2017-01-13 / Family

Senior ombudsman program meets changes in county’s elder care industry

Volunteer group advocates for residents in assistedliving homes
By Hector Gonzalez


ADVOCATES—Since 1981, a volunteer senior ombudsman program overseen by Long Term Care Services of Ventura County has advocated for the 8,500 residents of skilled nursing, assisted-living, and small board and care homes in the region. Every week, the volunteer advocates make unannounced inspections at some of the 233 residential care facilities across the county. ADVOCATES—Since 1981, a volunteer senior ombudsman program overseen by Long Term Care Services of Ventura County has advocated for the 8,500 residents of skilled nursing, assisted-living, and small board and care homes in the region. Every week, the volunteer advocates make unannounced inspections at some of the 233 residential care facilities across the county. Sylvia Taylor-Stein was inspired by her own family’s experiences when she launched a local crusade five years ago against what was the “go-to” practice in nursing homes of using drugs to calm agitated Alzheimer’s patients.

Her uncle, aunt and paternal grandmother all suffered from dementia, said Taylor-Stein, executive director of Long Term Care Services of Ventura County Inc.

“My uncle would run up the staircase of his home and across the landing, and he’d do it over and over,” Taylor-Stein said, sitting in the wood-paneled conference room in the organization’s suite in a Ventura office complex.

“The doctors said, ‘We can give him something.’ But my aunt said, ‘No. He was a shipbuilder. That’s all he ever did was go up and down scaffolding.’ Eventually, he would tire himself out and sit down.”

Although all three of her relatives were cared for at home by relatives, her story illustrates an important point about how nursing homes can provide better quality of care for their residents, Taylor-Stein said.

“It’s very important to know the patient’s story,” she said. “Facilities need to do a family interview and find out that person’s story. It makes all the difference in the world in the care of that person, especially if they have dementia or Alzheimer’s.”

Over-drugging and other forms of elder abuse in nursing homes can often go unreported, but when abuse or neglect occurs within any long-term care facility in Ventura County, residents have a way to be heard.

Since 1981 when it was founded, a volunteer senior ombudsman program overseen by Long Term Care Services of Ventura County has advocated for the 8,500 residents of skilled nursing, assisted-living, and small board and care homes in the region.

Every week, the volunteer advocates make unannounced inspections at some of the 233 residential care facilities across the county. They spend two to three hours going over a detailed checklist, Taylor-Stein said.

“They’re looking for hygiene,” she said. “They’re looking for safety, at the menus, at the quality of food, at activities. They’re looking for any signs of distress or neglect or abuse . . . for how long it takes that facility to answer a call line. They’re checking bathrooms, kitchens . . . walking the halls and talking to all the residents.”

When reports of physical abuse or serious neglect surface in the county, the local ombudsmen refer cases to Adult Protective Services and the county district attorney’s office.

Created during the Nixon administration, the federal Long- Term Care Ombudsman Program directed the Department of Health and Human Services to help states set up “investigative units which would respond in a responsible and constructive way to complaints made by or on behalf of individual nursing home patients.”

The federal mandate requires only annual visits to nursing homes. But when county residents Bee Ellisman and Shirley Radding launched the local ombudsman program 35 years ago with just one staff member and two volunteers, they insisted on weekly visits.

“Right now were working on bed rails,” Taylor-Stein said. “They’re not supposed to be used without the doctor’s order, but sometimes families or the facility will use them to keep a resident in bed, which they cannot do. So we’re trying to work with our volunteers to make them aware of these bed rails and to make sure there’s a doctor’s order, and they can only be half-bed rails. That’s something that’s been on our radar recently.”

Another problem that has increased in recent years is financial abuse, in which the son or daughter of a dementia patient takes control of the parents’ home. Grown children end up moving into the home, pushing parents into nursing homes, she said.

“Ten years ago, financial abuse wasn’t even on our radar. Now it’s on there a lot,” Taylor-Stein said. “I think it’s because our culture has changed. There’s more of a sense of entitlement among family members that we see. They feel entitled to it. ‘If Mom owns it, it should be mine.’ We didn’t see that a decade ago. We call it pre-allocation of assets.”

Today, the program has 57 state-certified volunteers and annually recruits for new applicants.

“There’s a constant need for volunteers. A lot of our volunteers are older. Sometimes they stop because of a spouse’s health issue or they have their own health issues,” she said.

The volunteer ombudsmen, mostly retired professionals with college degrees “who made great contributions during their careers and want to continue contributing,” are rigorously screened, including FBI background and fingerprint checks, Taylor-Stein said.

They complete a weeklong training course, which is given once a year, she said.

“The training is 9 a.m. to 4 p.m. every day—that’s a big commitment. So right away that weeds out a lot of people,” she said.

The training culminates in 15 hours of field work in which new volunteers shadow veteran ombudsmen making inspection visits.

The next training session is Feb. 13 to 17, and dozens of people have already applied. Taylor-Stein is hoping to add eight or nine new volunteers from the pool of applicants.

“We really, really need volunteers in Camarillo,” she said. “Right now we have a couple of people driving from out of Camarillo to cover those areas, and we also have an ombudsman at large, who is part of staff, who is helping cover the area.”

Although the screening and training for volunteers is intense, successful applicants can choose their own hours, fitting their inspection visits into their personal schedules.

“It’s a tough job,” said program manager Kathy Terry. “A lot of times the ombudsman will have to deal with a provider who is resentful of the implication that they’re not providing stellar care, and so they’ll take it out on the ombudsman.”

Two years ago, state lawmakers had to intervene and pass new legislation to give the ombudsmen access to patients after care providers began using patients’ privacy laws as an excuse to block visits with individual nursing home residents.

Now, however, most of the county’s long-term care facilities find that working closely with their ombudsmen improves the quality of care at their facilities and reduces residents’ complaints, Terry said.

With the help of the program’s cadre of volunteers, Ventura County reported only two complaints of serious abuse among long-term care residents in 2015-16, the lowest among 14 other counties in the state, according to the California Department of Public Health.

Five years ago, Taylor-Stein began working with the California Advocates for Nursing Home Reform to bring attention to the issue of using drugs to calm agitated patients with dementia or Alzheimer’s disease.

She brought local residential care providers together in a series of symposiums about non-drug options and was honored for her efforts in 2012 by the National Consumer Voice for Quality Long- Term Care.

She continues to track the “least drugging” facilities in the county, using statistics she gleans from Medicaid and Medi-Cal, and publishes the list on the program’s website.

“Most of our facilities are doing really good, with maybe one or two doing not so good,” Taylor- Stein said. “Overall, the facilities are coming around. It’s just taken a long time.”

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