Florida s Long-Term Care Ombudsman Program

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2 Florida s Long-Term Care Ombudsman Program Florida s Long-Term Care Ombudsman Program is a volunteer-based seeking to improve the quality of life of vulnerable elders who live in licensed longterm care facilities, including nursing homes, assisted living facilities and adult family care homes. The program s mission is To protect the health, safety, welfare, and human and civil rights of longterm care facility residents by investigating and resolving complaints; promoting the enforcement of laws and regulations; and advising and recommending policy to state and federal governments on long-term care issues. An ombudsman is a citizen representative who advocates on behalf of others to resolve specific issues and concerns. Florida s Long-Term Care Ombudsman Program does just that for the more than 150,000 elders living in long-term care facilities. By directly responding to the concerns of residents, ombudsmen advocate for one of Florida s most treasured resources. For more than 30 years, the program has sought to improve the quality of life of Florida s elders by providing free services, from investigating complaints and aiding in the development of family councils to educating long-term care residents about their rights and performing annual assessments of Florida s longterm care facilities. The Long-Term Care Ombudsman Program was created under the Older Americans Act, which was originally passed in It was amended in 1978 and required states to create an Office of the State Ombudsman, headed by a state ombudsman. The Office of State Long-Term Care Ombudsman was enacted in Florida by Section , Florida Statutes.

3 Table of Contents Commitment to Service 2 Residents Rights 3 Program Highlights 4 Statistics 6 State Council Recommendations 8 Annual Training Conference 10 Success Stories 11 Broward County Council 14 Serving Broward County East Central Florida Council 14 Serving Brevard, Orange, Osceola and Seminole counties First Coast Council 15 Serving Baker, Clay, Duval, Nassau and St. Johns counties First Coast South Council 15 Serving Flagler and Volusia counties Mid & South Pinellas Council 16 Serving Mid and South Pinellas County North Central Florida Council 16 Serving Alachua, Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy, Putnam, Suwannee and Union counties North Dade Council 17 Serving North Miami-Dade County Northwest Florida Council 17 Serving Escambia, Okaloosa, Santa Rosa and Walton counties Palm Beach Council 18 Serving Palm Beach County Panhandle Council 18 Serving Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla and Washington counties Pasco & North Pinellas Council 19 Serving Pasco and North Pinellas counties South Central Florida Council 19 Serving Hardee, Highlands and Polk counties South Dade & the Florida Keys Council 20 Serving South Miami-Dade and Monroe counties Southwest Florida Council 20 Serving Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties Treasure Coast Council 21 Serving Indian River, Martin, Okeechobee and St. Lucie counties West Central Florida Council 21 Serving Hillsborough and Manatee counties Withlacoochee Area Council 22 Serving Citrus, Hernando, Lake, Marion and Sumter counties District Council Directory 23

4 Commitment to Service From the State Ombudsman, Brian Lee Allow me to introduce you to a team of champions here in Florida that strives to help those who often have no one else to turn to. This year, Long- Term Care Ombudsman Program s stellar lineup of volunteers accomplished the following: Traveled 283,378 miles to investigate residents concerns within their local districts (equal to more than 12 trips around the earth); Contributed more than 16,500 hours of service to residents; Served more than 45,000 long-term care facility residents; Received more than 15,000 hours of training so they were aware of changes to laws, regulations and policies impacting residents quality of life and care; and Saved the state more than $5 million through volunteer services Our volunteers carry forward a tradition of excellence in first-rate advocacy on behalf of residents. As a state that depends solely on certified volunteers to defend residents rights, it is Florida s responsibility to ensure that our team has the necessary tools, training and resources at its disposal to serve those who need us. This report represents only a snapshot of our team s motivation to wholly protect the liberties of Florida s long-term care residents. I personally look forward to building on this past year s successes as we continually evolve toward reaching our full potential as advocates for one of Florida s most vulnerable and treasured populations. From the State Council Chair, Don Hering This year has been one of expanding the ombudsmen s influence of advocacy to other entities that share the mission of caring for residents of long-term care facilities, while refining and cementing relations with the Office of State Long-Term Care Ombudsman. Searching for ways to satisfy a range of goals without compromising the core objective of advocating specifically for residents, the State Council expanded its scope and actions in several ways. Liaisons were formed with the Florida Assisted Living Affiliation, the Florida Health Care Association and area agencies on aging with the intent of establishing ongoing cooperation at the local level. Working closely with the State Ombudsman, the State Council elected to hone the relationship between each council coordinator, individual ombudsman and state representative. This was accomplished by enhancing the coordinators value to the program through field training on assessments and complaint resolution, which helped cultivate the knowledge necessary to better understand the challenges confronting ombudsmen on a daily basis. To ensure continuity in training and advocacy across the state, the council embarked on moving the quarterly meetings from one location to four geographically dispersed locations. By geographically placing the meetings in the heavily populated areas, opportunities were afforded to ombudsmen to attend training provided by the program s state trainer without having to travel great distances, while affording the opportunity to more visitors to attend open sessions of the quarterly meetings. These meetings have acted as a springboard for focused training instrumental to each advocate s accomplishment in the field. 2 Visits to each local council by the State Chair and Vice-Chair provided invaluable insight into the various nuances that make each council different. The need for language services, assistance in conducting 100 percent of inspections and the provision of expertise not shared by all councils were addressed as the Council embraced the concept of Ombudsmen Without Borders. This concept permits ombudsmen from one council to assist other councils in resolving issues by coordinating related activities via local council leadership. By the very nature of an ombudsman s role, misunderstandings and personality clashes with facility management can occur and be disruptive to all concerned. To quickly resolve formal complaints while correcting misunderstandings about roles and expectations, the State Council and State Ombudsman designed a set of Ombudsman Taking Care of Their Own procedures that keep issue resolution at the local level as cases permit. This process provides opportunities for identifying in-service and training needs, providing an avenue for open communication. All of these initiatives were accomplished through time spent analyzing program requirements, predicting future resident needs and distilling the information into objectives to be achieved in the program s strategic plan, a bold and substantive document that speaks volumes about the passion, professionalism and concern for the residents of long term care that is embodied in the essence of the program and each of its more than 300 volunteers.

