Every year, the Ombudsman Program releases a report to highlight the program’s accomplishments and showcase its recommendations for change in the long-term care industry. Every year, the report is placed in the hands of lawmakers, consumers and providers alike. It traditionally includes statewide statistics on the number and types of complaints investigated, the number of facility assessments conducted and the number of free trainings ombudsmen offered to residents and the public. But this year, the report may look a little different. “In the past our reporting relied heavily on statistics,” said the director of the Ombudsman Program, Brian Lee. “We let the numbers speak for themselves. What we’re adding this year, to complement the data, are the actual ‘voices’ of residents. And ombudsmen too, in fact.” As readers thumb through this year’s

report, they’ll find dozens of quotes and short stories from residents, their caregivers, family members and ombudsmen. Each anecdote serves to bring the numbers and statistics to life by providing a glimpse of the impact that less-than-quality care can have on real people. “It’s easy to get lost in the data,” said Lee. “We don’t want to forget that each one of the 8,362 complaints we investigated this year represents a real person with a real concern. By publishing residents’ stories and comments, we’re fulfilling our mission as advocates in a truly unprecedented way.”For example, the Ombudsman Program investigated 518 complaints relating to inappropriate medication administration or organization in long-term care facilities last year. The seriousness of this issue is better illustrated, however, by the accompanying quote,

(continued on page 5)

New Port Richey assisted living facility “The Westbury House,” highlighted in last quarter’s edition of the Ombudsman Outlook, finally closed at the beginning of February as a result of its inability to adhere to the standards of quality and care set by the State of Florida. Ombudsman Program reports detailed numerous issues which, though the owner and staff were alerted several times, were never corrected. Issues included untrained staff, ongoing

staff shortages, lack of adequate food for residents, inappropriate food storage, lack of activities available to residents, broken/unusable furniture, unwashed linens and the disrepair of facility buildings. “One issue we brought to the owner’s attention sev-eral times was the use of old baked goods donated from a local café being heaped into garbage bags, stored on the floor and then being served to residents,” said Diane Carpenter,

(continued on page 5)

ombudsman program delivers revamped 35th annual report

Annual Report Revamped...................................................1Problem Facility Closure.......................................................1From Our Director:Legislative Session............................2Ambassadors for Aging Day...............................................2Winter Quarter Complaint Data.........................................3Resident Councils Benefit Residents & Facilities.........4

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OMBUDSMANOUTLOOK

spring 2010

THE OFFICIAL NEWSLETTER OF FLORIDA’S LONG-TERM CARE OMBUDSMAN PROGRAM

vol.12

Problem facility forced to close, owner applies for new license

State Ombudsman Brian Lee has been

serving Florida’s Ombudsman

Program as its director since 2003.

Governor Charlie Crist

Department of Elder Affairs

SecretaryE. Douglas

Beach, Ph.D.

State Long-Term Care Ombudsman

Brian Lee

Ombudsman Outlook EditorElizabeth Davis

Making Residents a Priority This Legislative SessionThis year, Tuesday, March 2, was the first day of the 2010 Legislative Session. For the Ombudsman Program, this means the beginning of a close watch of several bills that have the capacity to improve the lives of residents in long-term care facilities across the state. Bills of interest to the program this year are as follows: SB 1102 & HB 817, sponsored by Sen. Fasano and Rep. Anderson, respectively. These bills would provide discharge protection to residents of assisted living facilities. The bills amend section 429.28, Florida Statutes, to require that an ALF provide written notice of a relocation or termination of residency specifically to the resident and his or her legal representative. The proposals list the grounds under which a resident may be relocated and requires the Department of Elder Affairs to develop a standardized form to be used by facility staff when relocating a resident. The bills also require that the facility provide a copy of the notice to the Ombudsman Program within two days of issuing it and permit a representative of the local council to meet with the resident at the resident’s request. SB 656 & HB 529, sponsored by Sen. Fasano and Rep. Roberson, respectively. These bills concern the protection of ombudsmen personal information. The bills would exempt certain information related to an ombudsman and his or her family from public disclosure. Protected information would include the ombudsman’s home address, telephone numbers and places of employment of the spouses and children of ombudsmen or the names of schools and day care facilities attended by the ombudsman’s children. These bills would allow ombudsmen to advocate for residents without fear of harassment or retaliation. The Program will also be monitoring progress on SB 442 and HB 171, which propose raising a resident’s personal needs allowance from $35 per month to $70 per month. This amount has not been raised since 1988, and the Program believes that a raise is long overdue. Finally, the Ombudsman Program will be monitoring the background screening proposals, advocating to increase the minimum requirement to a Level 2 screening for all employees and contracted workers who have access to long-term care residents as well as several deregulation proposals, including SB 1816, to ensure that residents’ care and quality of life is not compromised by these proposals.My sincerest thanks to Governor Crist and Department of Elder Affairs Secretary Beach for your leadership and support of these important bills. Your outstanding service to our state’s elders will serve to improve the quality of life and care for long-term care facility residents.

