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The roleplayer: through the years, Ombudsmen are an ally for long term care.

For the last four years, Donna Hering has visited a nursing facility in her community. While that in itself isn't unusual, what makes her visits unique is that Hering is an ombudsman.

Hering is one of thousands of trained volunteer ombudsmen who regularly visit long term care facilities, educate residents of their rights, monitor conditions and care, collect data and provide a voice for those who are unable to speak for themselves.

Or, as she says, "all I do is show I care."

That's "CARE," as in Communicate with residents and listen to their concerns, Aid communication between residents and staff, Resolve problems and complaints and Educate residents and their families.

The aptly-named ombudsman--which means "citizen representative" in Swedish--is often a mediator. A typical example of Hering's day: an administrator asked her to meet with two residents who disagreed about T.V. "They shared a room and were always arguing about what to watch. I negotiated an agreement, and it worked."

Everywhere you look

The Long Term Care Ombudsman Program is in every state and was mandated more than 25 years ago to handle complaints from residents, families, staff and others involved with nursing home facilities. Paid and volunteer ombudsmen work to settle problems in nursing facilities, board and care homes, assisted living facilities and similar adult care facilities.

The Office of the State Long Term Care Ombudsman Program is most often housed within the state unit on aging, and funding for the program is patched together from multiple sources at the federal, state and local levels. Usually, local ombudsman programs are headed by a paid coordinator who in turn has trained volunteer ombudsmen, who are assigned to facilities in the community.

There are three broad categories of ombudsman work:

* Advocacy. Ombudsmen are the eyes and ears of the community, working to ensure that long term care residents are treated with dignity and respect. They can help educate residents and families on their rights and responsibilities. They can serve as a resource in developing resident and family councils. And, when a discharge or eviction is necessary, ombudsmen can assist in finding another facility and explaining options.

"When I wear my advocate's hat, I tackle issues from unappetizing food to unanswered call lights," Hering says.

* Mediation. An ombudsman can be an impartial third party to mediate disputes between residents, or to resolve conflicts between residents and staff or residents and family, according to Hering. Having someone to help resolve disputes can prevent disagreements from escalating.

* Visiting. Finally, ombudsmen are visitors and listen to residents' concerns and problems ["The No. 1 concern is that there isn't enough staff to care for the residents."] For example, moving to a long term care facility can be a difficult time for many residents. An ombudsman can visit new residents or those who need extra emotional support.

To obtain the services of or volunteer to be an ombudsman, or to learn more about the program, locate your state ombudsman at www.ltcombudsman.org or call Eldercare Locater at 800-677-1116.

CHRONOLOG

1977 The Health Care Financing Administration (HCFA) is created to better coordinate Medicare and Medicaid. In 2001, HCFA was renamed the Centers for Medicare & Medicaid Services (CMS).

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Early 1980s Diagnosis Related Groups come into prominence. The Medicare program constitutes a system for classifying patient care by relating common characteristics to determine necessary hospital resources and length of stay, and form the cornerstone of the prospective payment system. Ultimately, they lead to shorter hospital stays, thereby sending patients to nursing homes sooner and more often.

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1987 The Omnibus Budget Reconciliation Act of 1987 (OBRA-87) is enacted. Landmark federal legislation that made significant changes to the regulatory structure governing nursing homes. The Act changed many of the requirements for nursing homes participating in Medicare and Medicaid, including the institution of more thorough and frequent patient assessment routines, the improvement of nurse's assistant training requirements and a declaration of residents' rights. OBRA-87 also imposed significant new requirements on states to survey and certify nursing homes, and instituted a number of sanctions and enforcement mechanisms.

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Late 1980 Assisted living facilities begin to emerge, developing into a midway point for people between home care and nursing homes. Thus, they create a different (more affirmed) type of resident for nursing homes. And, they also open up more career opportunities for caregivers.

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1989 Under OBRA-87, all nursing assistants must complete special training and become certified nursing assistants (CNAs) by this year.

[ILLUSTRATION OMITTED]

1990 The Omnibus Budget Reconciliation Act of 1990 (OBRA-90) modifies some of the requirements of OBRA-87, with a focus on residents' rights and the standards of care facilities must meet.

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1995 The National Association of Geriatric Nursing Assistants (NAGNA) is established with a stated mission to "elevate the professional standing and performance of certified nursing assistants through recognition, advocacy, and education while building a stronger alliance with health care providers to maximize success and quality patient care.

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1997 HCFA establishes the Minimum Data Set (MDS), a standardized definition of items assessing the quality of care of residents. Taking effect in June 1998, the plan means long term care facilities are now required to complete and transmit MDS data to the designated state agency for all residents as a condition of participation in Medicare and Medicaid.

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1999 HCFA establishes the Outcomes Assessment Information Set (OASIS), which is designed to measure and improve the quality of care administered by home health agencies.

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Diane Persson is director of the Long Term Care Ombudsman Program and academic preceptor for the University of Texas Health Science Center at Houston School of Nursing's Long Term Care Administration Program.
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Title Annotation:Caregiving Through the Years
Author:Persson, Diane
Publication:Contemporary Long Term Care
Geographic Code:1USA
Date:Nov 1, 2003
Words:948
Previous Article:Professional aspirations: from bedside helpers to certified long term care experts, the nation's caregivers have come into their own.
Next Article:Comforting changes: in 25 years, long term care equipment has advanced to make residents' and caregivers' lives more comfortable.
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