5 Residents Rights Upon admission to a licensed nursing home, assisted living facility or adult family care home, all residents are provided a special set of federal and state mandated residents rights. Each resident has the right to: Civil and religious liberties. Private and uncensored communication. Present grievances and recommend changes in policies and services free from restraint, interference, coercion, discrimination, or reprisal. This right includes access to ombudsmen and other advocates. Participate in social, religious and community activities that do not interfere with the rights of others. Manage his/her own financial affairs. Retain and use personal clothing and possessions. Receive adequate and appropriate health care consistent with established and recognized standards. Be treated courteously, fairly, and with the fullest measure of dignity and recognition of individuality and privacy. Be free from mental and physical abuse, corporal punishment, extended involuntary seclusion, and from physical and chemical restraints except those ordered by the resident s physician. Reasonable opportunity to exercise and go outdoors at regular and frequent intervals. Thirty days notice of relocation or termination of residency for nursing homes and adult family care home residents, and 45 days notice for assisted living facility residents. Additionally, nursing home residents are afforded rights including the refusal of medication and treatment with knowledge of the consequences, and prior notification of room changes. Assisted living facility and adult family care home residents are given rights including sharing a room with a spouse if both are residents of the facility. Complete summaries of Nursing Home Residents Rights and Assisted Living Facility and Adult Family Care Home Residents Rights are available on the Long-Term Care Ombudsman Web site, or by calling the program toll-free at DUTIES AND RESPONSIBILITIES Florida Statutes State Long-Term Care Ombudsman; duties and responsibilities.-- (2) The State Long-Term Care Ombudsman shall have the duty and authority to: (i) Prepare an annual report describing the activities carried out by the office, the state council, and the local councils in the year for which the report is prepared. The ombudsman shall submit the report to the secretary at least 30 days before the convening of the regular session of the Legislature. The secretary shall in turn submit the report to the United States Assistant Secretary for Aging, the Governor, the President of the Senate, the Speaker of the House of Representatives, the Secretary of Children and Family Services, and the Secretary of Health Care Administration. The report shall, at a minimum: 1. Contain and analyze data collected concerning complaints about and conditions in long-term care facilities and the disposition of such complaints. 2. Evaluate the problems experienced by residents. 3. Analyze the successes of the ombudsman program during the preceding year, including an assessment of how successfully the program has carried out its responsibilities under the Older Americans Act. 4. Provide recommendations for policy, regulatory, and statutory changes designed to solve identified problems; resolve residents complaints; improve residents lives and quality of care; protect 3 residents rights, health, safety, and welfare; and remove any barriers to the optimal operation of the State Long-Term Care Ombudsman Program. 5. Contain recommendations from the State Long-Term Care Ombudsman Council regarding program functions and activities and recommendations for policy, regulatory, and statutory changes designed to protect residents rights, health, safety, and welfare. 6. Contain any relevant recommendations from the local councils regarding program functions and activities.

6 Program Highlights Ombudsmen and staff continually pursue numerous local and statewide projects to increase the program s effectiveness. These initiatives range from in-service training for long-term care facility staff and family council development to community outreach and public education. Strategic Planning In 2006, the program employed the services of a national consulting firm to work with staff and volunteers to perform an intensive analysis of the program s operational structure and processes, as well as its advocacy, training, communication and outreach efforts. From that analysis, a strategic plan will be developed to serve as a blueprint for the program s future, with an eye toward strengthening advocacy efforts and streamlining operational processes to maximize efficiency while providing as high a caliber of service to Florida s vulnerable population as possible. Media Outreach The program maintained its focus on public awareness through media outreach in Ombudsmen from various councils participated in radio, television and print interviews to inform the public about the program s services. Ombudsmen and staff wrote articles disseminated through the news media to help increase the program s visibility and to express the need for additional volunteers. A new set of public service announcements was professionally produced to begin airing statewide on television and radio in An integrated marketing firm was hired in summer 2006 to spread awareness of the program s mission and services through a targeted media outreach campaign, which began to yield a considerable amount of positive press coverage for the program by the end of the year. Community Outreach Ombudsmen across the state conducted community outreach through participation in health fairs and festivals, presentations at local senior centers and involvement in various community events. Ombudsmen answered questions about the program and provided pertinent information and recruitment materials at every available opportunity. A new set of recruitment materials was created, including a poster and brochure with response cards and a comprehensive application packet. Ombudsmen and staff took a grass roots approach to distributing the posters and brochures throughout their communities by approaching libraries, doctors offices and local merchants and requesting that they display the materials for clients and customers to see. The exercise elicited hundreds of requests for application packets, all of which were fulfilled in an effort to augment the program s membership, which is now beginning to grow. 4

7 Program Highlights In-Service Training Opportunities Through in-service trainings and presentations, ombudsmen provided facility staff and community groups with information about residents rights, the Long-Term Care Ombudsman Program s services and other relevant issues affecting the health, safety and well being of Florida s long-term care facility residents. The Ombudsman Program presents, exhibits and/or co-sponsors numerous health fairs and community events throughout the state each year Operation Spot Checks Multiple district councils participated in Operation Spot Check activities, working with facilities to improve residents quality of life. The spot checks were conducted under the auspices of local State Attorney offices in concert with other agencies Golden Choices Award Honorees Elizabeth Bairley Doris Benoit Donald Braverman Laretha Brown Marilyn dos Santos Boris Edelman Albert Elseroad Claudette Fabian Paula Farnham Pat Fluno Carolyn Gallagher Gloria Gallo Angelica Garcia Don Hering Kathleen Johnson Carole Oliver Ann Redyke Barbara Roby Barbara Ross Ron Sabellico Pat Sacco Dr. Daniel Schroeder Edgar Seibert Fernando Serrado Joe Torre Art Walker David Warshofsky Lesli Watkins Douglas Watson 5

