visit and

instructed the facility to not allow Mrs. Williams to leave the

facility. So Mrs. Williams asked the ombudsman whether she had a right to

leave the facility for a visit. She said she felt like she was imprisoned. The ombudsman investigated for

Mrs. Williams, finding that she was capable of making her own decisions and that the niece did not have

a history of any problems with the aunt. The ombudsman advocated that the facility should allow Mrs.

Williams to exercise her right and visit her niece. Since then, Mrs. Williams has been able to visit her

niece and see her home. She says she no longer feels like a hostage in the nursing home. I

9

OMBUDSMEN AND RESIDENTS OF NURSING HOMES
Ombudsmen Advocate for Residents' Rights
Mr. Taylor, a nursing home resident, walked into his room and found that his cell phone was missing. After thoroughly searching but not finding it, he decided someone must have stolen it, so he called the police to report the theft. When the police arrived, they spoke to the administrator who stated that she had taken the resident's phone because he had been using it to access the internet from his personal computer. She did not approve of Mr. Taylor accessing internet gambling sites. The police did not take any action against the administrator and did not help Mr. Taylor get his cell phone back. The administrator did indicate that the resident could use the facility phone and computer, but only under staff supervision. Mr. Taylor felt his rights were being violated, so he contacted the ombudsman. Both Georgia and federal laws protect nursing home residents' right to retain and use their own personal property in their own room as well as the right to communicate privately with whomever the resident chooses. The ombudsman worked with facility staff to be sure they understood Mr. Taylor's right to his own cell phone and right to privacy in his communications, including by phone and the internet. Later, the Office of Regulatory Services cited the facility for violating resident rights related to confiscation of personal property. As she worked with Mr. Taylor, the ombudsman made sure he understood the potential risks of gambling and its impact on his ability to pay for his nursing home care. She also helped him and facility staff to plan his transition out of the facility. Mr. Taylor hopes to be living in his own accessible apartment soon. I
Ombudsmen Help Residents Access Meaningful Activities
Mrs. Berger, a nursing home resident, has three beautiful oil paintings hanging on the wall of her room. One day a Volunteer Visitor of the Ombudsman Program visited Mrs. Berger and asked about the paintings. Mrs. Berger told her that she had painted them. Painting had been her life-long passion, and she longed to continue, but the nursing home staff had informed her that the paints and cleaning fluids were prohibited since they were toxic. The Volunteer Visitor asked the ombudsman how they could help Mrs. Berger pursue her passion again. The ombudsman explored options with the Activities Director. They eventually worked out a solution: the Activities Director agreed to lock up the toxic materials in her office when they were not in use. Later, Mrs. Berger's family found non-toxic paints that Mrs. Berger is able to keep in her room. Now Mrs. Berger is again creating works of art portraits of her grandchildren as well as landscapes. Mrs. Berger told the volunteer: "Thank you for helping me get my life back!" I
10

Ombudsmen and Residents of Intermediate Care
Facilities for the Mentally Retarded

VISITS TO ICF/MRs
In FY08 community ombudsmen made 86 visits, serving 2,734 residents of intermediate care facilities for the mentally retarded, during which they also monitored facility conditions.

COMPLAINTS HANDLED BY RESIDENTS' ADVOCATES
A principal function of the Ombudsman Program is to investigate and work to resolve complaints made by or on behalf of residents of longterm care facilities. In their complaint handling, ombudsmen respect resident and complainant confidentiality and focus their complaint resolution on the resident's wishes.
Ombudsmen received 8 complaints by and on behalf of residents of ICF/MRs in FY08. A total of 11 complainants were served.

