Advocates For Long Term Care Residents

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LONG TERM CARE OMBUDSMAN PROGRAM

• Advocates For Long Term Care Residents

John G. McDermott, LSW, ACSW, M.Div. State
Long Term Care Ombudsman (808)
586-7268 7/25/14
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Mahalo!

• Mahalo to the Executive Office on Aging (EOA)
  and National Association of States United for
  Aging and Disabilities (NASUAD).
• Mahalo also to Diane Kawasaki!!
• Understanding Hawaiis Long Term Care Ombudsman
  Program Preventing Elder Abuse.

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History

• Original concept go-between Sweden in 1809
• Federally mandated Older Americans Act 1965
• - 1975 pilot project
• - 1978 amendment
• - 1987 Nursing Home Reform Act (OBRA)
• State of Hawaii HRS 349- 21 to 25, part III
• - 1979 amendment
• - 2007 HB807 HD1 SD2 CD1 (May 24, 2007) - 32
  years late!!!
• - 2008 HB2289 and SB2151 Neighbor Island
  expansion
• Volunteer Representative Component
• (1999 Legislative Session)
• - Began June 1, 2001
• - 170 certified representatives
• - 19 active as of July 24, 2014

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State Ombudsman

• Robin Matsunaga
• Hawaii first state to start office
• 1967 authorizing legislation
• 1969 began operations
• Chapter 96, Hawaii Revised Statutes
• 587-0770
• www.ombudsman.hawaii.gov
• complaints_at_ombudsman.state.hi.us

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Functions (LTCO or Representatives)

• Identify, investigate, and resolve complaints
• Protect health, safety, welfare, and rights of
  residents
• Inform residents/families about obtaining
  services by providers or outside agencies
• Provide technical support to Resident and Family
  Councils

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Functions (LTCO or Representatives)

• Ensure residents have regular and timely access
  to services quarterly visits
• Represent interests of residents before
  governmental agencies
• Analyze, comment on, and monitor development
  implementation of federal, state, and local laws,
  regulations and other governmental policies and
  actions (Kupuna Caucus and PABEA Legislative
  Committee)

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Some Long Term Care Issues

• Personal Needs Allowance increase
• Transportation, Lunches, Debts
• Financial Abuse Accountability
• Federal Stimulus money social worker role
• Survey deficiency?
• Emergency Preparedness challenges
• Act 213 on-line LTC facility inspection results
• CCFFHs new role .. LTC Insurance problem
• Case Management /Exp. ARCHs/ reimbursement
• ADRC one stop shop/LTCOP www.hawaiiadrc.org

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Long Term Care Facilities

• Nursing Homes (ICF/SNF)
• Community Care Foster Family Homes (CCFFH)
• Expanded Adult Residential Care Homes
• Adult Residential Care Homes
• Assisted Living Facilities
• Group Homes/Independent Living
• Home Health Agencies

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Levels of Care (LOC)

• Acute hospital
• Skilled Nursing Home, CCFFH, Expanded ARCH or
  Going Home Plus (DHS)
• Intermediate Care Nursing Home, CCFFH, Expanded
  ARCH
• Custodial ARCH or Adult Day Care/Respite Care
• Assisted Living - combo
• Independent Group home, boarding home, senior
  home, own home

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Paying for Long Term Care

• Medicare
• Private Insurance
• Medicaid
• Long Term Care
• Insurance
• Out-of-Pocket

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Administrative Rules

• Assisted Living
• http//gen.doh.hawaii.gov/sites/har/AdmRules1/11-
  90.pdf
• Nursing Homes
• http//gen.doh.hawaii.gov/sites/har/AdmRules1/11-
  94.pdf
• Adult Residential Care Homes (includes Expanded)
• http//gen.doh.hawaii.gov/sites/har/AdmRules1/11-
  100-1.pdf
• Community Care Foster Family Homes
• http//hawaii.gov/dhs/main/har/har_current/AdminR
  ules/document_view

