Title: RELOCATING NURSING HOME RESIDENTS in CLOSURES
1RELOCATING NURSING HOME RESIDENTS in CLOSURES
- Tom La Duke Relocation Ombudsman Specialist
- State of Wisconsin-Board on Aging and Long Term
Care - PO Box 180, Kenosha, WI 53141
- (262) 654-4952 (phone) (262) 654-6194 (fax)
- Tom.Laduke_at_wisconsin.gov
2Wisconsins Ombudsman Program
- Wisconsin statutes authorize the Ombudsman
program to - Investigate complaints concerning improper
conditions in long term care - Serve as mediator or advocate to resolve disputes
- Promote public education to improve conditions
- Monitor laws, regulations, and policies
- Publish materials and initiate legislation to
correct inadequacies
3Wisconsins Ombudsman ProgramRegional Assignments
PAUL SOKOLOWSKI
4Volunteer Ombudsmen Program
- 90 volunteers in SNFs in 3 regions of the State
and 15 in select CBRFs - Training-orientation and quarterly training
- Responsibilities-weekly visit to assigned
facility. Monthly written reports to a volunteer
coordinator that shared with the assigned
Regional Ombudsman
5Wisconsin Statistics
- 90 Nursing Home closures and/or down-sizings,
since 1999 - Since the project began in March, 2006, there
have been - 6 Nursing Home closures and
- 1 Nursing Home down-sizing which have affected
hundreds of residents whove had to relocate - 3 replacement relocations that involved the
moving of another 350 residents as well as - Numerous down-sizing and closing of ICFs-MR and
CBRFs
63 Types of Relocation Activities in which a
Nursing Home files a Plan in Wisconsin
- CLOSURE- everyone must leave
- DOWN-SIZING- some must leave
- REPLACEMENT- everyone must leave, but have a new
place for everyone to move to.
7Wisconsin State Statues require that a facility
file a RELOCATION PLAN when
- The Facility is closing, intends to close or is
changing its type or level of service or means of
reimbursement - and
- Will relocate at least 5 or 5 of the residents
- whichever is greater
8JOB DESCRIPTION
- Title Relocation Ombudsman Specialist
- Status Temporary Project Position
- (March, 2006-March, 2009)
- Funding Civil Money Penalties
- GOAL To advocate focusing on quality of Care
and - the protection of rights while
residents - relocate from closing nursing
homes
9JOB DESCRIPTION-continued
- OBJECTIVES
- Inform, educate and assist residents and their
families (develop informational materials and
present to Resident and Family Councils) - Participate in Relocation Team meetings to
represent the interests of the resident and
promote preferences for alternate placement -
- Participate in Discharge Planning Sessions as
authorized Follow up on residents after having
relocated - Monitor closing facilities (communicate concerns
about care) Provide technical assistance to staff - Identify deficiencies related to the facility
closure and resident relocations. Advocate for
changes in public policy. Advise the State
Ombudsman and Board
10WORKING with OTHER OMBUDSMEN
- Relocation Specialist
- -Sits on Relocation Team
- -Refers to Regional Ombudsman
- -Monitors conditions
- -Advises staff
- -Reports on processes
-
- Regional Ombudsman
- -Does Case work
- -Takes Complaint
- referrals
- -Assists with appeals
- -Monitors conditions
11Work with Volunteers
- Volunteer at the Closing Facility to
- Monitor general conditions
- Report concerns for conditions
- Introduce program and offer services
- Communicate developments to residents and
families - Take referrals for questions/complaints
- Volunteers at the Receiving Facility to
- Follow up on residents that relocate from a
closing facility - Introduce program and offer services
- Report on adjustment to new facility
- Take referrals for questions/complaints
12INFORMATION and ASSISTANCE to RESIDENTS and
their FAMILIES
- Touring and introducing the Ombudsman Program to
Residents - Participating at Resident and Family
Informational Sessions - Setting up and maintaining a Resource Room.
- Providing written information on residential
options and services, funding, directories of
nearby facilities and contact lists for agencies
and programs. Brochures on the Ombudsman
program, resident rights and recommendations for
discharge planning - Presenting to the Resident and Family Councils
- More Touring and meeting to maintain contact with
residents
13EDUCATION to FACILITIES
- Reviewing elements of their Relocation Plan
- Reviewing a Roster of Residents to identify
potential obstacles for relocation (clarifying
legal status, diagnoses, special needs.) - Recognizing and addressing Transfer Trauma
- Providing Discharge Planning and Orientation
- Working with the Relocation Team and
understanding Processes (screening for funding,
etc.) - Understanding Ombudsmens and other agencies
roles
14RELOCATION TEAM
- Wisconsin Statutes assign responsibility the
state DHFS - Offer relocation assistance to the resident
- Prepare removal plans and transfer trauma
mitigation care plans - Assure safe and orderly removal from the facility
- Protect the residents health, safety, welfare
and rights - Wisconsin Statutes authorize the state DHFS to
- Place relocation teams in any facility for any
reason for the - purpose of implementing removal plans and
training staff of - transferring and receiving facilities in
transfer trauma mitigation.
15RELOCATION TEAM
- The DHFS Coordinator directs the activities of a
relocation team thats made up of
representatives from the - Facility (Social Worker, Director of Nursing,
- Nursing Home
Administrator) - County (Resource Centers and
- Care- Management
Organizations) - State (Relocation Coordinator)
- Advocacy (Ombudsmen and
- the Protection and
Advocacy Organization
16TRANSFER TRAUMA
- Relocation Stress Syndrome, also called Transfer
Trauma, is a formal nursing diagnosis and defined
as physiologic and/or psychosocial disturbances
as a result of transfer from one environment to
another. It is otherwise defined as the
combination of medical and psychological
reactions to abrupt physical transfer that may
increase the risk of grave illness or death.
