This Years Theme is: Better Staffing the Key to Better Care

Transcription

1 The District of Columbia Long-Ter m Care Ombudsman Program Fall 2014 O MBUDSMAN OUTLOOK I N S I D E T H I S I S S U E : Director s Message 2 Residents Right 3 Volunteer Spotlight 3 Discharge Process 4 News and Updates 5 Nursing Home Staffing 6 LONG-TERM CARE RESOURCES D.C. Long-Term Care Ombudsman Program caregiving/articles/ lce_longtermcare.html National Long-Term Care Resource Center The National Consumer Voice for Quality Long- Term Care: NCCNHR The Legal Counsel for the Elderly AARP District of Columbia O C TOBER IS R E SIDENTS RIGHTS MONTH Residents Rights Month is meant to honor residents living in long-term care facilities, including nursing homes, sub acute units, assisted living, board and care and retirement communities. A The celebration dates back to the 1980s when U.S. Congress declared Residents Rights Week through a Congressional resolution. In 2011, it expanded to a month. The Nursing Home Reform Law (1987) sought to improve quality of life, care and the general rights of nursing home residents. The battle and commitment continues. The 1987 law has led to significant initiatives to reform and improve public consumer awareness about what to look for and what to avoid in choosing a nursing home. This month also honors the groups and individuals that fight for the rights of nursing home residents and their families. This includes the staffers, ombudsmen, and oversight agencies. This Years Theme is: Better Staffing the Key to Better Care

2 MESSAGE FROM THE DIRECTOR Ombudsman Outlook Dear Residents, Families and Friends, It gives me great pleasure to introduce this to you: Office of the District of Columbia Long-Term Care Ombudsman Newsletter, the showcase of the program s newest interesting stories. Since 1985, Legal Counsel for the Elderly, DC Long-Term Care Ombudsman Program (DCLTCOP), has committed to advocating on behalf of residents receiving long-term services and supports (LTSS) in District nursing homes, assisted living facilities and community residence facilities. In October 2012 the program expanded its scope of advocacy services to include residents receiving LTSS through the DC Medicaid Elderly and Persons with Physical Disabilities (EPD) Waiver. The DC Long-Term Care Ombudsman Program is required by federal statue to investigate and resolve complaints, monitor the development and implementation of regulations, laws, and policies affecting nursing home residents, ensure residents rights protection. The program advocates for and promotes the highest quality of care and quality of life for the residents served throughout the District of Columbia. These activities and many more are successfully accomplished by a staff of 11 and a core group of volunteers. We hope to make this DCLTCOP newsletter informative, empowering and fun. We are honored to have one of our volunteer ombudsman as producer of this newsletter. We hope you enjoy reading this newsletter and stay connected with us. Sincerely, Lynne Person DCLTCOP Staff Lynne Person D.C. Ombudsman Lydia Williams Board and Care Ombudsman Mary Ann B. Parker, Esq. Attorney Genesis Cachedon Volunteer Specialist Anthony Kahaly Nursing Home Ombudsman Kamaria J. Sinclair Nursing Home Ombudsman Walter Williams HCBS Ombudsman Specialist Sheila Pannell HCBS Ombudsman Becky Hazlett HCBS Ombudsman Carmelita Turner Senior Secretary Keisha Davis Ombudsman Associate Ombudsman Outlook is published quarterly by: The District of Columbia Long-Term Care Ombudsman Program 601 E St., NW, Washington, DC The District of Columbia Long-Term Care Ombudsman Program What do long-term care ombudsman do? Long-term care ombudsman help residents of long-term care facilities understand their rights, voice their concerns, find solutions to problems, and obtain legal services. 2 Ombudsman Outlook FYI When was the Ombudsman Program Established? The 1978 amendments to the federal Older Americans Act required each state and the District of Columbia to establish a state level Long Term Care Ombudsman Program Who Does the D.C. Long-Term Care Ombudsman Program Serve? The D.C. Long-Term Care Ombudsman Program Serves people who reside in nursing homes, assisted living residences, and board and care homes.

