Long Term Care Division

1
Long Term Care Division
Alabama Medicaid Agency Long Term Care Division
Outreach and Education Unit
February 2004
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P R E S E N T SAn Overview of

• The Long Term Care (LTC)
• Ombudsman Program

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What is an Ombudsman?

• A Swedish word, Ombudsman (pronounced
  om-budz-man) is a specially trained advocate who
  is given authority under federal and state law to
  investigate and resolve complaints made by, or on
  behalf of, long term care consumers.

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Activities Performed by the LTC Ombudsman

• Investigate and resolve complaints of poor
  patient care
  
• Investigate complaints referred by the Medicaid
  Program regarding quality of care or issues about
  a facilitys structure
  

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Activities Performed by the LTC
Ombudsman..continued

• Provide direct
• client advocacy
• Make quarterly client visitation to each
  facility
  

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Activities Performed by the LTC
Ombudsman..continued

• Make presentations to nursing facility residents
  and staff
  
• Guide clients/families through the long term care
  system
  

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Activities Performed by the LTC
Ombudsman..continued

• Represent clients interest before state
  government officials by working to change laws,
  regulations and policies that affect those
  receiving long term care services and
• Report to the administering and operating
  agencies all cases under investigation that
  involve Medicaid residents or Medicaid
  facilities.

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Administering State Agency

• The Alabama Medicaid Agency has administrative
  authority over the Ombudsman Program.

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Operating State Agency

• The Alabama Department of Senior Services (ADSS)
  has the responsibility of operating the
  day-to-day activities of the LTC Ombudsman
  Program.

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When did the LTC Ombudsman program establish
collaboration began with the Alabama Medicaid
Agency?

• The LTC Ombudsman Program started on August 1,
  2002.

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Target Population

• Individuals residing in
• Nursing Homes
• Institutions for Mental Disease (IMD)
• Intermediate Care Facilities for the Mentally
  Retarded (ICF/MR)
  
• Specialty Care Assisted Living Facilities
  (SCALF)
  
• Other long term care facilities where Medicaid
  funding is approved.

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State Ombudsman

• There is one State Ombudsman located at ADSS
• There are currently 13 Lead Ombudsman in 13 Area
  Agencies on Aging.
  
• There are 57 certified Ombudsman in the State of
  Alabama.

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Who can ask for assistance?

• Any person interested in improving the quality of
  care for consumers
  
• A resident of a long term care facility
• A friend or relative of a resident or
• Representatives of public agencies and community
  groups.

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Residents Have the Right to Express their
Complaints...

• State Regulations for long term care facilities
  indicate that individuals may voice their
  grievances to anyone outside of the facility.
  
• All communication is confidential.

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What is the cost to receive Ombudsman services?

• All LTC Ombudsman services are free of charge.

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Additional Information

• If you have further questions regarding Alabama
  Medicaid Agency, Long Term Care Programs, please
  contact
  
• Wanda Davis, Assistant Director, Long Term Care
  Division, 334-242-5018, wdavis_at_medicaid.state.al.u
  s