8 Statistics Key Advocacy Efforts Every year, in addition to their community education and resident empowerment efforts, our ombudsmen tirelessly dedicate themselves to two primary endeavors: complaint investigations and administrative assessments. The total number of assessments and investigations completed during this reporting period (October 2005 through September 2006) reflects the ombudsmen s successful ability to protect, defend and advocate for residents. Long-Term Care Facilities & Administrative Inspections Complaint Investigations In , Florida s long-term care ombudsmen completed a total of 7,905 complaint investigations. Often, a single complaint may affect more than one resident; in fact, an entire wing or population of a long-term care facility may be affected. For example, a complaint filed by one resident regarding the quality of food served at a facility may affect the entire resident Complaint Resolution Complaint investigations may result in any number of outcomes, including recommendations to resolve the issue, notifying another agency when appropriate or making recommendations on policy changes to appropriate agencies. Ombudsmen continually strive for the highest level of resolution possible, keeping in mind that residents rights are the foundation of the program. Long-term care facilities in Florida fall into one of three categories: nursing homes (693 facilities; 83,338 beds; 4,739 complaints), assisted living facilities (2,391 facilities; 75,525 beds; 3,083 complaints) and adult family care homes (475 facilities; 2,145 beds; 83 complaints). There are 3,562 long-term care facilities in the state of Florida, with 163,003 beds. Administrative assessments are mandated by section , F.S. and are conducted annually. Administrative assessments focus on the rights, health, safety and welfare of residents. The ombudsman s responsibility is to ensure that the facility is meeting the needs of the residents in compliance with state statute and federal law. This year, ombudsmen completed a total of 2,852 assessments statewide, reflecting 80 percent of the licensed long-term care facilities in Florida. population. According to data gathered throughout the year, the program served 49,932 long-term care facility residents from October 2005 through September 2006 through complaint investigations. Partially or fully resolved 49% 6 Other* 16% No Action Needed 19% Complaint Resolutions Withdrawn /Referred 16% * Other indicates cases open for investigation at the end of the federal fiscal year Top Ten Complaints in Assisted Living Facilities and Adult Family Care Homes Complaint # 1. Medications - administration, Menu/Food - quantity, quality, choice Shortage of staff Billing/charges - notice, approval Dignity, respect Privacy - telephone, visitors, couples, mail Cleanliness, pests, general housekeeping Personal funds - mismanaged, access denied Equipment/Buildings - disrepair, hazardous Discharge/eviction- planning, notice, procedure Top Ten Complaints in Complaint # 1. Discharge/eviction- planning, notice, procedure Medications - administration, Injury of unknown origin; falls; improper handling Symptoms unattended Personal hygiene (includes oral hygiene) Personal property - lost, stolen, destroyed Call lights, response to requests for assistance Staff Attitudes Dignity, respect Care: Other

9 Statistics Range of Complaints Ombudsmen investigate a wide variety of complaints each year. Complaints regarding a long-term care facility, its employees, providers of long-term care services, public or private agencies, guardians, representative payees and other agencies or persons who are in a position of ensuring residents rights Origin of Complaints Complaints may be made by any person or group concerned about the rights, care and treatment of longterm care facility residents and, in fact, are received from many sources. Although most complaints in were called in by relatives of long-term care facility residents (43 percent), concerns were also reported by residents themselves (23 percent) and their guardians or legal representatives (five percent). Friends of residents, facility staff, medical personnel, other agency staff and even ombudsmen also filed complaints. Resident 23% Relative 43% Complainants Relation to Residents may be investigated by the program s volunteers. Specific complaints range from privacy, dignity and care issues to improper medication administration and discharge planning procedures. Even though complaints are confidential as required by federal and state law, approximately 13 percent of complainants preferred to remain anonymous this year, citing fear of retaliation as the primary reason. The Long-Term Care Ombudsman Program continues to educate callers regarding their protection from retaliation as specified in state law. Anonymous 13% Other 11% Guardian/Legal Representative 5% Friend 5% Legal Advocate s Activities In , the program s legal advocate assisted the state ombudsman in carrying out the duties of the office by participating in drafting rules, policies and procedures; tracking legislative issues and rule-making proceedings; preparing materials for the State Long-Term Care Ombudsman Council s legislative and advocacy committees; participating in Florida Bar activities and training regarding Elder Law issues; evaluating requests for state ombudsman consent; attending District Council meetings as a representative of the office; and gathering and preparing materials for program evaluation by outside consultants. The program s legal advocate also assisted the state and district ombudsman councils in carrying out their responsibilities by advising the state council s legislative and advocacy committees and assisting district councils on issues including conflict of interest, confidentiality, the Sunshine Law, the complaint process, documentation, conducting meetings, and working with legal representatives. The legal advocate responded to subpoenas and records requests; represented district ombudsmen and program interests at court hearings; prepared and delivered training on legal issues to district councils; and assisted long-term care residents, family members, and other interested citizens in finding answers to their questions. 7

