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LONG TERM CARE OMBUDSMAN PROGRAM

LONG TERM CARE OMBUDSMAN PROGRAM

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LONG TERM CARE OMBUDSMAN PROGRAM

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  1. LONG TERM CARE OMBUDSMAN PROGRAM Advocates For Long Term Care Residents John G. McDermott, LSW, ACSW, M.Div. State Long Term Care Ombudsman (808) 586-7268 7/25/14

  2. Mahalo! Mahalo to the Executive Office on Aging (EOA) and National Association of States United for Aging and Disabilities (NASUAD). Mahalo also to Diane Kawasaki!! “Understanding Hawaii’s Long Term Care Ombudsman Program & Preventing Elder Abuse.”

  3. History • Original concept: “go-between” Sweden in 1809 • Federally mandated: Older Americans Act 1965 - 1975 pilot project - 1978 amendment - 1987 Nursing Home Reform Act (OBRA) • State of Hawaii: HRS 349- 21 to 25, part III - 1979 amendment - 2007 HB807 HD1 SD2 CD1 (May 24, 2007) - 32 years late!!! - 2008 HB2289 and SB2151 Neighbor Island expansion • Volunteer Representative Component (1999 Legislative Session) - Began June 1, 2001 - 170 “certified” representatives - 19 active as of July 24, 2014 Volunteers are ESSENTIAL to our Program. We need more…..MAHALO!!

  4. State Ombudsman • Robin Matsunaga • Hawaii “first” state to start office • 1967 authorizing legislation • 1969 began operations • Chapter 96, Hawaii Revised Statutes • 587-0770 • www.ombudsman.hawaii.gov • complaints@ombudsman.state.hi.us

  5. Functions (LTCO or Representatives) • Identify, investigate, and resolve complaints • Protect health, safety, welfare, and rights of residents • Inform residents/families about obtaining services by providers or outside agencies • Provide technical support to Resident and Family Councils

  6. Functions (LTCO or Representatives) • Ensure residents have “regular and timely access” to services ……quarterly visits • Represent interests of residents before governmental agencies • Analyze, comment on, and monitor development & implementation of federal, state, and local laws, regulations and other governmental policies and actions (Kupuna Caucus and PABEA Legislative Committee)

  7. Some Long Term Care Issues • Personal Needs Allowance increase • Transportation, Lunches, Debts • Financial Abuse – Accountability • Federal Stimulus money – social worker role • Survey deficiency? • Emergency Preparedness challenges • Act 213 on-line LTC facility inspection results • CCFFHs – new role ….. LTC Insurance problem • Case Management /Exp. ARCHs/ reimbursement • ADRC “one stop shop”/LTCOP www.hawaiiadrc.org

  8. Long Term Care Facilities • Nursing Homes (ICF/SNF) • Community Care Foster Family Homes (CCFFH) • Expanded Adult Residential Care Homes • Adult Residential Care Homes • Assisted Living Facilities • Group Homes/Independent Living • Home Health Agencies

  9. Levels of Care (LOC) • Acute: hospital • Skilled: Nursing Home, CCFFH, Expanded ARCH or “Going Home Plus” (DHS) • Intermediate Care: Nursing Home, CCFFH, Expanded ARCH • Custodial: ARCH or Adult Day Care/Respite Care • Assisted Living - combo • Independent: Group home, boarding home, senior home, own home

  10. Paying for Long Term Care • Medicare • Private Insurance • Medicaid • Long Term Care Insurance • Out-of-Pocket

  11. Administrative Rules • Assisted Living http://gen.doh.hawaii.gov/sites/har/AdmRules1/11-90.pdf • Nursing Homes http://gen.doh.hawaii.gov/sites/har/AdmRules1/11-94.pdf • Adult Residential Care Homes (includes Expanded) http://gen.doh.hawaii.gov/sites/har/AdmRules1/11-100-1.pdf • Community Care Foster Family Homes http://hawaii.gov/dhs/main/har/har_current/AdminRules/document_view