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• HAWAII ADMINISTRATIVE RULES
• TITLE 1
• DEPARTMENT OF HEALTH
• CHAPTER 90
• ASSISTED LIVING FACILITY
• 11-90-1 Purpose
• 11-90-2 Definitions
• 11-90-3 Licensing
• 11-90-4 Minimum building and structural
  requirements
• 11-90-5 Emergency care and disaster planning
• 11-90-6 General policies, practices and
  administration
• 11-90-7 In-service education
• 11-90-8 Range of services
• 11-90-9 Records and reports
• 11-90-10 Admission and discharge requirement
• 11-90-11 Severability

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Residents Rights in Assisted Living
Facilities (chapter 90)

• The facility shall have written policies and
  procedures
• which incorporate the assisted living principles
  of
• individuality, independence, dignity, privacy,
  choice,
• and home-like environment.
• The resident shall be informed of his or her
  rights,
• including steps for complaints and appeals upon
• Admission.
  August 12, 1999

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Residents Rights (F151)

• A Facility MUST protect and promote the rights of
  each resident!!
• Dignified existence / Home-like Environment
• Self-determination
• Communication/access
• Exercise rights as a citizen of USA
• Free from interference, coercion, discrimination
  and reprisal

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More Residents Rights

• Even if adjudicated incompetent, facility must
  respect the residents wishes to the maximum
  extent practicable (F152)
• Facility must inform residents of their rights in
  writing and orally in a language resident
  understands (F156) OLA
• Resident has right to access ALL records
  pertaining to him/herself and purchase copies
  (F153)

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Why We Need Representatives For Hawaiis Long
Term Care Residents
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Hawaiis Long Term Care Residents

• 12,129 LTC residents state-wide
• - 49 Nursing Homes (4,309 beds)
• - 502 Adult Residential Care Homes
  (ARCH), exp, type I and II (2,748 beds)
• - 13 Assisted Living (2,249 beds)
• - 1,130 Community Care Family Foster Homes
  (2,823 beds) .Total community beds 7,820
• Total 1,694 Facilities
  (7/24/14)

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Long Term Care Ombudsman
Program Staffing

• 1 State LTC Ombudsman - John G. McDermott
• 1 LTC Ombudsman Specialist Susan Miyamoto
• 1 LTC Ombudsman Volunteer Coordinator
• Ashley
  Muraoka-Mamaclay
• 1 Clerical Support (eliminated by 2005
  Legislature)
• National Institute on Medicine (1995) MINIMUM
• Staff Recommendation 1 for 2,000
  (HI12,129)

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National Statistics

• More than 2 million elderly Americans are victims
  of neglect or mistreatment every year
• According to the National Elder Abuse Incident
  Study, only 15 of all elder abuse is reported.

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Knowledge is Power

• Older Americans Act of 1965
• The National Consumers Voice for Quality LTC
  (formerly NCCNHR)
• Nursing Home Ombudsman Demonstration Pilot 1975
• Long Term Care Ombudsman Program 1978
• Omnibus Budget Reconciliation Act of 1987 (OBRA)
• a.k.a. -Nursing Home Reform Act of 1987
• www.Medicare.gov Nursing Home Compare

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Kupuna Caucus!!

• Meets monthly at State Capitol
• Movers and Shakers
• Agenda Info
• Call Senator Suzanne Chun-Oakland
• 586-6130
• Next Meeting August 1, 2014
• Room 309, 130 -330 pm

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Community Resources

• Elderly Affairs Division
• Geriatricians/Case Managers/RNs and SWs
• Department of Veterans Affairs (PNA)
• DOH OHCA
• DHS/EOA/Office of Consumer Protection
• Senior Companion Program /AARP
• Family Caregivers Network / Hospice

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Hawaii Legislators

• Are you registered to vote??
• www.capitol.hawaii.gov
• Public Access Room
• 587-0478
• par_at_capitol.hawaii.gov

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Act 213!!

• ALL long term care facility inspections will be
  on DOH website beginning July, 2015!
• Similar to Nursing Home Compare
• website on medicare.gov
• CCFFHs moving from DHS to DOH
• starting July 1, 2014.

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Do not regret growing older.  It is a privilege
denied to many.  Author Unknown