RELOCATING NURSING HOME RESIDENTS in CLOSURES

1
RELOCATING 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
• [phone] (phone) [phone] (fax)
• Tom.Laduke_at_wisconsin.gov

2
Wisconsins 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

3
Wisconsins Ombudsman ProgramRegional Assignments
PAUL SOKOLOWSKI
4
Volunteer 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

5
Wisconsin 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

6
3 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.

7
Wisconsin 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

8
JOB 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

9
JOB 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

10
WORKING 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

11
Work 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

12
INFORMATION 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

13
EDUCATION 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

14
RELOCATION 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.

15
RELOCATION 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

16
TRANSFER 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.

17
REDUCING 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.

18
DISCHARGE 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.

19
Wisconsins 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

20
Wisconsin 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

21
Post 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

22
Notice 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

23
Notice 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)

24
MONITORING CARE and TREATMENT

• Staffing levels and Unmet Needs
• Food and Menus
• Activities
• Certain Regulatory Standards of Care (for choice,
  notice, dignity, restraints and abuse.)

25
REPORTING CONDITIONS

• To the facility
• To the Department of Health and Family Services
  Relocation Coordinator
• To the State Regulatory Agency

26
Other 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

27
Follow 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

28
Different Problems for Different Kinds of
Relocation Activities

• CLOSURES
• DOWN-SIZING
• REPLACEMENTS
• Any/All of the ABOVE

29
PROBLEMS 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

30
Recommendations 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

31
Problems 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.

32
Recommendations 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.

33
Problems 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)

34
Recommendations 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.

35
Educational Materials
Other materials include lists of area nursing
homes, residential types, etc.
36
QUESTIONS

• ???

37
For 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
• [phone] [phone]
• Thomas.Laduke_at_wisconsin.gov