The Michigan Ombudsman Program advocates for residents of long-term care facilities

A Michigan family didn’t like their grandmother having a boyfriend, so they activated a power of attorney she had set up in case she became incapacitated, moved her from a temporary rehab facility to a nursing home on the other side of the state, and took her along. phone and laptop – all despite her being at her full capabilities. But with the help of the Michigan Long Term Care Ombudsman Program, the grandmother was able to revoke the power of attorney, leave the nursing home and go home to the last love of her life.

Michigan Ombudsman Sandra Reno shares this story, omitting the woman’s name to protect her privacy. It’s just one of many success stories for MLTCOP, which is housed in the Michigan Elder Justice Initiative (MEJI). As advocates for the rights of more than 100,000 older adults and adults with disabilities in Michigan, MLTCOP ombudsmen improve the quality of care and quality of life for people living in nursing homes, retirement communities and adult foster care. MLTCOP services are confidential and free.

The program currently has 20 paid ombudsmen and 11 volunteer/student intern ombudsmen. According to MEJI Director and General Counsel Alison Hirschel, one of the program’s most meaningful uses is helping nursing home residents stay in their facilities when they have behavioral health problems. Too often, these residents are instead transferred to psychiatric hospitals.

Alison Hirschel.

Ombudsmen investigate resident concerns regarding abuse, neglect, exploitation, eviction/discharge, hospital dumping, Medicaid eligibility, guardianship, and harm to residents. They respond to notices of involuntary discharge, attend resident care planning meetings, and make regular visits to licensed homes. They also provide information and assistance to residents, families and staff, as well as training and information on long-term care topics.

Efforts are underway to increase funding for these critical advocates. Hirschel shares that while Ohio, Pennsylvania and Illinois spend millions annually to fund ombudsmen – $2.17 million, $4.3 million and $6.78 million respectively – Michigan spends only $822,000 annually.

“There has long been a national recommendation that each ombudsman be responsible for no more than 2,000 licensed beds,” Hirschel says. “In Michigan, more than half of local ombudsmen are responsible for more than double that number of beds, a quarter of local ombudsmen are responsible for triple the number of recommended beds, and one ombudsman is responsible for nearly 12,000 beds. “

Enforcing rights, responsibilities and quality of care

The most common complaints ombudsmen hear include involuntary dismissal; the inability of nursing home staff to process requests for assistance; patients’ rights and preferences are not taken into account; personal hygiene, medications and concerns about personal belongings; and the need for dignity, respect and a less restrictive living environment.

“We are individuals who have accessed long-term care facilities and are working to help resolve concerns raised by those residents or by other concerned individuals,” said Salli Pung, long-term care ombudsman at MLTCOP. “When we visit nursing homes, we advocate for individuals. Some of the ombudsmen in our program are social workers. Some are simply committed to making a difference in people’s lives.”

Salli Pung.

Nursing home residents have legal rights, and nursing homes that receive Medicare or Medicaid dollars are required to post a poster outlining these rights. Nursing homes are also required to notify the ombudsman program when they request a patient’s involuntary discharge, such as when behavioral health problems become apparent.

“A person has the right to stay in a nursing home and can only be involuntarily discharged under certain circumstances. This is stated in the regulations,” says Pung. “One of the first things we do (is) try to gather more information about the residents. We will talk about what other interventions have been tried and what has changed recently that may be impacting their behavioral health. Moving them to a different setting moving is not always the answer.”

In addition to helping individual nursing home residents, MLTCOP advocates for policies, procedures and legislation that can better serve all Michiganders who may need long-term residential care – a number that will only increase with the growing population of older adults in the stands.

“We will often testify on legislation. We speak on behalf of the residents and try to improve the system,” Pung said. “We also have the opportunity to meet with people from the Michigan Department of Health and Human Services and Michigan’s Licensing and Regulatory Affairs Agency and primary payer sources for Medicaid services. We talk to them about policies or procedures where change is needed, or new policies or procedures (are needed), to help support residents.”

Pung and her colleagues at MLTCOP are also actively involved in the Michigan Attorney General’s Elder Abuse Task Force. Past achievements include the continuation of medical coverage for survivors of auto accidents with traumatic injuries prior to changes in the state’s auto insurance law. MLTCOP also weighed in on minimum staffing requirements for nursing homes receiving Medicare and Medicaid funds. Current initiatives include improving guardianship requirements in Michigan.

“If I can get up every morning and know that I’m probably going to make an impact on people’s lives, that’s fantastic,” says Pung. “But that only happens because I have an amazing group of 20 people across the state who are providing these services at the local level. It’s an honor to lead this program and make a difference for people.”

A listening ear and confidant

Reno is one of those twenty paid ombudsmen. Under the auspices of the Area Agency on Aging of West Michigan (AAAWM), Reno works with nursing home residents in Allegan and Kent counties.
Sandra Reno.

“We can go to any retirement home, adult foster care home or nursing home that is licensed,” she said. “We provide everything from information to assistance, perhaps over the phone or during a routine visit. If they have questions and want information about resources, we can provide that. We can also open the gate for someone if they ask for help. Everything we do is resident-driven.”

Before becoming an ombudsman, Reno was a social worker in nursing homes for thirty years.

“I’m so happy to be on this side,” she says. “It’s the perspective I should have always had. But unfortunately, when you’re in the industry and you work for that company, it ends up being a little difficult.”

Reno has helped many nursing home residents escape guardianships that served them poorly. Under current state law, without an advanced directive, a person in a medical crisis can be appointed by the court as an emergency guardian to make medical decisions for him or her. The guardians can take full control of the person’s medical decisions, finances, social connections and property – selling houses, throwing away belongings and moving their wards to nursing homes, even if they can live independently.

“A number of people who are given guardians when they are in the hospital or during a medical crisis never get rid of them,” Reno says. “So they have someone put in charge of them, making decisions for them and working with them unnecessarily. Many of them can be fired when they are no longer needed. But they end up staying on for a long time because no one questions that or has them told you can try to end it.”

Reno’s first success story involved a woman who asked for help because her professional guardian took away her prescription for a medication that helped her go to the bathroom.

“We got it back for her,” Reno says. “It was a different kind of victory. But it’s an example of the control that (guardians) sometimes exert that they shouldn’t exercise without communicating with the resident.”

Reno believes the ombudsman program is important for adults and adults with disabilities in Michigan, but worries many people aren’t even aware of it.

“People are in these circumstances and they don’t even know what their rights are. The nursing home owners don’t give them that information. They’re just unknowingly housing people instead of letting them live,” Reno said. “Having someone who doesn’t work in the area where they live, an outsider on their side, that gives them a lot of comfort, even if it’s just giving them information. And we just don’t listen to the residents. They are heard.”

You can reach a local ombudsman at (866) 485-9393 or www.MLTCOP.org. The website also offers free information sheets in Arabic, Chinese, English and Spanish and a booklet on advance directives.

Estelle Slootmaker is a working writer who focuses on journalism, book editing, communications, poetry and children’s books. You can contact her at (email protected) or www.constellations.biz.

Salli Pung photos by Doug Coombe. Alison Hirschel photo by Roxanne Frith. Sandra Reno photo courtesy of Sandra Reno.