3 Ombudsman Outlook Page 3 RESIDENTS RIGHTS An Overview D.C. nursing home residents have the following rights under federal law: Right to be fully informed: Of available services and charges; facility regulations, written copy of rights and information in a language they understand Right to Complain: Present grievances to staff, ombudsmen, or regulation/law enforcement officials Right to Participate in One s Own Care: Notification of all changes in medical condition and treatment; Refusal of chemical or physical restraints; Review one s own medical record; Participant in one s treatment plan. Right to Privacy and Confidentiality Right to a valid Discharge, Transfer, or Relocation: Receive a 30 day notice, a discharge plan, request legal assistance and appeal or challenge Right to Dignity, Respect and Freedom: KNOW YOUR RIGHTS Free of abuse and guaranteed security of possessions Right to Make Independent Choices: Choose one s own physician, participate in community activities and a Resident Counsel, manage own financial affairs. Help? Questions? VOLUNTEER SPOTLIGHT Saundra Brown-Asante A big welcome to one of our new volunteer ombudsmen Saundra Brown-Asante. She attended June 2014 orientation class. Reportedly Legal Counsel for the Elderly s largest volunteer Ombudsman orientation to date. The class successfully produced a wide and diverse group of volunteers to join our dedicated volunteer Ombudsmen program. A plus for us is that Saundra is willing to take on the task of coordinating our newsletter the Ombudsman Outlook. She brings experience as a writer of magazine articles and news bulletins as part of her many years as employee wellness manager for a local county government. She is currently Nurse Manager for a small health education and regulatory compliance company. So, she is still writing and editing frequently. Saundra is a native Washingtonian with a long time love for the city and its people. She was a long term caregiver for her mother who had Alzheimer s disease. Her interest in the level of care available for the elderly increased when she had to place her mother in an assisted living facility. You may see her at facilities and outreach events interviewing fellow volunteer ombudsmen, staff, and other contributors interested in the care of elderly citizens in Washington, DC. Special Thanks: The D.C. Long-Term Care Ombudsman Program would like to thank its corps of volunteers and staff for their advocacy. Your efforts help us fulfill our mission.

4 Discharge Process from Nursing Homes though the D.C. Medicaid Elderly and Persons with Physical Disabilities (EPD) Waiver Program 1. To secure EPD WAIVER BENEFITS, the initial point of contact is the Aging and Disability Resource Center (ADRC): The intake specialist will provide contact information about home health agencies (HHA) that provide Case Management services. The main intake (ADRC) number to call for Elderly and Persons with Disabilities (EPD). Enrollment is Resident will select an agency for case management services and send it back to the ADRC. The ADRC will contact the Case Management Agency and confirm acceptance. (This should be done within 48 hours). 3. The Case Manager will travel to the nursing home (NH) to do a Level of Care (LOC) assessment. If resident meets the LOC requirement, the Case Manager will send documentation to Qualis to approve or deny. (This should be sent within three days). 4. Qualis reviews LOC and will either confirm or deny approval for services. If Qualis confirms LOC they will issue a prior authorization (PA) for EPD Waiver services (example PERS). NOTE: This approval does NOT include PESONAL CARE AIDE (PCA) services. (which will be evaluated at a later time in this process). 5. If Qualis approves LOC, the documentation is sent to the Economic Security Administration (ESA) to review for financial eligibility (This can take up to 45 days). 6. If financial eligibility requirements are approved by ESA, a doctor s (Primary Care Physician-PCP) prescription will be required to accompany a request for an assessment (from Delmarva) for PERSONAL CARE AIDE (PCA) services. (Delmarva is supposed to come out within 72 hours). SPECIAL NOTE: This assessment for PCA services is in effect for ONLY 14 days. 7. DELMARVA then issues a prior authorization (PA) to inform the Case Management Agency and the Home Health Agency TO BEGIN SERVICES. Discharge Process from Nursing Home via Medicaid State Plan: 1. Qualis does LOC 2. Delmarva does assessment Ask Attorney Mary Ann Parker. Esq.: What are the ABC s of Nursing Home Residents Rights regarding Discharge, Transfer, and Relocation? General Overview: A resident admitted into a nursing home has rights regarding any type of discharge or transfer from the facility or relocation within the facility. All residents are entitled to counseling and assistance prior to a discharge and a discharge plan needs to be implemented. Involuntary Discharges: This type of discharge occurs when the facility initiates the resident s discharge from the facility. A discharge means that the resident leaves permanently and thus must have an appropriate location of his choice. A resident cannot be discharged to a hospital. Once initiated certain requirements must be met and followed: A- Advance written and oral notice must be given to resident and resident s representative and written notice must be sent to regulatory agency and to the Ombudsman Program. B-The Discharge must be based on the following grounds-1) Change of level of care, 2) Safeguard resident or more residents from injury; 3) Nonpayment; 4) Meet administrative needs/no practicable alternative is available; and 5) Facility is closing. C-Notice must contain at a minimum the following: specific reasons, date of discharge, transfer and/or relocation, location, statements about appealing, hearing request form with postage paid envelope preaddressed, names, address and phone number of person supervising discharge, names, addresses and telephone numbers of Ombudsman program and local legal service organizations -copies need to be in file. 4 Ombudsman Outlook