10 State Council Recommendations State Council This year, Chapter 400 of the Florida Statutes was updated to clarify the roles and responsibilities of the State Long-Term Care Ombudsman Council State Long-Term Care Ombudsman Council; duties; membership.-- (1) There is created within the Office of State Long- Term Care ombudsman, the State Long-Term Care ombudsman Council. (2) The State Long-Term Care ombudsman Council shall: (a) Serve as an advisory body to assist the ombudsman in reaching a consensus among local councils on issues affecting residents and impacting the optimal operation of the program. (b) Serve as an appellate body in receiving from the local councils complaints not resolved at the local level. Any individual member or members of the state council may enter any long-term care facility involved in an appeal, pursuant to the conditions specified in s (2). (c) Assist the ombudsman to discover, investigate, and determine the existence of abuse or neglect in any long-term care facility, and work with the adult protective services program as required in ss (d) Assist the ombudsman in eliciting, receiving, responding to, and resolving complaints made by or on behalf of residents. (e) Elicit and coordinate state, local, and voluntary al assistance for the purpose of improving the care received by residents. (f ) Assist the ombudsman in preparing the annual report described in s (3) The State Long-Term Care ombudsman Council shall be composed of one active local council member elected by each local council plus three at-large members appointed by the Governor. (a) Each local council shall elect by majority vote a representative from among the council members to represent the interests of the local council on the state council. A local council chair may not serve as the representative of the local council on the state council. (b) 1. The secretary, after consulting with the ombudsman, shall submit to the Governor a list of persons recommended for appointment to the at-large positions on the state council. The list shall not include the name of any person who is currently serving on a local council. 2. The Governor shall appoint three at-large members chosen from the list. 3. If the Governor does not appoint an at-large member to fill a vacant position within 60 days after the list is submitted, the secretary, after consulting with the ombudsman, shall appoint an at-large member to fill that vacant position. (c) 1. All state council members shall serve 3- year terms. 2. A member of the state council may not serve more than two consecutive terms. 3. A local council may recommend removal of its elected representative from the state council by a majority vote. If the council votes to remove its representative, the local council chair shall immediately notify the ombudsman. The secretary shall advise the Governor of the local council s vote upon receiving notice from the ombudsman. 4. The position ovf any member missing three state council meetings within a va1-year period without cause may be declared vacant by the ombudsman. The findings of the ombudsman regarding cause shall be final and binding. 5. Any vacancy on the state council shall be filled in the same manner as the original appointment. (d) 1. The state council shall elect a chair to serve for a term of 1 year. A chair may not serve more than two consecutive terms. 2. The chair shall select a vice chair from among the members. The vice chair shall preside over the state council in the absence of the chair. 3. The chair may create additional executive positions as necessary to carry out the duties of the state council. Any person appointed to an executive position shall serve at the pleasure of the chair, and his or her term shall expire on the same day as the term of the chair. 4. A chair may be immediately removed from office prior to the expiration of his or her term by a vote of two-thirds of all state council members present at any meeting at which a quorum is present. If a chair is removed from office prior to the expiration of his or her term, a replacement chair State Council Representatives Elizabeth Bairley, East Central Florida Audrey Bennett, Broward County Laretha Brown, North Dade Lu de Wette, Palm Beach County Marilyn dos Santos/Ella Lawrence, Southwest Florida Ed Forman, Mid & South Pinellas Kay George/Marcia Reynolds, Northwest Florida Farrell Groves**, South Central Florida Don Hering*, West Central Florida Bob James/Grace Rondeau, Withlacoochee Area Barbara Ross, North Central Florida Ron Sabellico, Pasco & North Pinellas Ed Seibert, First Coast South Joe Torre, Treasure Coast David Warshofsky, South Dade & the Keys Lesli Watkins, First Coast Catherine Wynne, Panhandle * chair ** vice chair shall be chosen during the same meeting in the same manner as described in this paragraph, and the term of the replacement chair shall begin immediately. The replacement chair shall serve for the remainder of the term and is eligible to serve two subsequent consecutive terms. (e) 1. The state council shall meet upon the call of the chair or upon the call of the ombudsman. The council shall meet at least quarterly but may meet more frequently as needed. 2. A quorum shall be considered present if more than 50 percent of all active state council members are in attendance at the same meeting. 3. The state council may not vote on or otherwise make any decisions resulting in a recommendation that will directly impact the state council or any local council, outside of a publicly noticed meeting at which a quorum is present. (f ) Members shall receive no compensation but shall, with approval from the ombudsman, be reimbursed for per diem and travel expenses as provided in s

11 State Council Recommendations Assisted Living Facility Discharge Appeals Process Section , Florida Statutes, could be revised to require specific criteria be met for the involuntary discharges and transfers of assisted living facility (ALF) residents and include an appeals process that is similar to what is currently required for nursing homes. Residents are currently unable to appeal discriminatory discharges/transfer. Discharges may cause decline in a resident s condition due to trauma caused by the event. State Council representatives listen intently during a quarterly leadership meeting in Tampa Nursing Home Staffing The Nursing Home Law, Section (3)(a), F.S., could be revised to require staffing per shift rather than per each 24-hour period. Currently, nursing homes typically have more staff during the day than at night and, as such, may not meet the direct care needs of residents. Continuity of care and quality of care will help to relieve care concerns. More comprehensive staffing levels will help residents who have Alzheimer s disease and mental health problems, as they typically require more care and closer monitoring than other residents. Adult Family Care Home Staffing Florida Administrative Code 58A (2)(a) could be revised to no longer allow residents in adult family care homes (AFCH) to be left unattended and unsupervised. The code currently allows for residents to be unattended for up to two hours; however, the council believes this allowance leaves residents in potentially unsafe situations. Eliminating or closing the loophole allowing AFCH owners to leave residents alone would better protect the safety and security of the residents. 9 Long-Term Care Facility Staff Background Screening Individuals seeking employment within a long-term care facility in Florida are currently required to undergo a Level 2 background investigation, including Florida Department of Law Enforcement (FDLE) and Federal Bureau of Investigation (FBI) screenings. The measure is meant to screen out persons who are inappropriate to work with vulnerable elders; however, it currently affects only direct care staff, such as certified nursing assistants (CNAs). The council has learned there are facilities within Florida that employ registered sexual offenders and/or predators in indirect roles; while such a practice is legal, many of those individuals have access to frail elders residing in those facilities. As such, the council recommends the security measure be broadened in statute to include all employees and contracted workers who have physical access to long-term care facility residents in order to further ensure their safety.

