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September 26, 2023

Long-Term Care Ombudsmen Are Needed More Than Ever

Angela St. Julien, MDR, CPG, LTCO

A Wake-Up Call

A few months ago, while going about my day of running errands between work, it occurred to me that for the first time in almost 3 years I was feeling the wind on my face again. As odd as that sounds, I am sure there are some who know what I mean. Because of the chronic illness I live with, I was one of the people who kept a face mask on for what felt like an eternity. I did this to keep myself safe from covid and to protect the residents of the long-term care facilities I volunteer in. The wonderful feeling of that cool breeze across my face was a wake-up call. I was suddenly aware of the many everyday activities I took for granted.

In the United States millions of residents aged 65 and over are currently live in a long-term care facility. Some are still thriving and able to go out with family and friends or take a shuttle to shop or visit their physician’s office. Others have not left their rooms or the facility halls for years. They have not seen friends or family and they certainly have not been shopping. These are everyday activities for most of us and rarely do we have occasion to question if a time would come when we would not be able to do this. Well… until recently. During the pandemic, we all felt the sting of social isolation and limited activities.

For a lot of us, isolation and limited activities are behind us. We are out feeling the wind on our faces again. For others isolation is a daily reality and unfortunately limited activities mean something else entirely. In the long-term care environment, a resident’s limited activity can extend to not being able to feed themselves, take care of their toileting needs, or even move without assistance. These residents depend on the skills and experience of the facility’s staff. What do they do when the facility has a staffing shortage?

Staffing Issues in Long-term Care Facilities

Across the country staffing shortages in nursing facilities are at an all-time high, resulting in a decline in the quality of care and the safety of the residents they are meant to serve. Facilities with staffing shortages or high turnover receive far more complaints of abuse and neglect and place further strain on regulatory agencies with the need to investigate. The current standard allows facility owner/operators to staff based solely on what they consider to be “sufficient.”

The use of the word “sufficient,” subjective language, is an inappropriate and negligent way to draft guidance for the care of a population heavily dependent on the altruism of those operating and working in these facilities. According to Centers for Medicare & Medicaid Services (CMS) studies, each resident requires the combined services of registered nurses, licensed practical or vocational nurses, and certified nursing assistants for approximately 4.1 hours per resident day at the minimum. The operative word there is “minimum.” The wait for an established set of minimum staffing standards has been years coming, and the current administration is still attempting to produce them despite its success in other initiatives for our aging community.

Accountability in Facility Ownership and Finances

The nursing home and long-term care industry can be rife with mismanagement primarily due to the fact they are majority privately owned and easily leveraged for the financial gain of individuals and private equity firms. The industry has grown significantly in recent decades due to population growth and increased life expectancy. Regulatory agencies and advocacy groups have been unable to keep up. As a result, many unsavory practices like abuse, neglect, and exploitation go unchecked, and unsafe living conditions and financial malfeasance go unreported or undetected.

Despite the fact that a facility can be privately owned and operated, billions of taxpayer dollars paid through Medicaid and Medicare programs go unaccounted for. From the state of their facilities, the shortage and turnover of their staff, and the increased mortality rates, it becomes clear that these dollars are being misappropriated. Relaxed reporting standards and oversight along with “related party” payment practices act as a veil between the owner/operators and government or public accountability. Mechanisms like minimum staffing standards, profit caps, and auditing could offer transparency and accountability, resulting in better working conditions for staff and increased quality of care for residents.

Get Involved

Long-Term Care (LTC) Ombudsmen investigate and assist in resolving issues for individual residents that directly and uniquely impact them, or they may work on issues that affect several residents or the entire facility. These issues can range from food services, room assignments, request for additional medical services or assistance with finances. Another essential function of the LTC Ombuds is their duty to educate residents on their rights, how they can get their needs met, and basic actions that can be taken to correct simple concerns. An Ombudsman can also assist families in searching for the right facility for their loved ones.

Beyond the work done inside of the facility, an LTC Ombud can also be found lobbying their local and state elected officials to address the needs and concerns of the long-term care consumers, families, and members of the community. According to the National Center for Health Statistics the number of older citizens with physical or mental disabilities are expected to grow by 150% in less than 50 years. At this pace, Long-term Care Ombudsman are sorely needed. If you have the time in your schedule and desire to serve, we need you. Consider joining your local LTC Ombuds program today. Click here for a list of programs in your state.

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