30

30

29

20

26

24

20

10

15

0

8

FY 02

FY 03

FY 04

FY 05

FY 06

FY 07

FY 08

Total ICF/MR Complaints for FY02 Through FY08

11

OMBUDSMEN AND RESIDENTS OF INTERMEDIATE CARE FACILITIES FOR THE MENTALLY RETARDED

Residents' Rights
5
(62%)
Problems Outside Facility
1
(13%)
Resident Care
1
(12%)
Quality Of Life
1
(13%)
Administration (0%)

ICF/MR Complaint Groups FY08

Most Frequent Types of ICF/MR Complaints in FY08
Type of Complaint
Abuse physical Abuse verbal, psychological Privacy, telephone, visitors, couples, mail Infection conrol Personal funds mismanaged, access denied, money not returned Legal guardianship, power of attorney, conservatorship, wills Accidents, unknown injuries, falls, improper handling

Number of Complaints
2 1 1 1 1
1
1

Percentage of All ICF/MR Complaints
25% 13% 13% 13% 13%
13%
13%

12

Percent of all ICF/MR Complainants

OMBUDSMEN AND RESIDENTS OF INTERMEDIATE CARE FACILITIES FOR THE MENTALLY RETARDED

Types of ICF/MR Complainants FY08
60

50

3

40

(50%)

30

20

10

1 (17%)

1 (17%)

1 (17%)

0

Relatives, Ombudsmen Facility General Public,

Friends

Staff Anonymous,

Other

ICF/MR Complaint Investigation Results FY08
60

Percent of all ICF/MR Complaint Investigation Results

50

4

40

(50%)

30

20

10

2

2

(25%) (25%)

0

Verified; Undetermined Not

Partially

Valid

Verified

1

P Percent of all ICF/MR Complaint Outcomes

Outcomes FY08 (100% Positive Outcomes)

100

90

8 (100%)

80

70

60

50

40

30

20

10

0

Resolved* * indicates "positive outcomes"

Referrals to Other Agencies FY08

Percent of all ICF/MR Complaint Referrals

100

90

1 (100%)

80

70

60

50

40

30

20

10

0

Office of Regulatory Services

Read the state's rules about ICF/MR residents' rights (at http://tinyurl.com/4roswd) and federal regulations online (go to http://www.gpoaccess.gov/executive.html, use the search / browse function, select Title 42 Public Health, then Part 483 subsection 420 which will be in Chapter V, Volume 4).
13

Ombudsmen and Residents of
Personal Care Homes

FACILITY VISITS
In FY08 community ombudsmen made 7,716 visits, serving 43,969 personal care home residents, during which they also monitored facility conditions.

COMPLAINT PROCESSING
A principal function of the Ombudsman Program is to investigate and work to resolve complaints made by or on behalf of residents of longterm care facilities. In handling complaints, ombudsmen respect resident and complainant confidentiality and focus their complaint resolution on the resident's wishes.
Ombudsmen received 1,350 complaints by and on behalf of personal care home residents in FY08. Ombudsmen, as resident advocates, served a total of 817 complainants in handling these personal care home complaints.

1,800 1,600 1,400 1,200 1,000
800 600 400 200
0

1,793

1,716

1,603

1,491

1,236

1,212

FY 02

FY 03

FY 04

FY 05

FY 06

FY 07

Total Personal Care Home Complaints for FY02 Through FY08

1,350 FY 08

Read the state's rules and regulations about personal care homes (at http://tinyurl.com/5nfvyl).
14

OMBUDSMEN AND RESIDENTS OF PERSONAL CARE HOMES

Residents' Rights
407
(30%)
Problems Outside Facility
121
(9%)
Administration
151
(11%)
Resident Care
226
(17%)
Quality Of Life
445
(33%)

Personal Care Home Complaint Groups FY08

Most Frequent Types of Personal Care Home Complaints in FY08
Type of Complaint
Food quantity, quality, menu, condiments, utensils Medications administration, organization Dignity, respect staff attitudes Equipment disrepair, hazard, poor lighting TIE: Discharge / eviction planning, notice, procedure Cleanliness, pests Activities choice, appropriateness Environment air quality, temperature Supervision of residents Exercise choice / rights, right to smoke

