Welcome to Pennsylvania’s State Long-Term Care Ombudsman Training Standardized Orientation

1. Welcome to Pennsylvania’s State Long-Term Care Ombudsman Training • Standardized Orientation

2. Welcome • We welcome you to the Pennsylvania State Long-Term Care Ombudsman team. • You are joining a unique and dedicated group of individuals comprised of over 500 staff, sub-contractors, volunteers, and over 2,000 trained residents through the Pennsylvania Empowered Expert Residents (PEER) Program.

3. Today’s Agenda History of Ombudsman Program PA State Long-Term Care Ombudsman Office Expectations of Local Ombudsmen Elements of the Ombudsman Program Ombudsman Roles PEER Program Types of Facilities & Services Ombudsman Serve Resident Rights Resources

4. Our Vision . . . “Advocate for those who can’t, support those who can, and ensure all long-term care consumers live with dignity and respect.”

5. The Starfish Story Why is the Starfish Story so important to us? It’s all about “Making a Difference.”

6. History of Ombudsman Program Older Americans Act of 1965 established the Ombudsman Program – Swedish term meaning “citizen representative” • In 1978, the law mandated that every state have an Ombudsman program for nursing home complaints • In 1981, the law expanded the program to encompass personal care homes, assisted living residences, and domiciliary care homes • In 1987, the creation of State Long-Term Care Ombudsman Office and training requirements for ombudsmen prior to investigating complaints • In 1992, required that residents have regular and timely access to ombudsman For more information, visit the National Ombudsman Resource Center at https://sites.google.com/site/historyandroleofltcop/home-1

7. National Level The U.S. Administration on Aging (AoA) is the federal agency responsible for oversight of all Ombudsman programs across the country. For more information visit the AoA website at www.aoa.gov. In 2011, national statistics on Ombudsman programs reported – • 1,186 paid program staff and 9,065 volunteers, certified to resolve complaints • 289,668 consultations to individuals • 134,775 new cases • 204,044 complaints, with top complaints regarding discharge, respect/poor staff attitudes, food, medications, & resident conflict

8. State Level PA State Long-Term Care Ombudsman program is federally funded via Title VII under the OAA, and the Pennsylvania Lottery provides state funding. The Office of the State Long-Term Care Ombudsman (State Office) is located at the PA Department of Aging and is comprised of – • State Long-Term Care Ombudsman • Division Chief • Specialists • Regional Ombudsmen (4 regions)

9. State Level Requirements The State Office is responsible for statewide operations of the program in partnership with the 52 Area Agencies on Aging covering all 67 counties in the commonwealth. This includes – Implementation of policies/procedures to meet federal standards Certify local ombudsmen (tier-based system) Develop training curricula and conduct trainings to certify local ombudsmen via a tier-based system: Standardized Orientation (pre-requisite), Tier I (Basic), Tier II (Advanced), and Tenured Track Conduct quality performance via monitoring of local programs, and provide technical assistance to local agencies Access to the OmbudsManager, the statewide reporting system to capture local activities Publish federal and state annual reports to meet reporting requirements Organize and provide an annual conference for ombudsmen enrichment purposes and quarterly regional network meetings

10. Local Level Requirements Include, but are not limited to – • Receive, investigate, and resolve complaints • Maintain complaint and case data to meet reporting requirements and report to State Office • Provide information and education about ombudsman program and rights of consumers • Visit each licensed facility • Support resident and family councils • Ensure confidentiality of all information • Collaborate with licensing agencies • Recruit and maintain a volunteer complement

11. Local Level How many volunteers and staff serve in this county? How valuable is a new ombudsman to the State Long-Term Care Ombudsman program? What additional training opportunities are available to ombudsmen? Who will be the local coordinator/supervisor? How often does the local ombudsman team meet?

12. Local Level Job description Time commitment (volunteers) Facility assignment Confidentiality Paperwork / documentation

13. Local Level Volunteers and Staff Increase timeliness Expand skills and expertise Increase personalization of service Create pro-active vs. reactive approach

14. Scope and Limitations of Ombudsman You will become a representative of the State Long-Term Care Ombudsman Office. As a certified ombudsman, you will have access to facilities and the consumers who live there. Only consumers can deny you access. You will not be a care provider. You will not be a regulator/inspector. You will not be an undercover agent. You will not be the expert on capacity – that is a medical/legal finding.

15. Conflict of Interest Professional / Employment Family / Resident Emotional / Trigger Issue Financial Interest Program Conflicts

16. Confidentiality Confidentiality Statement Conduct all conversations with residents in private Safeguarding of all records, which include volunteer reports Avoid gossip Re-direct questions Respect the resident’s wishes to share or not information relayed to the ombudsman

17. Code of Ethics Respect for human dignity Self-determination and self-resolution Respect Safeguard Maintain competence in relevant areas Protection from abuse, neglect, exploitation and abandonment

18. Elements of the Program Client-Directed Legally-Based Highly Visible Access to facilities, residents, records Impartial Non-partisan

19. Consumer = Resident The resident directs all activities of the ombudsman. Ensure that you always knock before entering a resident’s room. It is important the resident directs the activities performed during visits. If the resident says “no,” no further action is required by the ombudsman.