12 Annual Training Conference Ombudsmen complete 20 hours of training, plus 10 hours annually through the program s local districts. The Fifth Annual Ombudsman Training Conference was held in May 2006 and featured nationally recognized speakers, providing ombudsmen with additional opportunities to learn and discuss issues relevant to their work as advocates. Fifth Annual Ombudsman Training Conference This year s main plenary session was presented by keynote speaker Dr. William Thomas. His presentation, The Culture of Aging, gave attendees an in-depth view of various civilizations perspectives on aging and provided a glimpse into the broad impact elder advocates have on society. A second plenary session was presented by national ombudsman expert Bill Benson, who outlined the program s strategic planning process for the year to come. Breakout sessions were held during the conference on topics requested by ombudsmen throughout the state. These sessions focused on abuse prevention, common nursing home issues, community relations, the SHINE (Serving Health Insurance Needs of Elders) program, the National Ombudsman Resource Center s offerings and best practices in long-term care. Ombudsmen throughout the state were recognized for their contributions to the program, and tribute was paid to those who joined the distinguished group of ombudsmen who have completed at least eight continuous years of service. Special recognition was also given to the District Ombudsmen of the Year as selected by each council for their outstanding contributions to the councils and to the residents within their districts. This particular group, listed on this page, consists of some of the finest advocates the program has to offer. District Ombudsmen of the Year Doris Benoit and Gloria Gallo, Southwest Florida Don Braverman, First Coast Albert Elseroad, East Central Florida Paula Farnham, Withlacoochee Carolyn Gallagher, South Dade Angelica Garcia, North Dade Kay George, Northwest Florida Farrell Groves, South Central Florida Don Hering, West Central Florida Kathleen Johnson, Pasco and North Pinellas Charles Kutner, Palm Beach County Arlyne Lewis. Broward County Dr. Daniel Schroeder, Mid and South Pinellas Pat Sacco, Treasure Coast Ed Seibert, First Coast South Donna Speed, North Central Florida Ann Redyke, Panhandle Annual Training Conference

13 Success Stories Florida s long-term care ombudsmen are trained, dedicated volunteers who donate their time, knowledge and energy to advocate for one of Florida s most treasured and often vulnerable populations. Included here are several examples of the kinds of services ombudsmen provide every day throughout the state, helping to brighten the lives of our parents and grandparents. Each case presented here occurred this past year and was resolved on behalf of the resident(s) with a combination of care, effort and teamwork on the part of these passionate advocates, many of whom are elders themselves. Success Story 1 A local ombudsman council received a call from a complainant regarding an issue affecting all the residents of a local, private assisted living facility. The residents had been informed of a new policy under which a fee of $150 would be added to their monthly bills if they did not consent to use the facility s in-house pharmacy for the production and distribution of their medicines. Residents also were not being permitted to view their personal care plan point systems, and wheelchair and walker users were often made to eat outside during meals so as not to crowd the dining area. All three of these actions were direct violations of the residents rights mandated by federal and state law. An ombudsman met with the administrator of the facility, who claimed that the issues were simply matters of company policy. The ombudsman reiterated the existence and importance of residents rights and worked with the administrator to devise a solution to the issue of the crowded dining room; as a result, once a plan was agreed upon, the residents with wheelchairs and walkers were permitted to eat in the dining area. The other issues were not as easily resolved with the administrator; after much discussion, the ombudsman contacted the facility s regional vice-president to seek potential solutions to the remaining problems. The regional vice-president visited the facility personally and quickly resolved both issues. Residents now have the freedom to choose their own pharmacy and can view their personal care plans whenever they wish. Thanks to the ombudsman s knowledge, assertiveness and hard work, the facility s residents now have a higher quality of life. 11

14 Success Stories Success Story 2 A local ombudsman council received a phone call from a former assisted living facility employee who was concerned about the safety and welfare of the residents in her former place of employment. Her issues of concern included alleged sexual harassment of a resident, as well as the overall physical condition of the facility. The case was assigned to two ombudsmen who began their investigation by interviewing the residents, several of whom verified that an employee was harassing them for sexual favors either by offering them money or by intimidation. One resident stated in his interview that he would barricade himself in his room at night because he was afraid of the employee. Two other residents confided in the ombudsmen that they had engaged in sexual activity with the employee; one stated that he was forced to participate in sexual acts, while the other said he was terrified and intimidated by the employee and felt he did not have any choice. The ombudsmen indicated in their report that they suspected other residents may have been forced to participate but were too ashamed to admit that they had engaged in sexual contact of any kind with the employee. The ombudsmen discussed their findings and concerns with the owner and the administrator of the facility. The owner indicated that the employee would not be allowed to return to work and that the police department would be contacted to resolve the situation. Upon leaving the facility, the ombudsmen contacted the local police, Adult Protective Services (APS) and the Agency for Health Care Administration regarding their investigation and its findings. The ombudsmen expressed their concern to both APS and the police that the alleged perpetrator also worked at a daycare center, granting him access to another vulnerable population he could possibly exploit. All involved agencies conducted investigations and confirmed that the residents were sexually harassed and abused. A police investigation also ensued. On the facility s part, the employee was terminated, psychological counseling was provided to the affected residents in an effort to help them through the healing process and decisive actions were taken to ensure a safe environment for all residents from that point forward. Success Story 3 A local ombudsman council received an 18-page letter from a complainant detailing a litany of concerns about the living conditions in a local assisted living facility. After reviewing all the information provided in the letter, the council determined that at least 20 residents were being affected directly by the issues presented, and the subjects of several complaints seemed to affect all residents. Working together to prioritize and document each individual complaint, the program s local council coordinator, local council chair, state council representative, state ombudsman and legal advocate moved cooperatively through the extensive complaint resolution process, verifying 24 separate complaints ranging from call light response time and building disrepair to infection control and medical neglect. When they presented their findings to the facility s new administrator, who had accepted the position just prior to the ombudsmen conducting their investigation, she immediately asked for a resignation letter from the director of nursing, the source of many of the issues being investigated. Other issues were also dealt with to the satisfaction of the residents. Months later, the council was asked to return to the facility to provide a residents rights training for the staff; several of the facility s residents also joined the training to lend their perspective. Since the complaint investigation, the facility has shown remarkable improvement in its service to residents. This success story is a prime example of the program s Ombudsmen Without Borders policy, enacted earlier in the year to facilitate cooperation among councils in special cases wherein support from neighboring councils may be necessary in order to effectively resolve a case. Together, the local council worked with ombudsmen from two additional councils to effectively serve the large number of residents involved. Working side by side and exemplifying the word teamwork, the ombudsmen and staff brought about swift and positive outcomes for the residents affected. 12