Number of Complaints
124 108 62 55

Percentage of All Personal Care Home Complaints
9% 8% 5% 5%

51

4%

51

4%

45

3%

39

3%

36

3%

23

2%

15

Percent of Total Personal Care Home Complainants
Percent of all Personal Care Home Complaint Investigation Results

OMBUDSMEN AND RESIDENTS OF PERSONAL CARE HOMES

Types of Personal Care Home Complainants FY08

35

30

229 218

25

(31%) (30%)

20

15

10

90

5

(12%) 66 (9%)

50 (7%)

49 (7%)

29 (3%)

6 (1%)

0

Residents Ombudsmen Relatives, Friends

Facility Staff

General Public, Anonymous, Other

Other Agency
Staff

Physicians, Medical Personnel

Other

Personal Care Home Complaint Investigation Results FY08

80

70

949

60

(75%)

50

40

30

20

161 155

(13%) (12%)

10

0

Verified; Undetermined Not

Partially

Valid

Verified

7 6
16

1
OMBUDSMEN AND RESIDENTS OF PERSONAL CARE HOMES

Percent of all Personal Care Home Complaint Outcomes
Percent of all Personal Care Home Complaint Refferals

Outcomes FY08 (91% Positive Outcomes)

60

723

50

(60%)

40

30

20

10

112 (9%)

97 (8%)

88 (7%)

80 (7%)

73 (6%)

0 Resolved* Partially Explained* Resolved*
* indicates "positive outcomes"

Not Withdrawn* Resolved

No Action Needed*

25 (2%)
Other

Referrals to Other Agencies FY08

90

80

230

70

(89%)

60

50

40

30

20

10

15

6

3

1

1

1

(6%) (2%) (1%) (<1%) (<1%) (<1%)

0

Office of Regulatory Services

Legal Services

Law Enforcement

Other Mental Health, Family Community

Developmental and

Care

Disabilities, Children Services

Addictive Services Program

Diseases

IN-SERVICE EDUCATION
Ombudsmen trained facility staff on topics such as the Ombudsman Program, residents' rights, and abuse reporting. In FY08, community ombudsmen made 96 presentations to 1,382 personal care home and CLA staff.
CONSULTATIONS TO FACILITIES
Ombudsmen provided consultations involving 2,340 personal care home and CLA staff during FY08. Consultations concerned residents' rights, personal care home services and care issues, and the Ombudsman Program, among others.
17

Ombudsmen Negotiate Solutions for Residents
Mrs. Garcia's brother couldn't figure out how to help his sister, a resident of a personal care home. The personal care home was telling families they had to use a new way of packaging medications. This would require a change to another pharmacy that Mrs. Garcia's insurance would not cover. With medications costing several hundred dollars a month, the brother was worried that Mrs. Garcia could no longer afford her medications. So, he called the ombudsman for help. The ombudsman intervened by contacting the pharmacy as well as the insurance representative. They were able to work out a solution: the insurance company, which also provided mail order medications, would send the covered medications to the pharmacist who could repackage the medications according to the personal care home's new protocol. Today Mrs. Garcia continues to have access to the medications she needs. I

Ombudsmen and Residents of
Community Living Arrangements

FACILITY VISITS
In FY08 community ombudsmen made 1,036 visits to 2,606 residents of community living arrangements, during which they also monitored facility conditions.

COMPLAINTS HANDLED BY RESIDENTS' ADVOCATES
A principal function of the Ombudsman Program is to investigate and work to resolve complaints made by or on behalf of residents of longterm care facilities. In handling complaints, ombudsmen respect resident and complainant confidentiality and focus their complaint resolution on the resident's wishes.
Ombudsmen received 33 complaints by and on behalf of residents of community living arrangements in FY08. Ombudsmen, as resident advocates, served a total of 30 complainants in handling these community living arrangement complaints.