5 Ombudsman Outlook Page 5 Long-Term Care Setting Updates and News N U R S I N G HOMES W A S H I N G T O N N U R S I N G F A C I L I T Y L O C A T E D AT THS T S E IS N O W T R A N S I T I O N S H E A L T H C A R E C A P I T O L C ITY U N D E R N E W M A N A G E M E N T. T HE M E T H O D I S T H O M E 0 F C O N N E C T I C U T A VE N W IS N O W F O R E S T H ILLS OF D C. F OR F U R T H E R I N F O R M A T I O N P L E A S E C O N T A C T T H E A D M I N I S T R A T O R S F O R T H E S E N U R S I N G H O M E S. Assisted Living Residences Residents Rights Corner You have the right to: Not be coerced into making a decision File a complaint without fear of retaliation and have that complaint acknowledged Have access to both an internal and external grievance review process Address grievances with the ombudsman Designate someone to represent you in a dispute Have any instance of abuse, neglect, or exploitation reported Home and Community-Based Services Program (HCBS) In 2012, The D.C. Long-Term Care Ombudsman Program (DCLTCOP) expanded its advocacy services to include residents living in private residences in the community receiving long-term care services through the D.C. Medicaid Elderly and Person with Physical Disabilities (EPD) Waiver Program. Home and Community-Bases Services Ombudsmen serve as advocates for residents living in their homes in the community, protect residents rights and promote the highest possible quality of care. If you or someone you know is receiving long-term services and supports needs help contact the D.C. Long-Term Care Ombudsman Program at or DCOmbuds@aarp.org.

6 NURSING HOME STAFFING CAMPAIGN The Consumer Voice Nursing Home Staffing Public Awareness Campaign was launched on June 24, 2014 with a virtual kickoff held by webinar/teleconference. The short-term goal of the campaign is to educate residents, families, and the public, along with members of congress, about increased staffing in nursing homes, with a long-term goal of requiring that residents receive at least 4.1 hours of nursing care (care from certified nursing assistants, licensed practical nurses and registered nurses) every day. Currently, federal regulations only require nursing homes to provide sufficient nursing staff to meet residents needs. Research has established that higher levels of staffing are associated with better care. Speakers at the kickoff included Sarah Greene Burger, former Consumer Voice (formerly NCCNHR) Executive Director and currently the Coordinator of the Coalition of Geriatric Nursing Organization, who discussed the history of staffing policy and Consumer Voice/NCCNHR advocacy; Brain Capshaw, chair of the Consumer Voice Leadership Council and Executive Board Member of the Statewide Coalition of Presidents of Resident Councils in Connecticut, who described the impact of short staffing on residents; and Karen Guice, Lead Long-Term Care Ombudsman with the Jefferson County Council on Aging in Alabama, who spoke compellingly about the importance of the Campaign and the need for everyone to get involved. In conjunction with the kick off, the Consumer Voice released a new staffing webpage and a Nursing Home Staffing Campaign Toolkit that contains fact sheets, an issue brief, talking points, a ready to go Power Point presentation, and more. To access the toolkit, click here. Consumer Voice asks all residents, advocates, caregivers and LTC professionals to take action and join the campaign. Since technical problems with the webinar prevented some people from hearing speakers, it will be held again in the near future. Details will be announced soon. Exert; Consumer Voice The Gazette June 26, 2014 For free confidential help: Long Term Care Ombudsmen listen to concerns about issues such as: abuse, neglect, discrimination, retaliation, restraint use, residents' rights and appeals, and work with facility staff members and resident to resolve them. Call the D.C. Long-Term Care Ombudsman Program at: (202) , TDD: (202) , or DCOmbuds@aarp.org. Legal Counsel for the Elderly, an AARP affiliate, operates the state Long-Term Care Ombudsman Program with the support of the District of Columbia Office on Aging, as part of the Senior Services Network.