15 Success Stories Success Story 4 An 80-year-old man who could not get a straight answer from his assisted living facility s staff when he asked for his personal needs allowance contacted his local ombudsman council for help. The man believed he was entitled to $54 per month and said staff had evaded his questions for months. A review of the complainant s financial records found he was approved for Optional State Supplementation (OSS) six months earlier. The OSS record showed he was required to pay the assisted living facility (ALF) $603 and retain $ When the ombudsman asked the administrator why the resident had not received the money, she replied the value of the ALF service exceeded $603 and the remainder was his voluntary contribution. The administrator acknowledged the ALF was withholding OSS payments from about 12 other residents. She told the ombudsman the ALF had been recently sold and the present owner s responsibility was limited. To resolve the complaint, the ombudsman asked the ALF to refund the residents money. The administrator wrote a letter to OSS residents that stated, As you are aware, the (ALF) has been sold We were given incorrect information in the past, believing your OSS check could be used toward room and board This was an honest mistake on our part In (light) of our mistake, the ALF has decided to issue you a refund for the past four months. You will receive a check in the amount of $216. The council s records, however, showed that the individual had been the ALF s administrator for at least three years. In order to ensure that residents received all they were due, the council asked the Agency for Health Care Administration (AHCA) to review several years worth of residents financial records. AHCA reported that the ALF had not been sold and that there was no record of a change of ownership. In addition, the AHCA surveyor found the ALF had misappropriated OSS checks for almost four years not four months. AHCA ordered the ALF to refund 13 residents a total of more than $16,000. Individual refunds ranged from $108 for two months to $2,538 for 47 months. The resident who contacted the ombudsman program began receiving his monthly personal needs allowance as well, allowing him an important measure of financial independence. 13 Success Story 5 A nursing home administrator contacted a local ombudsman council on behalf of two coherent male residents who had transferred from the same assisted living facility and whose monthly benefits checks had not been forwarded by the administration of the former residence. As a result, both residents were accumulating a considerable amount of debt to the nursing home. The ombudsman contacted both residents and received consent to investigate the complaints. One resident alleged that his Veterans benefits were improperly retained by his former residence for ten months after he moved to the nursing home. The second resident alleged that his Social Security benefits were improperly retained by the same facility for four months. Two ombudsmen were assigned to investigate this case at different intervals. Upon investigation, the ombudsman learned that the assisted living facility where the residents previously lived had closed, but that its owners possessed licenses for two other assisted living facilities in a nearby county. The ombudsman visited one of the facilities and spoke with the owners, who claimed that they had an agreement for one of the two residents, permitting them to retain his benefits. The resident refuted this statement. The ombudsman investigating the complaint reviewed the legality of the facility s action and found that a lack of adequate documentation existed to justify the assisted living facility s withholding of the resident s checks. The Veteran s Administration and the Social Security Administration had continued to send both residents monthly benefits checks to the assisted living facility for the months in question, and the assisted living facility had cashed them. Police reports were filed, and a hold was placed on the closed assisted living facility post office box. The Department of Children & Families was also contacted; its investigation found several indicators of maltreatment. The case has since been referred to the Medicaid Fraud Control Unit for further consideration. The ombudsman met with the nursing home administrator and social worker and learned that steps were being taken to change the mailing address for both residents. The nursing home expressed no intention of discharging the residents for the months of non-payment. As a result of the investigation and repeated follow-ups with the assisted living facility, the alleged debt has been written off. Both residents are pleased with the care at their new home and are receiving their monthly benefits.

16 Broward County Serving Broward County Broward Council Ombudsman Council Audrey Bennett Kaye Brown Dorothy M. Cox Irwin Golden Marvin Greisel Stephen Jones Seymour Landau Arlyne Lewis Nadine Litterman Dolores Navarra Margaret Perry Charlotte Reiter Daniel Reiter Beverly Resnick Norman Smith Victoria Steele Theodore Sobo Rhea Weiss Irving Weiss Number of Cases 227 Complaints Investigated 521 Assessments Completed Symptoms unattended 2. Personal property - lost, stolen, used by others, destroyed 3. Call lights, response to requests for assistance 1. Personal funds - mismanaged, access denied 2. Privacy - telephone, visitors, couples, mail 3. Medications - administration, East Central Florida Serving Brevard, Orange, Osceola and Seminole Counties East Central Florida Ombudsman Council Elizabeth Bairley Ruth Battle-Hall Robert Bornstein Shirley Edwards Albert Elseroad Daphne Frutchey Linda Funderburk Vicki Goranson Joseph Laschober Jo Ann Miller Suzanne Popaditch Mary Redding Sandra Robison Mary Will Simpson Jeffery Slater Kathleen Vermette James Walton John Zeher Roberto Zuniga Silvia Zuniga Number of Cases 226 Complaints Investigated 678 Assessments Completed Medications - administration, 2. Dignity, respect 3. Discharge/eviction- planning, notice, procedure Dignity, respect 2. Billing/charges - notice, approval 3. Discharge/eviction- planning, notice, procedure