60 50 40 30 20 10
11 0
FY 03

38 FY 04

53 FY 05

33 FY 06

44 FY 07

33 FY 08

Total Community Living Arrangement Complaints for FY03 Through FY08

Read the state's rules about CLA residents` rights (at http://tinyurl.com/6gxf61).
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OMBUDSMEN AND RESIDENTS OF COMMUNITY LIVING ARRANGEMENTS

Residents' Rights
14
(42%)
Problems Outside Facility
3
(9%)
Administration
2
(6%)
Resident Care
7
(21%)
Quality Of Life
7
(21%)

Community Living Arrangements Complaint Groups FY08

Most Frequent Types of Community Living Arrangement Complaints in FY08

Type of Complaint

Number of Complaints

Abuse, verbal, psychological (including punishment, seclusion) Medications administration, organization Abuse, physical (including corporal punishment) Discharge / eviction planning, notice, procedure Mental health, psychosocial services Food quantity, quality, menu, condiments, utensils Supplies and linens TIE 13 other types of complaints

4 4 3 3 2 2 2 1 each

Percentage of All CLA Complaints
12% 12% 9% 9% 6% 6% 6% 3% each

19

Percent of all CLA Complainants

OMBUDSMEN AND RESIDENTS OF COMMUNITY LIVING ARRANGEMENTS

Types of Community Living Arrangements Complainants FY08

60

15

50

(60%2)

40

30

Percent of all CLA Complaint Outcomes

20

5

2

10

(20%) (8%)

1

1

1

(4%) (4%) (4%)

0

Residents Ombudsmen Other Agency Staff

Relatives, Friends

Facility Staff

General Public, Anonymous, Other

Outcomes FY08 (89% Positive Outcomes)

70

60

17

50

(63%)

40

30

20

10

4

(15%)

0

Resolved*

Withdrawn*

* indicates "positive outcomes"

3 (11%)
No Action Needed*

3 (11%)
Not Resolved

Community Living Arrangements Complaint Investigation Results FY08
90

Percent of CLA Complaint Investigation Results

80

28

70

(88%)

60

50

40

30

20

10

4

0

(12%)

Verified;

Not

Partially

Valid

Verified

Referrals to Other Agencies FY08
60

Percent of all CLA Complaint Referrals

50

2

2

40

(50%)

(50%)

30

20

10

0

Mental Health, Developmental
Disabilities, Addictive Diseases

Office of Regulatory Services

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Issues Advocacy and
Interagency Coordination

Through their work on behalf of residents, ombudsmen identify systemic issues that require change. They initiate interagency efforts and join other collaborations to improve long-term care for the benefit of residents. Ombudsmen work closely with social services, regulatory, advocacy, policy-making, law enforcement, and other organizations all with the goal of improving the lives of Georgians needing long-term care. Ombudsmen evaluate the effectiveness of their work and develop strategies for continuous quality improvement.
During FY08, ombudsmen:
Completed duties as Patient Care Ombudsman in two bankruptcy filings
Referred 562 complaints to other agencies
This number represented 9.5% of all complaints received by ombudsmen. Ombudsmen made referrals to agencies that regulate facilities and agencies that will take other action to assist residents. When a complaint is referred to another agency, the ombudsman maintains contact with the resident or complainant and follows up to determine whether the problems have been resolved.
Developed, with other agencies, procedures for assisting nursing home residents in the implementation of the Money Follows the Person transition project
Participated in the Advisory Group for the Culture Change Network of Georgia and attended training on person-centered care and culture change

