Your Ombudsman is Here to Help You

I became involved in nursing home resident advocacy through my work as a music therapist. I had a number of elderly clients who declined and had to be moved to nursing homes. I followed them there. In addition, I worked for a time in nursing homes conducting individual and group music therapy sessions.

As a music therapist I could do a lot for these people within the scope of my own practice. However, they had many needs that went beyond music therapy and that I was helpless to address. There is little a music therapist can do if a resident remains unchanged for hours, is not getting needed medical services, or is being treated disrespectfully by staff members. I could bring these matters to the attention of staff, but after that it was out of my hands.

Only later did I realize I had an additional resource at my disposal: the long-term care ombudsman. Many caregivers have no idea that this resource exists, but if they can find a good ombudsman at their facility they will discover an effective ally in getting their problems addressed and often solved.

In 1978 the revised Older Americans Act required every state to establish a Long-Term Care Ombudsman Program (LTCOP). An “ombudsman” is literally an advocate. A long-care ombudsman is a resident advocate, whose duty it is to protect residents’ rights and to intervene when a resident acquires assistance. While ombudsmen (which of course include many women) have no enforcement authority, there is much that they can do as advocates to improve the quality of the residents’ lives. They do this in several ways:

  • They bring problems to the attention of the staff that would otherwise be neglected.

  • They educate the staff on the requirements of nursing home regulations.

  • In difficult cases they can negotiate with staff and administration to secure the best possible outcome for the resident consistent with the legitimate needs of the nursing home.

  • They can be the “bridge over troubled waters” when relations between staff and residents, or between staff and family members, are poor and communication has been difficult.

The ombudsman does not work for the facility, but is independent. A staff member, say a music therapist or even a volunteer, who witnesses an infraction and tries to intervene, may be subject to dismissal. The administration, however, cannot dismiss the ombudsman. In fact, it is a violation of the law for a facility to interfere willfully in the performance of the ombudsman’s duties.

The ombudsman is not limited by HIPAA. The Health Insurance Portability and Accountability Act of 2010 (HIPAA) is a very strict law protecting confidentiality of medical information. If anyone other than a resident’s immediate family member or legal representative tries to intercede for the resident, the nursing home can justifiably refuse to deal with that person because of HIPAA restrictions. The long-term care ombudsman, however, is not subject to such restrictions. The LTCOP is considered by law a “health oversight organization” and is exempt from HIPAA requirements. Therefore, if the ombudsman has the authorization of the resident or the resident’s designated representative, he or she also has the right to discuss the case with any staff member and to access the resident’s medical record.

The ombudsman has training in nursing home regulations. Residents or family members may not be well acquainted with their rights under the law, but the ombudsman has that information and can educate them on the considerations to which they are entitled.

So if you are experiencing a problem in the nursing home that you can’t solve by yourself, call your local long-term care ombudsman program. The number should be readily available. The nursing home is required to display it prominently, and to give it to you upon request.

Unfortunately, largely due to economic reasons not every nursing home has an individual ombudsman assigned. Find out if yours does. Even if it does not, you can call your local LTCOP office and ask to speak to a supervisor, and they may be able to give you some advice or direction over the telephone.

Don’t fight all your battles by yourself. Take advantage of this valuable resource.

August 2015