17 First Coast Serving Baker, Clay, Duval, Nassau and St. Johns Counties First Coast Ombudsman Council Kristen Adams Eugene Botts Carol Braverman Donald Braverman Nellie Brown John Brundage Marion Cook Millicent Dangerfield Frances Di Filippo Mary Domask Alma Flowers Bettie Griffith Mitchell Holloway Neely Inlow Elizabeth James James Jen Valerie Matta Arthur Molina Roy Provost Joseph Quinn Mary Jane Rau George Sloan Tommy Stringfellow Lesli Watkins Number of Cases 177 Complaints Investigated 504 Assessments Completed Symptoms unattended 2. Personal hygiene 3. Dignity, respect 1. Menu/Food - quantity, quality, choice 2. Gross neglect 3. Dignity, respect First Coast South Serving Volusia and Flagler Counties First Coast South Ombudsman Council Stuart Albert Kalaya Behneman John Behneman Susan Bornman Romana Colby Vera Rose Coleman Lawrence Davis Leonard Dills Leo Fox Duane Gross Barbara McCarthy John Murphy Jeannette Roselli Edward Schultz June Seibert Edgar Seibert Martha Shetler John Shetler Dorothy Stevens Shirley Thompson Mary Wells Number of Cases 195 Complaints Investigated 336 Assessments Completed Care: Other 2. Financial, Property: Other 3. Environment/Safety: Other Admission, Transfer, Discharge Eviction: Other 2. Medications - administration, 3. Environment/Safety: Other

18 Mid & South Pinellas Serving Mid and South Pinellas County Mid & South Pinellas Ombudsman Council Florence Balheimer Hope Berg Timothy Blackmon Julia Burkart Kenneth Burry Carol D Amico John Flint Cynthia Floyd Edward Forman Nancy Gray Suzanne Greacen Doyce Hayth George Kehoe Kay Korwin- Kasander Robert Landstra Kathleen Lincoln Ted Lundberg Thomas Mall Joann Martino Elaine Mikurak William Morgan James Mortensen Paul O Connor Carole Oliver Charles Parker Laila Petrou Joseph Rosenthal Delia Saavedra Danielle Schaffer Daniel Schroeder Richard Short Donna Smith Judy Smith Walter Tyc Jacqueline Walsch Douglas Watson Jacquelin Weeks Carol Weideman James West Number of Cases 281 Complaints Investigated 701 Assessments Completed Personal property - lost, stolen, used by others, destroyed 2. Gross neglect 3. Social services - availability, appropriateness 1. Medications - administration, 2. Personal funds - mismanaged, access denied 3. Staff Attitudes North Central Florida Serving Alachua, Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy, Putnam, Suwanee and Union Counties North Central Florida Ombudsman Council JoAnna Emerson Bernard Garnett Larry Haskett Patricia Haskett Patricia Hatcher Dawn McCullers Sue Pedone D.P. Ramayya Frank Robinson Marion Spangler Donna Speed Ann Tillman Number of Cases 78 Complaints Investigated 291 Assessments Completed Personal hygiene 2. Shortage of staff 3. Medical Neglect Menu/Food - quantity, quality, choice 2. Equipment/Buildings - disrepair, hazardous 3. Shortage of staff

19 North Dade Serving North Miami-Dade County North Dade Ombudsman Council Marti Benenfeld Laretha Brown-Bryant Jeanette Bryson Marion Evans Yolene Francois Angelica Garcia Lucila Huerta Sara Kelly Shirlee Leifert Carolina Lombardi Bertha Price Luisa Ruffin Number of Cases 110 Complaints Investigated 273 Assessments Completed Accidental or injury of unknown origin; falls; improper handling 2. Transfer or Discharge for Inappropriate Reasons 3. Personal property - lost, stolen, used by others, destroyed 1. Staff Attitudes 2. Menu/Food - quantity, quality, choice 3. Dignity, respect Northwest Florida Serving Escambia, Okaloosa, Santa Rosa and Walton Counties Northwest Florida Ombudsman Council Henrietta Elston James Evans Raymond Johnson Anne Manning Winona Nichols Michael Phillips Marcia Reynolds Joshua Sparrow Leonard Swartz Kathy Wilks Number of Cases 80 Complaints Investigated 218 Assessments Completed Room assignment/room change 2. Pressure sores 3. Personal hygiene Cleanliness, pests, general housekeeping 2. Equipment/Buildings - hazardous or in disrepair 3. Air/environment temperature and quality

20 Palm Beach County Serving Palm Beach County Palm Beach County Ombudsman Council Ana Avello Ruth Bloch Rose Britton Annette Cassuto Jerry Cooper Mary Day Lucienne de Wette Boris Edelman Patricia Ann Evans Claudette Fabian Joann Farrell Howard Feuer Shelia Gettelson Ilana Green William Hartmann Dorothy Hernandez Sister Audrey Hull Elizabeth Johnson Annette Karp Charles Kutner Jermone Leftow Barbara Leonard Eugene Loeser Delores McCarthy Ruth Meada Anna Pressly Sylvia Schupler Mark Shalloway Marilyn Shapiro Rita Steinback Eleanor Vogt James Wilbers Number of Cases 305 Complaints Investigated 736 Assessments Completed Medications - administration, 2. Toileting; incontinent care 3. Discharge/eviction- planning, notice, procedure 1. Personal property - lost, stolen, used by others, destroyed 2. Billing/charges - notice, approval 3. Staff Attitudes Panhandle Serving Holmes, Jackson, Washinton, Bay, Calhoun, Gadsden, Liberty, Gulf, Franklin, Leon, Madison, Taylor, Jefferson and Wakulla Counties Panhandle Ombudsman Council Archie Austin Myra Clark Jerome Conger Ben Dudley Norma Hemphill Alex Littlefield Christa McGuire Linda Putnam Warren Schave Catherine Wynne Number of Cases 103 Complaints Investigated 266 Assessments Completed Care: Other 2. Admission, Transfer, Discharge Eviction: Other 3. Medications - administration, System: Other 2. Privacy - telephone, visitors, couples, mail 3. Billing/charges - notice, approval