Ombudsmen Advocate for Residents to be Free from Exploitation
A provider in Southwest Georgia had a long history of operating residences in Georgia and Florida without a license. When she was required by the state licensing agency to submit an application in order to operate a personal care home, her application was denied due to an unsatisfactory criminal background check. The ombudsman believed the provider was moving residents between the states without their consent to evade regulators and law enforcement.
The ombudsman made numerous reports to regulatory bodies, including the state licensing agency, adult protective services, and law enforcement, including code enforcement officers. Together these agencies and the ombudsman strategized to protect these residents and assist residents who wished to move. The ombudsman worked with the Florida Attorney General's office which successfully prosecuted this provider, in part based on ombudsman testimony.
Meanwhile, the ombudsman collected evidence that this provider was financially exploiting these residents, including misuse of their Social Security checks. She notified the Social Security Administration and the Internal Revenue Service of her findings. As a result of these referrals and subsequent investigations, the provider was convicted of the federal crimes of theft of government property, aggravated identity theft, and forgery.
Today, the ombudsman hopes that with these criminal convictions and court orders this provider will never again exploit older individuals or individuals with disabilities. I

If you are part of an organization that would like to continue its culture change journey of transformation toward increased person-centered care, be sure to routinely visit the Culture Change Network of Georgia website (at http://culturechangega.org) to keep apprised of new learning opportunities.

If you are part of an organization that would like to improve the quality of long-term care, contact the Ombudsman Program office in your area to discuss ways you can partner with the Ombudsman Program (see the list on the inside of the front cover).

21

Information and
Outreach

Schedule a presentation by contacting the Ombudsman Program Office in your area (see list on the inside front cover).

Ombudsmen answered 11,430 requests for information, serving 15,016 consumers and the friends and family who care for them statewide in FY08. Ombudsmen provided information regarding residents' rights, care, admission and discharge procedures, abuse reporting, and many other long-term care issues.
Ombudsmen provided community education on the rights of residents, the services of the Ombudsman Program, facility regulation and enforcement, resident care practices, and elder abuse. In FY08, ombudsmen provided 346 educational sessions and other outreach activities to 17,419 persons (including representatives of churches, public and private agencies, educational institutions, civic clubs, and senior groups, and attendees at health fairs). In addition to presentations, ombudsmen informed the public about long-term care issues through professional newsletters, the news media, publications, and the websites of the Office of the State Long-Term Care Ombudsman (www.georgiaombudsman.org) and the Council of Community Ombudsman (www.gacoco.org).
The State Office administered the Barbara Fraser Legacy of Learning Fund to promote professional development and public educational efforts. Please contact the State Office for more information or to contribute to the Fund.

22

Operations, Funding and
Program Effectiveness

Responsiveness to complaints
Ombudsmen responded to 95% of abuse complaints where the resident was believed to be at risk within 1 working day; 98% of abuse complaints where the resident was not believed to be at risk within 3 days; and 99% of all other types of complaints within 7 working days.
Ombudsmen achieved 97% positive outcomes rate for complaint resolution
"Positive outcomes" include these types of resolutions: the resident or complainant was satisfied or partially satisfied, the complaint was explained or withdrawn, and no action was needed or appropriate.
Ombudsmen participated in a multi-state effort to evaluate the effectiveness of local LTCO programs
Local long-term care ombudsman programs in Georgia were evaluated for their effectiveness by the University of California, San Francisco. The project confirmed our program strengths in complaint resolution, education, and issues advocacy for residents. It focused our energies on areas for improvement, such as volunteer development, interagency relations, and responding to populations with developmental disabilities or mental illness.

Advisory Council assisted State Ombudsman Program in quality improvement and advocacy
The Council has been engaged, asking excellent questions, and providing suggestions on program policy and operations. It has frequent communications, even between meetings, and has been an excellent asset during the General Assembly. It has hosted helpful dialogues with provider associations and other agencies. Having residents and former residents on the Council has provided a very helpful perspective.
IN APPRECIATION
The Long-Term Care Ombudsman Program wishes to remember and recognize the contributions of two founding Advisory Council members John Munzenmaier and Samuel Mitchell. Both of these
gentlemen had the experience of being a former nursing home resident. And both passed away during the past year. John and Samuel generously shared their experiences, insights, and inspiration
with the Ombudsman Program and are greatly missed.
JOHN MUNZENMAIER (seated) shown with family members, standing, from left to right: Fred (his brother), Abby (Fred's daughter), and Fred Jr. (Fred's son).