20. Quality of Life Quality of Life is defined differently for each individual. The goal is to strive for those individual differences, and the challenge is how that is done in a long-term care setting. As ombudsmen, it is important we respect each individual’s right to quality of life.

21. Ombudsman Roles Visible Presence Enabler Educator Facilitator Mediator Negotiator Advocate Broker Catalyst Complainant

22. Self-Advocacy Ombudsmen have a responsibility to empower individuals to self-advocate. Since residents are living in these long-term care setting (homes) 24/7, as ombudsman we need to empower residents to also self-advocate. “Ten Steps to Being an Effective Self-Advocate”

23. What is Pennsylvania’s Empowered Expert Residents (PEER)? In 2002, a group of residents were interested in enhancing their advocacy skills. • PEERs advocate for themselves and other fellow residents in their homes. The State Office together with PEERs developed a 10-hour training curriculum for residents living in long-term care settings. Volunteer ombudsmen play a pivotal role in the success of the PEER program.

24. Where would you find ombudsmen? Nursing Homes Personal Care Homes Assisted Living Homes Domiciliary Care Homes Older Adult Daily Living Centers / LIFE Assisting consumers receiving Home and Community-Based Services

25. Nursing Homes Department of Health (DOH) regulates and inspects nursing homes in PA. Types of Nursing Homes A person entering a nursing home must be deemed appropriate for that level of care. Some residents may qualify for financial assistance (medical assistance).

26. Personal Care Homes (PCH) Department of Public Welfare regulates and inspects PCHs in PA. PCHs are responsible for pre-admission screening to deem whether the level of care is appropriate. Residents requiring SSI supplemental payments are screened by the Area Agencies on Aging. Majority of residents in PCHs are private pay.

27. Assisted Living Residences (ALR) Implemented in January 2011 ALRs are different from PCHs in three ways. • Concept – ALRs allow residents to “age in place.” • Construction – ALRs have private living units with kitchen capacity, locked doors, and private bathrooms. • Level of Care – ALR residents are able to continue to live in ALR when they reach a nursing home level of care. Department of Public Welfare regulates and inspects ALRs in PA. ALRs are only private pay.

28. Domiciliary Care Homes (Dom Care) Dom Care homes are small home-like placements for consumers who – • Need 24-hour supervision • Need assistance with activities of daily living • Do not require a nursing home Department of Aging regulates Dom Care in PA. AAAs handle application, review, certification, and ongoing monitoring of quality of care in Dom Care homes.

29. Other Settings Home and Community-Based Settings Older Adult Daily Living Centers Living Independence for the Elderly (LIFE)

30. Understanding Resident Rights Resident Rights are outlined in regulations. • Nursing Homes – PA Department of Health regulations (28 PA Code § 201.29) and Federal Nursing Home Reform Law (42 C.F.R.) • Personal Care Homes – PA Department of Public Welfare regulations (55 PA Code § 2600.42) The State Office provides posters that are visible in all types of facilities, which include contact information for the local Ombudsman, and also “Know Your Rights” brochures. Scenarios to consider...

31. Abuse in Facilities Act 79 provides for Older Adult Protective Services. Each AAA has a Protective Services unit, which is responsible for receiving reports of abuse. Abuse is defined as abuse, neglect, financial exploitation, and abandonment. What is Imminent Risk? What to do if you witness – • No food in the facility • Batteries removed from smoke detectors • An incident of abuse Statewide Elder Abuse Hotline 1-800-490-8505.

32. Resources – Advocacy Partners Pennsylvania Department of Aging (PDA), www.aging.state.pa.us National Long-Term Care Ombudsman Resource Center (NORC), www.ltcombudsman.org The National Consumer Voice for Quality Long-Term Care (“The Consumer Voice”), www.theconsumervoice.org National Association of State Long-Term Care Ombudsman Programs (NASOP), www.nasop.org National Association of Local Long-Term Care Ombudsmen (NALLTCO), www.nalltco.org

33. Next Steps Schedule a facility visit with a certified ombudsman Attend Tier I (Basic) training Identify a certified ombudsman to be a mentor Any questions?

34. Thank You Welcome to the Pennsylvania Ombudsman Team! Office of the State Long-Term Care Ombudsman Pennsylvania Department of Aging 555 Walnut Street, 5th floor Harrisburg, PA 17101 (717) 783-8975 www.aging.state.pa.us