from our director

Once a year, usually just after the start of the Legislative session, the city of Tallahassee extends a warm welcome specifically to elders. This year, the 10th Annual Ambassadors for Aging Day (AFAD) will kick off on March 10 on the front steps of Florida’s Capitol Building and will celebrate and feature elders from senior centers, nursing homes, assisted living facilities and senior community groups from around the state. Seniors will have the unique opportunity to receive free health screenings, enjoy live entertainment, giveaways and a complimentary lunch. Seniors who inquire early will also have the opportunity to meet with various lawmakers to discuss issues that are of special importance to the senior population. Festivities will run from 10 a.m. to 2 p.m. in the courtyard between the old and new Capitol buildings in Tallahassee. If you or your local senior group would like to attend Ambassadors for Aging Day or if you would like more information, please call the Department of Elder Affairs at 850-414-2000.

2010 Ambassadors for aging day to kick off at capitol

Summary of top complaints:winter quarterUnder federal and state law, the Long-Term Care Ombudsman Program is responsible for publishing its complaint data each quarter. The following data reflects complaints received December 1, 2009 - February 28, 2010.

Facilities with the highest number of complaints in Florida this winter:

39 complaints Windsor Woods Rehab & Healthcare - Hudson(examples: pressure sores, infection control, residents wandering, injuries, inadequate nutrition, physical restraints)

20 complaints Parks Healthcare & Rehab Center - Orlando(examples: staff unresponsive/unavailable; pests; neglect of catheter, gastric, NG tubes)

18 complaintsParklands Rehab Nursing Center- Gainesville(examples: discharge/eviction, failure to respond to requests for assistance, accidental injuries, privacy)

16 complaintsMunne Center - Miami(examples: verbal/psychological abuse, retaliation, gross neglect, abuse reporting, illegal policies, personal funds)

15 complaintsCarden House Assisted Living - St. Petersburg(examples: gross neglect, infection control, illegal policies, reprisal/retaliation, symptoms unattended)

14 complaintsGuardian Home II Assisted Living - New Smyrna Beach(examples: accidental injuries, staff unresponsive)

13 complaintsGroves Center - Lake Wales(examples: gross neglect, over-use of nursing pools, menu)

12 complaintsBroadview Assisted Living - Tallahassee(examples: failure to respond to requests for assis-tance, menu, personal/oral hygiene, personal property)

12 complaints Terra Vista Rehab & Health Center - Orlando(examples: pressure sores, staff unresponsive, hygiene)

To find out more about the Long-Term Care Ombudsman Program’s complaint or facility assessment data, call toll-free 1-888-831-0404 and ask to be transferred to a representative in your area. All services are free and confidential.

12 complaintsLoving Care Assisted Living - St. Petersburg(examples: infection control, illegal policies, no activities)

12 complaintsSavannah Cove - West Palm Beach(examples: illegal confinement, discharge/eviction, retaliation, dignity & respect, menu, personal property)

11 complaintsShady Oaks Rest Home - Daytona Beach(examples: illegal policies, physical restraints, menu, staff training, equipment or buildings in disrepair)

11 complaintsHeritage Health Care Center - Venice(examples: failure to respond to requests for assistance, shortage of staff, language barriers between staff & residents)

11 complaintsEden Gardens Assisted Living - Miami (examples: confinement, infection control, pests, odors)

3

*

*

* Asterisks indicate facilities that have previously appeared on the Ombudsman Program’s list of highest numbers of complaints per quarter.