  12. HAWAII ADMINISTRATIVE RULES TITLE 1 DEPARTMENT OF HEALTH CHAPTER 90 ASSISTED LIVING FACILITY §11-90-1 Purpose §11-90-2 Definitions §11-90-3 Licensing §11-90-4 Minimum building and structural requirements §11-90-5 Emergency care and disaster planning §11-90-6 General policies, practices and administration §11-90-7 In-service education §11-90-8 Range of services §11-90-9 Records and reports §11-90-10 Admission and discharge requirement §11-90-11 Severability

  13. Residents Rights in Assisted Living Facilities (chapter 90) The facility shall have written policies and procedures which incorporate the assisted living principles of individuality, independence, dignity, privacy, choice, and home-like environment. The resident shall be informed of his or her rights, including steps for complaints and appeals upon Admission. August 12, 1999

  14. Residents Rights (F151) • A Facility MUST protect and promote the rights of each resident!! • Dignified existence / Home-like Environment • Self-determination • Communication/access • Exercise rights as a citizen of USA • Free from interference, coercion, discrimination and reprisal

  15. More Residents Rights • Even if adjudicated incompetent, facility must respect the resident’s wishes to the maximum extent practicable (F152) • Facility must inform residents of their rights in writing and orally in a language resident understands (F156) [OLA] • Resident has right to access ALL records pertaining to him/herself and purchase copies (F153)

  16. Why We Need Representatives For Hawaii’s Long Term Care Residents

  17. Hawaii’s Long Term Care Residents • 12,129 LTC residents state-wide: - 49 Nursing Homes (4,309 beds) - 502 Adult Residential Care Homes (ARCH), exp, type I and II (2,748 beds) - 13 Assisted Living (2,249 beds) - 1,130 Community Care Family Foster Homes (2,823 beds) ….Total community beds 7,820 Total: 1,694 Facilities (7/24/14)

  18. Long Term Care Ombudsman Program Staffing • 1 State LTC Ombudsman - John G. McDermott • 1 LTC Ombudsman Specialist – Susan Miyamoto • 1 LTC Ombudsman Volunteer Coordinator Ashley Muraoka-Mamaclay • 1 Clerical Support (eliminated by 2005 Legislature) • National Institute on Medicine (1995) MINIMUM Staff Recommendation: 1 for 2,000 (HI:12,129)

  19. National Statistics • More than 2 million elderly Americans are victims of neglect or mistreatment every year • According to the National Elder Abuse Incident Study, only 15% of all elder abuse is reported.

  20. “Knowledge is Power” • Older Americans Act of 1965 • The National Consumer’s Voice for Quality LTC (formerly NCCNHR) • Nursing Home Ombudsman Demonstration Pilot 1975 • Long Term Care Ombudsman Program 1978 • Omnibus Budget Reconciliation Act of 1987 (OBRA) • a.k.a. -Nursing Home Reform Act of 1987 • www.Medicare.gov “Nursing Home Compare”

  21. “Kupuna Caucus!!” • Meets monthly at State Capitol • “Movers and Shakers” • Agenda Info: • Call Senator Suzanne Chun-Oakland 586-6130 Next Meeting: August 1, 2014 Room 309, 1:30 -3:30 pm

  22. Community Resources • Elderly Affairs Division • Geriatricians/Case Managers/RNs and SWs • Department of Veterans Affairs (PNA) • DOH OHCA • DHS/EOA/Office of Consumer Protection • Senior Companion Program /AARP • Family Caregivers Network / Hospice

  23. Hawaii Legislators • Are you registered to vote?? • www.capitol.hawaii.gov • Public Access Room • 587-0478 • par@capitol.hawaii.gov

  24. Act 213!! • ALL long term care facility inspections will be on DOH website beginning July, 2015! • Similar to “Nursing Home Compare” website on medicare.gov ******* • CCFFHs moving from DHS to DOH starting July 1, 2014.

  25. “Do not regret growing older.  It is a privilege denied to many.”  ~Author Unknown