Thanks to the American Rescue Plan, the crucial work being done in Nursing Homes and Assisted Living Facilities by Long Term Care Ombudsman Programs is being acknowledged in a meaningful way. These programs work more independently and closely with facility residents and their families than any other organization. Since the programs’ inception the positive impact of these crucial services has been undeniable. The Rescue Plan is the most meaningful and well-deserved acknowledgement in over 30 years.
As valuable as the Ombudsman Program has been, it has never been able to reach all of those who need and are entitled to these vital services. Hopefully, Rescue Plan resources can be used to address two of the issues that have stood in the way of the Program fulfilling its charge. Those would be; 1) The substantially inadequate staffing level of Certified Ombudsmen in Programs at the Local Level across the country, and 2) an overdependence on volunteers to provide the bulk of direct services. Hopefully, an influx of new resources can target these concerns.
Inadequate Staffing in Local Ombudsman Programs
The Older Americans Act, Section 712(a)(3)(D), requires that the Long-Term Care Ombudsman Program “ensure that the residents have regular and timely access to the services provided” (emphasis added). The sad truth, however, has been that thousands of vulnerable residents are not, and have never been afforded such access. Lacking anything close to adequate staffing resources has rendered ensuring said access impossible. Ironically, where the lack of clinical staffing in Nursing Homes has long been a hot issue that gets national attention, staffing for Local Ombudsman Programs has never been adequately acknowledged. It is beyond time to do so and it is beyond time to do something about it.
The most critical services provided by the Long-Term Ombudsman Program include investigating complaints, responding to concerns from residents and family members, observing conditions in facilities, attending care plan meetings and working with resident and family councils. Clearly, in order to satisfy the Federal charge of “regular and timely” access to services for residents, Ombudsmen must conduct regular, in person visits to the facilities for which they are responsible, preferably on a weekly basis. The numbers below irrefutably show that they are not able to do so for a substantial number of facility residents.
To illustrate the dire circumstances around Ombudsman staffing, consider the following 2019, national data posted by the Administration on Community Living:
· 4,931 (30%) of the 16,253 nursing homes were not visited by a Certified Ombudsman (paid or volunteer) at least quarterly (once every three months).
· 40,394 (70%) of the 58,078 Assisted Living/Board & Care facilities were not visited by a Certified Ombudsman (paid or volunteer) at least quarterly (once every three months).
· On Average, each paid Ombudsman (1FTE) was responsible for trying to serve 2,320 long term care beds.
o In nine states the ratio was 1 FTE for every 4,000 beds.
o In five states the ratio was 1 FTE for every 5,000 beds.
Overdependence on Volunteers
In almost every state, the model for providing Long Term Care Ombudsman services is to have a core of volunteers supported by a smaller team of paid staff. That support includes recruiting, training, supervising and placing each volunteer at a particular facility or facilities. Each volunteer receives approximately 36 hours of training, including visits to facilities, after which they are Certified to provide services.
The bulk of volunteers are often seniors themselves. Many are retired. Few have any background directly or indirectly related to the type of work required of an Ombudsman. The training includes complicated topics like complaint investigations, medical confidentiality, legal guardianships, healthcare benefits, appeals and due process, etc. Many are asked to provide up to 10 hours of service per week. As one can imagine, the quality of services these devoted individuals provide varies greatly. The task of recruiting, training, placing and supervising volunteers is extremely labor intensive for the paid support staff. Consequently, the volunteers are left providing the vast majority of direct core services.
Being a Volunteer Ombudsman is very much like a paid job in and of itself. The work is often quite stressful and difficult. Consequently, the turnover rate is very high. Since 2000, the number of volunteers has dropped nearly 30% nationally, from 8,393 to 5,947, prior to the pandemic. Since the pandemic, although actual data is not yet available, Local Ombudsman Programs are reporting a substantial drop in volunteer numbers. Going forward it is fully expected that that trend will not just continue, but is likely to increase. Thus, the already inadequate ability of programs to provide core services is destined to worsen.
Summary
As the numbers listed above clearly show, the current staffing resources are inadequate and the model of reliance on Volunteers in providing core services just isn’t working. Many of those who are entitled to receive services are not being afforded that opportunity. And, due to the impact of the Covid-19 pandemic, things are destined to get worse. Where the value and need for Ombudsman services has been proven essential, the current method of providing those services has fallen far short. What began as a well-intended program of much needed vital services is undoubtedly falling short of meeting that need.
It is clearly time to modify how the services of the Long-Term Care Ombudsman are provided. It is hopeful that the new influx of resources yet to be provided by the American Rescue plans can be put to use in making the necessary modifications. Many thousands of residents are waiting for that to happen.