Resident councils are one of the best-kept secrets of the long-term care industry today. There are currently over 3,800 long-term care facilities in Florida. It is estimated that while several hundred resident councils exist in these facilities statewide, most long-term care consumers may never have heard the term.

Resident councils have the potential to improve the health and wellbeing of residents and jumpstart culture change in long-term care facilities, turning difficult situations into new opportunities. Understanding the need for and structure of a resident council is the first step to introducing its many benefits. Quoted text throughout this article was borrowed, with permission, from The Resident Council Handbook, created by Resident Councils of Washington (RCW).

What is a resident council? Simply put, a resident council is “a group of residents with a purpose.” A council can be as complex and “sophisticated as a PTA with officers, directors and committees” or as simple and casual as an ongoing roundtable-style discussion. Councils can form in any type of care community, including long-term

care facilities like nursing homes and assisted living facilities. The Resident Council Handbook defines the purpose of a council as being able “to create opportunities for residents to execute meaningful decisions.”

How does it benefit residents? When considering the formation of a resident council, it is important to recognize where the potential council’s members, the residents, are coming from, in order to know what the purpose of the council will be.

“Many who come to long-term care are undergoing a series of losses. The most apparent losses are external: loss of physical or cognitive functioning, loss of a life-long home or loss of personal possessions. The less apparent internal losses can be equally or more devastating: loss of identity, self-worth, autonomy, sense of future and choice.” (RCH, 5)

As such, the formation of a recurring meeting in which residents can come to voice his or her desires and concerns on a consistent basis provides a much-needed outlet for socialization, productive communication and stability.

“Often the process of bringing residents together to discuss issues, ideas and concerns is more important than the outcome of the discussion. It is the discussion itself which begins the process of resident empowerment and group confidence-building. Residents can begin to feel positive about their abilities to change things. They begin to feel good about themselves. People who feel good about themselves can do anything.” (RCH, 2)

How does it benefit facilities? According to data presented in this year’s Ombudsman Annual Report, approximately 96 percent of the complaints made to the Program in the past year concerned issues with facility staff or administration. Most

of the problems that arise within facilities, therefore, begin with staff/resident relationships. It is important to recognize that in many long-term care facilities, a conflict of perspectives presents itself on a daily basis: staff and administration naturally view time spent at the facility as a job. He or she is free to clock out, leave the premises at the end of his or her shift and return home. For long-term care residents, however, a facility is home. “Staff members shouldn’t express surprise when an issue they consider routine (i.e., switching a resident’s bath day) becomes a major confrontation encompassing care staff, family members and an ombudsman. The choice of the bath day may be the only area in which the resident feels any control.” (RCH, 5)

This conflict of perspective can create a culture of tension and misunderstanding between residents and staff. Resident councils offer the means by which vital lines of communication between residents

and staff are kept open. Facilities can benefit tremendously by listening and responding to residents’ concerns. Administrators and staff can then make educated decisions about meals, activities, schedules and other daily facility happenings, creating an environment in which respect and dignity of residents is cornerstone. Furthermore, “the administrator’s role advocating a specific philosophy of care is strategic. Administrators set the tone, establish policy and enforce the rules; senior staff closely follows their example. Administrators have found that residents who have a say

How resident councils benefitboth residents and facilities

http://ombudsman.myflorida.com

“Many who come to long-term care are undergoing a series of losses.

The less apparent internal losses can be...devastating- loss of identity, self-worth, autonomy, sense of

future and choice.”

“Residents can begin to feel positively about their abilities to change things. They begin to feel good about themselves. People who feel good about themselves can do anything.”

taken verbatim from a complaint made to the program:“All [our mother’s] existing medications were changed to include strong medications for pain, anxiety and depression. Our mother suffered from none of these problems. The use of these strong, unnecessary drugs, Seroquel, Ativan and others put her almost immediately into a comatose, vegetative state. The

family spoke extensively with the nursing staff about our mother’s sudden changes in condition, but we received conflicting and nonsensical explanations from everyone we spoke to.” This and other recurring issues are highlighted in this year’s annual report. It is the ombudsmen’s hope that by publishing the testimonies of both residents and ombudsmen, they can encourage lawmakers and

consumers to be more aware of the most common deficiencies in long-term care facilities and work to improve the quality of life for Florida’s most treasured population. To receive a free copy of this year’s annual report, call toll-free 1-888-831-0404 or send an email to LTCOPinformer@elderaffairs.org. The report is also available for viewing and printing online at http://ombudsman.myflorida.com.

