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RELOCATING NURSING HOME RESIDENTS in CLOSURES

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Title: 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
  • (262) 654-4952 (phone) (262) 654-6194 (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
  • (262) 654-4952 (800) 815-0015
  • Thomas.Laduke_at_wisconsin.gov
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