Contact the Ombudsman Program office in your area to learn more about becoming a Volunteer Ombudsman (see the list on the inside of the front cover).

SAMUEL MITCHELL at the "Long Road Home" for Georgia ADAPT.

23

OPERATIONS, FUNDING AND PROGRAM EFFECTIVNESS

The budget for the Long-Term Care Ombudsman Program totaled $3,091,336
The largest sources of funds supporting the Ombudsman Program in FY08 were federal sources (46%) and state sources (41%), while local funds and grants from other sources made up the remaining 13%.

Other

Fed. Title VII

State Funds State Match Elder Abuse Prevention

$290,794 $80,224

$29,480

Local Match $110,607

Fed. Bankruptcy Trustee $5,022

State LTCO Funds $895,566

Fed. Title VII LTCO Activity
$532,725

Fed. Title III B $854,881

Other Local Funds and Grants $292,037

110 volunteers assisted the Ombudsman Program
6 certified volunteer ombudsmen, 79 volunteer visitors, and 25 volunteers who performed other services were involved in the Ombudsman Program in FY08. Community ombudsmen recruited, trained, and supervised volunteers, while State Office staff approved volunteer training curricula, administered certification examinations, and assisted with volunteer training.
The Ombudsman Program maintained its mandatory training program
Because ombudsmen work with a variety of complex issues, they need up-to-date information and the skills to appropriately investigate and successfully resolve complaints. Only after extensive training does the State Office certify community ombudsmen to resolve complaints. In FY08, the State Office certified three staff ombudsmen and one volunteer ombudsman, holding certification and on-site classes in November 2007 and February 2008.
The State Office conducted a statewide training conference in November 2007 and regional training events in April and May 2008, required for ombudsman staff to maintain their certification. In addition, coordinators of community programs provided training on a regular basis to their staff and volunteers, and many ombudsmen participated in other professional training events.

Total Budget by Funding Source.

Learn more about the Georgia Council of Community Ombudsmen at http://gacoco.org.

24

OPERATIONS, FUNDING AND PROGRAM EFFECTIVNESS

L LLLLLLLL

LL

Georgia Long-Term Care Ombudsman Training Requirements INITIAL TRAINING AND EXAMINATIONS OVER 120 HOURS

Classroom Training
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 Residents' rights Long-term care reimbursement Role of government agencies Complaint investigation and resolution skills Community resources

Minimum of 24 Hours

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 35 HOURS
Ombudsmen attend conferences and other training events each year to keep abreast of current information on relevant long-term care issues and LTCO management and practice. All staff ombudsmen are required to attend training to maintain certification.
25

LL

LLLLL

Recommendations

Based on the experience of ombudsmen throughout the state, Georgia's Long-Term Care Ombudsman Program recommends the following to improve the lives of Georgians who live in long-term care facilities:
Make long-term care services available and affordable
Problem:
An ever-increasing number of individuals need assistance due to their disabilities, but do not require nursing home care. Alternative long-term care services currently available in Georgia are not sufficient or sufficiently affordable to provide for many persons who need them. Those individuals who are served in community settings need access to quality services.
Recommendations:
I 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 living levels of care) with appropriate protections for residents.
I Georgia should continue to allocate resources to expand community-based services to meet the needs of elders and persons with disabilities.
I Georgia should assist every nursing home resident who is able and wants to to live in a less restrictive setting. The Ombudsman Program is participating in Georgia's Money Follows the Person program to help nursing home residents transition into community-based care.