annual report revamped (continued from page 1)

who is the Regional Manager for the northern portion of the state. Carpenter worked closely with local ombudsmen and Agency for Healthcare Administration (AHCA) officials to document the facility’s many deficiencies. When the facility closed on February 5, Carpenter, along with the entire Pasco & North Pinellas ombudsmen and staff, had assisted all 27 residents with relocation and helped inform them of their rights.“We co-monitored the facility with AHCA on a regular basis throughout the closure process, making sure that staffing, food and medical care remained in place until every resident was moved,” said Carpenter. “Our volunteers were fantastic. They gathered the contact information for every resident’s case manager, caregiver, family member, etc. , divided up the list and called everyone to inform them of the facility’s closure and of the need to be vigilant to retain all of the residents’ personal effects during the move.”The employee who was convicted of multiple counts of aggravated stalking, Raymond Lugo, who was mentioned in the previous article concerning the Westbury House, remained on the premises until the facility officially closed its doors on February 5. The owner of the Westbury House, Julius Reyez, recently applied for new license under which he intends to reopen the facility.

resident councils (continued from previous page)

the operation of their facilities tend to be more satisfied with their care. Investment and support of residents’ rights would therefore seem to be not only a moral obligation, sometimes a legal necessity, but a solid business decision.” (RCH, 6)

What does a good resident council look like?“The primary purpose of a resident council is to create opportunities for residents to execute meaningful decisions. It is essential for residents to define and control all aspects of a resident council.” (RCH, 2)

According to the National Citizens’ Coalition for Nursing Home Reform (NCCNHR), a “model resident council” has the following characteristics: -Residents run the council-The council receives support, but not interference, from facility staff as the council sees fit-Residents feel comfortable speaking freely and raising issues-Residents are treated in a dignified manner and their issues are taken seriously-Concerns and problems are promptly addressed by the appropriate departments and

resolved to residents’ satisfaction-Residents have access to information as needed and requested by the council-Different committees address the issues raised and then follow up at the next meeting-The council is a vehicle to bring about positive changes for all residents in the facilityEssentially, the “culture of a residence depends upon the operation of administrators, owners and operators, with staff, in concert with residents, their family members and the community. All these elements working together combine to form the character of a facility.” (p5, RCH)

If you would like more information on how to begin a resident council, visit the Resident Councils of Washington website at www.residentcouncil.org or call 360-275-8000. The full, 82-page Resident Council Handbook is available for purchase on the organization’s website. Further information is availalbe at any local ombudsman office. We would be happy to assist you in the formation of a resident council. Call us Toll-free 1-888-831-0404.

facility with history of problems (continued from page 1)

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4040 Esplanade Way Tallahassee, Florida 32399-7000

OMBUDSMAN PROGRAM Florida’s Long-Term Care

ombudsman[awm-buhdz-man]

An ombudsman is a volunteer who helps to improve the lives of people who live in long-term care settings like nursing homes, assisted living facilities and adult family care homes.

As members of Florida’s elder population make the transition into long-term care facilities, a strong support system for each individual becomes critical. Unfortunately, many long-term care residents do not have anyone to look out for their best interests when it comes to personal health, safety, welfare and rights.

The Long-Term Care Ombudsman Program is made up of more than 400 volunteers who are passionate about improving the quality

of life for residents. It takes a special kind of person to commit to such a mission. We are proud to be a unique program whose success depends on the boldness and compassion of volunteers. These special individuals dedicate thousands of unpaid hours each year to ensuring that the voices of Florida’s long-term care facility residents are heard.

To learn more about how the Long-Term Care Ombudsman Program can help you or

someone you know, call us toll-free at

1-888-831-0404 or visit us online at

http://ombudsman.myflorida.com.All services are free and confidential.

If you would like to start receiving a free copy of the Ombudsman Outlook at your home or business, call us toll-free at 1-888-831-0404 or send an email to LTCOPInformer@elderaffairs.org today.