17REDUCING TRANSFER TRAUMA
- The involvement of familiar people, the
maintaining of consistent daily patterns and
routines, and assisting the resident in becoming
acquainted with new surroundings can help
minimize stress associated with relocation. - Slow and thorough discharge planning that
provides the resident with an opportunity to tour
alternate living arrangements and, most
importantly, that asks the residents what it is
that they want can help ease the adjustment of
needing to move.
18DISCHARGE PLANNING
- F204 Orientation for transfer or discharge
-
- A facility must provide sufficient preparation
and orientation to residents to ensure safe and
orderly transfer or discharge from the facility.
19Wisconsins Transfer and Discharge Activities
- HFS 132.53(3)(b)3.
- Transfer and discharge activities shall
include - Counseling
- Opportunity to visit potential alternate
placement - Assistance with moving
- Provisions for medications and treatments
20Wisconsin Requirements for Discharge Planning
Conferences
- HFS 132.53(3)(b).
- Prior to any involuntary discharge, a planning
conference shall be held at least 14 days before
discharge to - Review the need for relocation
- Assess the effect of relocation on the resident
- Discuss alternatives placements
- Develop a relocation plan
21Post Discharge Plan of Care
- F284 When a facility anticipates discharge a
resident must have a discharge summary that
includes a post-discharge plan of care that is
developed with the participation of the resident
and his or her family, which will assist the
resident to adjust to his or her new living
environment - HFS 132.45(5) Documents, prepared upon a
residents discharge, summarizing needed
continued care and instructions
22Notice and Appeal Rights
- F203 Notice before transfer
-
- Before the facility transfers or discharges a
resident, the facility must notify the
residentof the transfer or dischargein writing
and in a language and manner they understand -
23Notice Timing and Contents
- F 203 The notice must (usually) be madeat least
30 - days before the resident is
transferred or - discharged and must include
- The reason for the transfer or discharge
-
- The effective date of the transfer or discharge
- The location to which the resident is transferred
or discharged - A statement of the right to appeal the action
- The name, address and telephone number of the
State long term care ombudsman (or the protection
and advocacy agency)
24MONITORING CARE and TREATMENT
- Staffing levels and Unmet Needs
- Food and Menus
- Activities
- Certain Regulatory Standards of Care (for choice,
notice, dignity, restraints and abuse.)
25REPORTING CONDITIONS
- To the facility
- To the Department of Health and Family Services
Relocation Coordinator - To the State Regulatory Agency
26Other Duties as Assigned
- Identify and report deficiencies in processes
- Make recommendations to the department and the
Board on Aging and Long Term Care - Assist in rewriting the States Relocation manual
27Follow Up Activities
- By the Facility
- By the County
- By the State
- By the Ombudsmen
- By the Volunteers
- By the Regional Ombudsman
- By the Relocation Specialist
28Different Problems for Different Kinds of
Relocation Activities
- CLOSURES
- DOWN-SIZING
- REPLACEMENTS
- Any/All of the ABOVE
29PROBLEMS in CLOSURES
- Stress of having to move (involuntarily.)
- Not having options or knowing they exist.
- Not being kept apprised of developments
- Moving before being ready
- Inadequate discharge orientation and planning
- Being Unaware of Notices and appeal rights
- Experiencing Subsequent relocations from closing
facilities
30Recommendations in Closures
- Keeping residents and families informed and up to
date - Explaining options and facilitating discovery
- Repeated mini discharge planning sessions
- Develop adequate discharge materials (summaries,
post discharge plans.) - Demand some kind of notice
- Follow up contacts and visits
31Problems is Down-Sizing Facilities
- Stress of possibly having to move (involuntarily)
or to lose contact with other residents
(survivors remorse) - Anger and resentment related to arbitrary
decisions being made (unfair selection for being
discharged.) - Loss of faith after being confronted with having
to go through appeal process.
32Recommendations in Down-sizings
- Encourage facilities to plan ahead and to
decrease census through attrition (to avoid
involuntary discharges.) - Educate residents and families (and facilities)
about the rights to notice and appeal - Monitor for violations of those rights and be
prepared to assist in appealing a discharge
decision.
33Problems in Replacement Relocations
- New buildings arent fully ready for occupancy
(beds unavailable, call lights/electronic systems
not operational.) - Residents/families unsure of details for the move
- Residents/families preferences arent
accommodated (for room/roommate choice) - Residents arent fully prepared (belongings not
packed or left behind.) - Staff arent oriented to the new building (cant
find equipment and supplies)
34Recommendations in Replacements
- Facilities should plan well in advance and expect
the contractors dates to be off. - The regulatory agency should ensure the building
is completely ready for occupancy well in advance
of anticipated move date (and should require beds
be made immediately available upon the residents
arrival.) Plans should be required and monitored
for implementation - Residents and families should be included in the
planning and their preferences accommodated. - They should be offered tours and periodic updates
on how the project is proceeding. - Belongings should be sent simultaneously and
promptly unpacked - Staff should be oriented to the building and have
access to all needed equipment and supplies. - Extra staff and volunteers should be on hand
before, during and after the move.
35Educational Materials
Other materials include lists of area nursing
homes, residential types, etc.
36QUESTIONS
37For more information, please call or write
- Tom La Duke Relocation Ombudsman Specialist
- State of Wisconsin-Board on Aging and Long Term
Care - P.O. Box 180, Kenosha, WI 53141
- (262) 654-4952 (800) 815-0015
- Thomas.Laduke_at_wisconsin.gov