21 Pasco & North Pinellas Serving Pasco and North Pinellas Counties Linda Alspaugh Donna Blazevic Clifford Church Louise Collins Garett Coursen Norman Crews Lorraine Domanski Robert DuBrul Pasco & North Pinellas Ombudsman Council Mary Erickson- Tweiten Linda Eustice Martha Favillo W.C. Jim Grimes Barbara Grimes Patty Huffman Roberta McIntosh Mildred Pagani Sharon Proue Sharon Puchosic Patricia Reilly Barbara Rodgers Ronald Sabellico John Swintek Samuel Tancredi Number of Cases 339 Complaints Investigated 896 Assessments Completed Discharge/eviction- planning, notice, procedure 2. Shortage of staff 3. Accidental or injury of unknown origin; falls; improper handling 1. Medications - administration, 2. Shortage of staff 3. Menu/Food - quantity, quality, choice South Central Florida Serving Hardee, Highlands and Polk Counties South Central Florida Ombudsman Council Mary Arnold Wesley Britton John Gabrick Farrell Groves Arthur Hubert Thomas Hunt Donna Miller William Norrell Barbara Roby Donald Roys Lynn Schmidt William Teague Judith Turk Arthur Walker Number of Cases 149 Complaints Investigated 424 Assessments Completed Discharge/eviction- planning, notice, procedure 2. Accidental or injury of unknown origin; falls; improper handling 3. Staff Attitudes Staff Attitudes 2. Billing/charges - notice, approval 3. Medications - administration,

22 South Dade and the Keys Serving South Miami-Dade and Monroe Counties South Dade and the Keys Ombudsman Council Leila Adderton Joel Beyer Alexis Carter Jose Castillo Dolores Dimitriou Carmen Gutierrez Robin Proctor Thomas Qafzezi Joann Redmond Maria Caridad Rojas Heidy Santizo Monica Santizo Fernando Serrado Deborah Sokolow David Warshofsky Robert Yates Number of Cases 134 Complaints Investigated 447 Assessments Completed Discharge/eviction- planning, notice, procedure 2. Care plan/resident assessment 3. Menu/Food - quantity, quality, choice 1. Menu/Food - quantity, quality, choice 2. Equipment/Buildings - hazardous or in disrepair 3. Staff training, lack of screening Southwest Florida Serving Charlotte, Collier, Desoto, Glades, Hendry, Lee and Sarasota Counties Southwest Florida Ombudsman Council Veronica Abbate Anthony Abbate Mary Achilles Richard Achilles Doris Benoit Shirl Blau Susan Bond Donna Brooks- Lomanto Ed Christenbury Marilyn dos Santos Gloria Gallo Margaret Gillis Arthur Goodman Valerie Healey Natalie Krasik Ella Lawrence Ed Leaffer Charles Lomanto Kay Moudry Eugene Nikolai Geraldine Osenga John Paximadis Marvin Potter Ann Reehill Jesus Sierra Eunice Silverman Carol Silverman Charl Squeri Harold Sterne Philip Surowitz Number of Cases 203 Complaints Investigated 481 Assessments Completed Discharge/eviction- planning, notice, procedure 2. Call lights, response to requests for assistance 3. Care plan/resident assessment Privacy - telephone, visitors, couples, mail 2. Billing/charges - notice, approval 3. Medications - administration,

23 Treasure Coast Serving Indian River, Martin, Okeechobee and St. Lucie Counties Treasure Coast Ombudsman Council Helen Beachler Eunice Crump Arthur Falk Stella Guy Sue Henrich Janice Johnson Sheldon Kanars Carol Kline Victor Lazarus Lucille Lazarus Alvin Malley Irene Rathbun Pat Sacco Jeanette Sanz Lori Tomlinson Joe Torre Paul Ward Dr. Arlene Weir Number of Cases 82 Complaints Investigated 170 Assessments Completed Pressure sores 2. Discharge/eviction- planning, notice, procedure 3. Medications - administration, 1. Dignity, respect 2. Admission, Transfer, Discharge Eviction: Other 3. Medications - administration, West Central Florida Serving Hillsborough and Manatee Counties West Central Florida Ombudsman Council Ellen Canfield Donna Courtney Donald Courtney Cathleen Dietz Stephanie Estevez Donald Evans Joann Ferro Alfred Germer Donald Hering Joe Hottinger Margaret Machado Doug Mohl Belinda Noah Sara Nuttall Janis Rumberger Sherrill Trbovich Yen Trieu Carol Wells Clarence Westerson Cynthia Zadeh Number of Cases 166 Complaints Investigated 451 Assessments Completed Medications - administration, 2. Accidental or injury of unknown origin; falls; improper handling 3. Call lights, response to requests for assistance Medications - administration, 2. Billing/charges - notice, approval 3. Menu/Food - quantity, quality, choice

24 Withlacoochee Area Serving Citrus, Hernando, Lake, Marion and Sumter Counties Donald Akers Dana Bedwell Marie Brand Joseph Centineo Peter Connelly Gloria Dale Joseph Ellner Mary Furr Walter Furr Bonnie Groves Richard Hancock Carol Hermanski Withlacoochee Area Ombudsman Council John Hlivyak Dorothy Hoey Robert James William Kageler Thomas Kelley Gloria McCall Elaine McFadden Wiliam McMahan Ernest Muller Claire Naughton Maria Penland Charlotte Ross James Ranson Seymour Rosenblatt Gerald Roth Tracey Schoonmaker Georgia Skinner Lewis Smith Margaret Velasquez Tom Weiland Virginia Winkel Viola Wittpenn Number of Cases 256 Complaints Investigated 512 Assessments Completed Discharge/eviction- planning, notice, procedure 2. Billing/charges - notice, approval 3. Medications - administration, 1. Cleanliness, pests, general housekeeping 2. Shortage of staff 3. Personal hygiene 22