Friday, February 14, 2020

Ombudsman: The Few, The Underqualified, No Real Authority

The organization that's supposed to oversee the safety and well being of individuals living in Long Term Care facilities is the organization known as the Ombudsman

In Missouri, a few years ago, there was a "change of name" to VOYCE.  

Created by Federal Law, like Medicare, it's administered by the States and varies from State to State how it operates, functions and what it does.

As with all these Federally mandated "answers" to the problems we've been experiencing in our "modern" society, the breadth and depth are also dependent on State as well as Federal funding, Grants and other resources.

And, as usual, this segment of "social well being" (many call it social welfare) is usually the last to be considered and the first to be cut dramatically when adjustments for other "needs" of society are made more necessary.

However, setting aside the funding, let's focus on the management and the choices made by the States in effectively applying and using the funds they have. 

As with any "business" endeavor, its top down and bottom up with clear, concise and timely transparency that facilitate and increase the high level of effectiveness of a program.

Check out your own State's website; here's an example of the Missouri website outlining the "responsibilities" of the Ombudsmen. CLICK HERE for the complete page.

Here's a small selection of the content of the page and my comments for you to think about are placed in italics:

"The focus of the Ombudsman efforts is resident-initiated complaints.  

"While complaints may be made on behalf of residents by other individuals, care is taken that such complaints accurately reflect the concerns of the resident. Complaints are received in the strictest of confidence."

Writer's Note:  Complaints are received and also never made public, at least in Missouri.  


This means you and I have no way of knowing what "challenges" any facility is experiencing and since the focus of this group is to "mediate" and there's no real power or ability to ensure compliance to resolving a problem, they're often repeated and if yet another resident doesn't see, hear and/or report the neglect or abuse, it simply continues to happen and negatively impact Senior's quality of life.

MANY CONCERNS, PROBLEMS AND ABUSES NEVER REACH THE LIGHT OF DAY BECAUSE THE "OMBUDSMAN" PROGRAM IS SET UP TO "HANDLE THEM" and that includes not ensuring any report is generated that is available to the general public.


"accurately reflect the concerns of the resident". Well, with Lewy Body Dementia or other forms of Dementia, how can you rely on the resident to even be able to remember what they called about when calls made on a weekend do not go to a Hotline but wait until Monday or even Tuesday.

How many residents of a facility even know their telephone number so they can receive a return call. If they do not have a cell phone, they have to understand the "phone system in the LTC that includes the main number and how to ensure the resident is given any messages."

Incidents happen during all hours and the office of the Ombudsman operates on standard business hours, Monday through Friday, closed on holidays and for many meetings -- at least in Missouri.

In our case, when we called on a Friday to report neglect and abuse for my dying mother, a recording announced the office was closed because everyone was attending a meeting and would reopen the following Monday.

As the message I left said, by that time my Mom would have died. 
And she had. 
Call the DHSS?  
That's a call to our State Capital area and results in creating red tape that takes from a few days to a week to form a response. 

Been there, done that. 
Slaps on the wrist were what our facility received. 
Even a recent fine of $8,000 wasn't enough to stop the neglect we still see happening and have decided a public outcry via this blog is the only real way to raise awareness.

Continuing from the written State of Missouri website above:

"Investigation/resolution is not attempted without the resident's permission unless the problem affects a number of residents and can be approached in a generic sense without breaching confidentiality. 
No problems is too big or too small for an ombudsman to deal with. Ombudsmen can often solve problems before they become serious."

My experience is the contact with the Ombudsmen comes when problems ARE SERIOUS.  
When residents and those who support them have tried, often many times, to resolve issues and hit constant brick walls all up and down the lines or "chains" of command.

Where on this site or any Ombudsman site do they define "serious"?
When someone dies or is seriously injured? 

Let's think about this.  
The clock is ticking, remember that. 
A call is made. 
Who is this person? Which facility are they living at?  
What's their name and room number?  Etc Etc.

I'VE WITNESSED THREE TIMES IN THE PAST SEVERAL MONTHS where a local Police Officer has appeared at the front desk of the facility where Mom lived.

It's the same story each time: They've received a 911 call and someone needs help. They have no name, no room number, just a call for help.

Someone knows to call 911 when they need help so they dial. 
On a facility provided phone, chances are they have to dial a 9 to get an outside line and then the 911 -- 
since these are people mostly on medications, with sight and hearing problems and who have cognitive (memory) function challenges, 
they do not have the cognitive ability to make the call!
Please tell me why the Ombudsman is segregating its services in Missouri to be directed and meant "for the resident of Long Term Care."  Many do not have the ability to make a call "outside"

ARE YOU SURE?  What if they had no way to contact the Ombudsman Office and were being neglected or abused? Or they'd tried that number and got a recording which they could barely hear or follow -- just like the creative website that's great for many but definitely not designed for the people it's meant to serve -- many with few computer skills, little or no access to a computer

THE FACILITY ALWAYS HANDLED THE "CHALLENGE" the same way. They had no idea who made the call and no way of finding out who did.

AND SO THE STORY CONTINUES. Those making the rules and regulations, those who respond from the outside world, have no real authority or ability to give real and timely assistance or ensure the person who reaches out gets the right help, at the right time, in the right way.

MAYBE, JUST MAYBE, If we realized living in a Long Term Care Facility is not a secure and caring environment no matter if they're For Profit or Not For Profit. 
Vigilence and constant contact frequently and in many ways.

Ombudsmen work within the system to make the system work for residents. By assuming the role of an independent, neutral mediator in seeking mutually satisfying solutions to grievances, Ombudsmen make a significant contribution to living conditions for residents.

"A key in this program is the word "empower." To empower is to enable or permit some action. Ombudsmen should always look for ways to empower residents to help themselves. It would be ironic if this very system, set up to ensure that residents know their rights and maintain their dignity, became part of the problem. Mediating a situation is just as important a function as is being an advocate.

Let's analyze the content of this section:

How many residents of Long Term Care Facilities,the only level in the State of Missouri the Ombudsman Office has any authority to "oversee" have both the physical and mental ability to make this connectivity happen directly?

How many have the means to connect during the limited times the Ombudsman's office is actually open?

There is no Ombudsman "Hotline" serving the Long Term Care residents whom they're supposed to protect.

In other entries, we've outlined how limited the abilities are of many of the most vulnerable of our society yet we allow this "shell" of an organization, this "mediator" between the resident and the facility, to spend millions of tax payer dollars continuing to be ineffective.

On the Missouri site, mention is made of how an Ombudsman was able to get new teeth for a resident when she was being ignored by the facility.

MEDICAID PROVIDES ONE SET OF TEETH -- no matter how old the individual is and when they "received" their pair or how bad it is.

In Mom's facility, unless you have your own phone (and if you do, you sometimes find your charger has "disappeared", especially if your someone who has "problems" with the facility, you rely on a telephone in your room and you must remember to dial a "9" before getting an outside line.