I The General Assembly should again provide funding to implement adult day care licensure and regulation to ensure quality of services and protect consumers. Although it appropriated funding for this purpose in the 2008 General Assembly, this appropriation was later cut from the state budget.
Improve care in nursing homes
Problem:
Nursing home residents deserve to receive high quality care, but sadly they don't always receive the care they deserve. Nursing home providers, government agencies, advocates and others are working collaboratively to improve care in nursing homes through a nationwide effort called "Advancing Excellence in America's Nursing Homes" (www.nhqualitycampaign.org). As a result of these efforts, nursing homes have more access to training, clinical consultation and information about their performance. Despite these achievements, challenges remain that impact the quality of life for residents.
Recommendations:
I Providers, government agencies, and advocates should promote culture change in facilities to improve residents' quality of life and quality of care. The Culture Change Network of Georgia, spearheaded by Aging Services of Georgia, is leading Georgia toward this important goal.
I Providers, government agencies, and advocates should continue to work together with the common goals of decreasing the numbers of residents who are suffering from pressure sores or are restrained in Georgia's nursing homes.

26

R E C O M M E N D AT I O N S

Increase staffing in nursing homes
Problem:
In order for Georgians who live in nursing homes to receive quality care, the facility in which they live must provide sufficient, well-trained and well-supervised staff. When staffing is inadequate, residents may develop serious and avoidable medical problems, including malnutrition, dehydration, and pressure sores. Inadequate staffing in nursing homes is a continuing problem and one that is the basis for many of the complaints ombudsmen receive. When the Centers for Medicare and Medicaid Services (CMS) launched its five-star rating system for nursing homes, Georgia's nursing homes compared unfavorably to other states in the area of staffing.
Recommendations:
I Georgia and federal laws should require and state and federal budgets should support adequate direct care staff to meet residents' needs.

examiners typically receive no report of the death, and are therefore unable to determine whether an investigation is warranted.
Recommendations:
I The United States Congress should pass the Elder Justice Act which would create federal government leadership on elder abuse response and prevention.
I 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.
I Ombudsmen should collaborate with those in the criminal justice system to help raise their awareness of long-term care issues.
I The General Assembly should pass legislation providing coroners and medical examiners notification of and authority to investigate deaths where the decedent was receiving long-term care in any setting immediately prior to the death.

I Facilities should develop innovative practices to improve staffing levels and staff retention and share the best practices with other facilities.
Improve the criminal justice system's responsiveness to elder abuse
Problem:
Law enforcement and prosecutors are becoming increasingly aware of problems of elder abuse in their communities including in long-term care facilities but this awareness needs to grow. Too often elder abuse is treated as only a regulatory or a social service concern, rather than as a criminal matter. Where a death occurs in a nursing home or hospital, coroners and medical

Improve mental health services for nursing home residents
Problem:
With state-run psychiatric facilities downsizing and insufficient resources in the mental health system, too often individuals with mental illness reside in nursing homes because there are no other available or affordable options. While some individuals' needs are met in the nursing home setting, others need placements that can provide more intensive treatment and services. Despite the existence of the PASRR (Preadmission Screening and Resident Review) system to identify and meet these needs, residents with mental illness continue to have critical needs that are not being met.

Recommendations:

Read recommendations to improve long-term care nationally at the NCCNHR website (go to http://nccnhr.org), the "consumer voice for quality long-term care."

I The Georgia Department of Human Resources, through its Division of Mental Health, Developmental Disabilities, and Addictive Diseases, and the General Assembly should increase resources to support individuals with serious mental illness.

27

R E C O M M E N D AT I O N S

I Nursing facilities should improve their assessment of the mental health needs of residents and, together with the PASRR provider, provide appropriate treatment.
I We support the creation of the Disability Ombudsman to assist consumers of mental health, developmental disabilities, and addictive diseases services.
Improve complaint investigations in long-term care facilities
Problem:
While nursing homes have access to an informal dispute resolution process and all long-term care facilities have an appeals process to protest citations, there is not a similar process for complainants. Sometimes complainants want an opportunity to submit additional information to the Office of Regulatory Services or to request a review of an investigation.
Recommendation:
I Complainants should have an opportunity to seek review of a complaint investigation if they are dissatisfied with an Office of Regulatory Services complaint investigation.
Find ways to meet the needs of "unbefriended" elders and persons
with disabilities
Problem:
When residents of Georgia are unable to make their own decisions and are without family or a friend available to serve as a decision-maker, they frequently lack access to needed services. While guardianship should be avoided whenever possible since it removes many of the rights of the ward there are times when a guardian is necessary to protect against financial exploitation or to consent to medical treatment.

