1. Assisted Living: What to Expect From Us
Patty Ducayet, State Long-Term Care
Ombudsman

2. Agenda
• Give background about the ombudsman
program
• Explain why our services are expanded
• Let you know what to expect on a visit
• Most common complaints to ombudsmen
• Q and A
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3. Objectives
• Distinguish between the role of an
ombudsman and surveyor
• Be prepared for an ombudsman visit
• Know how to contact an ombudsman
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4. LTC Ombudsman Overview
• State- and federally-mandated program
• DADS contracts with 28 area agencies on aging to
operate the long-term care ombudsman program
under the direction of the state ombudsman
• Texas operates its program with 68 FTEs and 675
volunteer ombudsmen, ranking 4th in the nation
in program size
• Texas has 2nd most nursing facilities and 11th
most assisted living facilities in the country
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5. Distinguishing Ombudsmen
• Medicaid services
• Waiver services
• Managed care
• Independent Ombudsman
for SSLCs
– State Supported Living
Centers
– Staff and volunteers
• State Long-term Care
Ombudsman Program
– Nursing home
– Assisted living
– Staff and volunteers
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6. Ombudsman Program History
• 1972, a grant program—
operated as the Nursing Home
Ombudsman Program—by the
Texas Department of Aging
• 1980, Texas began to operate
statewide; focused on
developing volunteer
component
• 1981, assisted living and board
and care homes added to
program responsibilities
• 1999, assisted living facilities
licensed by the State of Texas
• 2000, Texas ombudsman
statute updated to include AL
• 2000-2003, Unlicensed facility
project
• 2003 and 2008 State
performance measures of AL
• 2013, funded by the Texas
Legislature to expand services
in assisted living facilities
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7. LTC Ombudsman Overview
• Protect the health, safety, welfare, and rights of
residents of nursing and assisted living facilities
• Identify, investigate, and resolve problems
affecting residents
• Work with residents, family and friends, facility
staff, and outside agencies to resolve problems
• Represent the interests of residents to facilities
and agencies
• Make policy recommendations to government
agencies and elected officials
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8. Ombudsmen Advocate
• Nursing facilities
• Intermediate care facilities
for persons an intellectual
disability
• Adult day care facilities
• Assisted living facilities
• Home health care providers
• Hospice providers
• Intellectual disabilities
waiver providers
• For quality of life and care for
residents in nursing homes and
assisted living facilities.
• Federal and state authority
mandates ombudsmen to
identify, investigate and resolve
complaints made by, or on behalf
of, people living in nursing homes
• Provide services to help in
protecting their
health, safety, welfare and rights.
• Provide information and
assistance in choosing the most
appropriate living residence.
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9. There are the people who walk across the
bridges as though they built them.
The bridge builders are few and far between.
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10. Ombudsman History with ALFs
• 2011, 2012, 2013 ALF
quarterly visits
– 11% and 13% and 10%
– 5000+ total
• 2011, 2012, 2013 NH
quarterly visits
– 82% and 86% and 82%
– 30,000+ total
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11. Why Ombudsman Services Are
Needed in ALFs
Proliferation of
ALFs
Complexity of
residents’ needs
Compared to
nursing
homes, fewer
standards
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12. Ombudsman Training on ALFs
• October 2013
• December 2013
• DADS computer based training
– Aging in Place and Retaliation (aka Annual
Surveyor)
– Basic Licensure
– Desk Review Process
• March 2014 – ALF rules, specialized services
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13. Two-Way Education Process
• Staff may…
– Appear resistant
– Protective of information
• Educate staff…
– On ombudsman program
– Role
• Bring resources
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14. Two-Way Education Process
• Educate yourself
– Ask good questions
– Listen to language
• On the visit…
– Ask for a blank admission packet
– Familiarize yourself
– Request a copy of the Disclosure Statement
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15. ALF Fee Structures and Billing
• Ombudsmen have been educated about ALF fee
structures, such as:
– Private pay environment
– Three main delivery approaches:
– All inclusive
– A la carte
• Packaged plans
– Fixed service plans
– Flexible service packages
– Time specific packages
– Other common fees
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16. Visit Basics
• Educate
• Request facility documents
• Collect roster
• Locate postings
• Talk with residents, staff
• Build trust, relationships
• Resident councils
• Strategize approach
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17. Visitation Schedule and
Expectations
• Generally, quarterly visits
• Visit Schedule Exceptions:
– Large programs (100+)
• 2x/yr to small facilities (Type A,C)
– Small and Medium ombudsman
programs
• 6x/yr to large facilities (Type B)
(6 diff. mos. & 4 quarters)
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18. When a Complaint is Identified
• Listen to the resident, take
time, speak privately if
resident is willing
• Observe, Interview, Record
Review
• Determine if other people
can help and whether the
res. tried to address the
problem
• Collect information
• Speak to the resident
• Observe, Interview, Record
Review
• ONLY TAKE ACTION WITH
PERMISSION FROM
RESIDENT or COMPLAINANT
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19. Most Common Complaints
1. Food service
2. Equipment and building in disrepair
3. Medications
4. Discharge process
5. Information regarding rights
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20. • Home kitchen
• Check food supplies
• Request menu
• Adult day lunch
• Commercial kitchen–like
nursing home
• Visit at mealtime to see
more residents
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Food Service

21. • Neighborhoods
• Decaying buildings
• Fire safety in old homes
• More people at risk
• Multiple stories
• Wheelchairs and evacuation
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Equipment and
Building Disrepair

22. • Common medication
storage area
• Attendants and residents as
reminders
• Common medication
storage area
• In-room storage
• Bubble packaging
• Automatic dispensing
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Medications

23. Questions and Answers

24. Contact Information
• State office
– State ombudsman – Patty Ducayet
– State office – 512-438-4265
• Local
– Statewide toll free number
• 1-800-252-2412
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25. Texas Resources
• S&CC 13-04 Skilled Nursing Services in ALFs
• S&CC 10-03 Home and Community Support Services Agency Compliance
with Texas Human Resources Code Chapter 102, Rights of the Elderly
• PL 14-01 – ALF Locked Alzheimer’s Units
• PL 14-02 Changes to ALF Standards (NFPA and other)
• PL 13-33 Emergency Planning for Individuals Who Require Bariatric Care
• PL 13-32 Aging in Place
• PL 13-16 Ashtrays of Noncombustible Material and Safe Design
• PL 12-25 Annual Mandatory Training for ALFs
• PL 12-09 Inappropriately Placed Residents
• PL 11-37 Skilled Nursing Services in an ALF
• PL 11-36 New Health and Safety Code (HSC) Chapter 260A Regarding
Reporting and Investigating Abuse, Neglect and Exploitation (ANE)
• IL 13-18 Prefilling Medication Planners
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26. Computer-Based Training (CBT)
Courses
• ALF Pre-Licensure Training
– Approx. 1-2 hours
– http://www.dads.state.tx.us/providers/ALF/training/cbt/in
dex.html
• Annual Mandatory Training for ALFs
– Approx. 30 mins.
– http://www.dads.state.tx.us/providers/ALF/training/cbt/an
nual.html
• Desk Review Compliance
– Approx. 30 mins.
– http://www.dads.state.tx.us/providers/ALF/training/cbt/d
eskreview.html
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