When cognitively impaired individuals have no one to make decisions, they may go without needed medications, critically important surgery, or other treatment, which can endanger their health and well-being.
Recommendations:
I Georgia needs a system of public guardians to serve as "guardians of last resort" for needy residents of long-term care facilities as well as for other "unbefriended" elders and adults with disabilities. Although the 2005 General Assembly authorized the initiation of such a system, the related funds were eliminated in 2008.
I Wherever possible and appropriate, alternatives to guardianship including financial and health care powers of attorney and other advance directives should be encouraged by ombudsmen, elder law attorneys, and other aging advocates.
Make appropriate wheelchairs available to nursing home residents
Problem:
Georgia residents of nursing homes who are Medicaid recipients are not able to access medically-necessary, customized wheelchairs. As a result, many of these residents are not able to participate fully in the community. Others suffer health consequences by being provided with ill-fitting wheelchairs, not designed for the individual's needs. Nursing homes argue that such equipment is too expensive to be covered under their Medicaid payments.
Recommendation:
I The Department of Community Health should change its policy that prohibits nursing home residents, but not other Medicaid recipients, from receiving Medicaid coverage for customized wheelchairs.
Learn about home- and community-based services through the Georgia Division of Aging Services (go to www.aging.dhr.georgia.gov or call 1-866-55Aging / 404-657-5258).

28

Ombudsmen Help Residents Get Needed Services
Mr. Wang was brought to the dining room, seated at a table, and his lunch tray placed in front of him. He had a good appetite that day, but he wasn't able to eat his lunch without assistance, so he waited for someone to come help him. Meanwhile, he saw that the ombudsman was in the dining room, and he overheard her ask an aide why Mr. Wang wasn't getting help with lunch. The aide, who was helping another resident with lunch, responded, "Mr. Wang can feed himself. He's just being lazy." A few minutes later, another aide came and took away Mr. Wang's food without asking him if he wanted any of it.
The ombudsman described what she had observed to the Director of Nursing who informed the ombudsman that Mr. Wang does need assistance with dining. The nurse immediately addressed the problem with staff and later trained all staff on the importance of good nutrition and treating the residents with dignity and respect. Now, when the ombudsman visits, she observes that Mr. Wang continues to receive the assistance he needs during meal time. I

Ombudsmen Advocate for Residents' Rights

Mrs. Simpson's daughter was puzzled. Mrs. Simpson had only been in the nursing home for 17 days and the facility was already telling her she needed to find another placement. Her Medicare benefit was going to expire and the facility couldn't arrange transportation to the dialysis clinic, according to facility staff. So the daughter called the ombudsman to help her understand Mrs. Simpson's rights.
The ombudsman visited Mrs. Simpson who stated that she did not want to move to a different facility. Then the ombudsman explained that Mrs. Simpson had a right to stay in the facility until her Medicare benefit was exhausted and then she had a right to stay as long as she would pay privately or apply for Medicaid benefits. She also had a right to continue to access dialysis treatments. So Mrs. Simpson's family told the facility they planned to have Mrs. Simpson stay in the facility of her choosing and exercise her right to see if she qualified for Medicaid benefits. Today Mrs. Simpson continues to live in this facility and to access the treatments she needs. I

2 Peachtree Street, NW
8th Floor (Office Location) 9th Floor (Mailing Address) Atlanta, Georgia 30303-3142
(888) 454-LTCO (5826) TTY (404) 657-1929
www.georgiaombudsman.org