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 3950 Industrial Blvd., Ste. 500 West Sacramento, CA 95691 office: 916-­‐375-­‐3313 fax: 916-­‐376-­‐8795 www.CLTCOA.org The Ask The California Long-­‐Term Care Ombudsman Association is requesting $4,264,038 for Local Long-­‐Term Care Ombudsman Programs (LTCOPs) in California. Of the total requested funding: • $2,784,150 will enable the program to conduct vital unannounced monitoring visits to all long-­‐
term care facilities in California • $351,331 will enable the program to supervise and train volunteer Ombudsmen • $1,128,557 will enable the program to investigate 6,000 more complaints per year About the Long-­Term Care Ombudsman Program Monitoring of long-­‐term care (LTC) facilities is provided by three separate State agencies, each with different authority and scope. The California Department of Public Health’s Licensing and Certification Division, provides statutory and regulatory oversight of Skilled Nursing Facilities (SNFs), while the California Department of Social Services’ Community Care Licensing Division provides the same in Residential Care Facilities for the Elderly (RCFEs). The LTCOP differs from these agencies in three important ways. First, the LTCOP is mandated, through State and federal law, to protect residents’ rights and ensure that resident are treated with respect and dignity. Complaints identified and investigated by Ombudsmen are often the precursors to more severe cases of abuse and neglect. Residents may become dehydrated when water is placed out of reach, or malnourished if food is served cold. Residents may also develop painful and costly conditions such as pressure ulcers if care or equipment is inadequate. Ombudsmen are often able to identify, investigate, and resolve these complaints before they result in more serious and costly cases of abuse and neglect. Second, while the Licensing and Certification Division conducts on-­‐site surveys at SNFs about once every 12 – 15 months, and Community Care Licensing is required to visit RCFEs once every five years, these visits are to determine facility compliance with laws and regulations. The LTCOP must ensure that residents of SNFs and RCFEs have “regular and timely access” to an ombudsman who will advocate for residents and identify, investigate, and resolve complaints on behalf of residents. The Administration on Aging has defined regular visits to facilities as weekly, monthly, or quarterly. Third, the LTCOP is the only agency that utilizes certified volunteers in addition to paid staff to conduct their work. Certified Volunteer Ombudsmen are the eyes, ears, and heart of the program. They provide an astonishing number of service hours each year – 127,556 hours statewide in 2013, the equivalent of 61 additional full time paid staff. Training and supervision of volunteers represents a significant investment of time and resources by paid Ombudsman staff. Conservatively, initial training, monthly in-­‐
service training, and individual support in the first year of a volunteer Ombudsman require more than 100 hours of staff support. Despite the training and supervision time required, the use of certified volunteers makes the LTCOP an extremely efficient program. CLTCOA California Long-­Term Care Ombudsman Association Why Are Regular Unannounced Visits So Important? On their facility visits, Ombudsmen meet with residents and families as well as facility staff and management. They assess the safety of the facility environment as well as resident wellbeing; provide consultation and referrals when needed; and identify, investigate, and resolve complaints. Unannounced visits allow the LTCOP to detect complaints or cases of abuse that would have gone undetected or unreported. Residents and their families may not make reports for a number of reasons including: they do not know their rights, they may be unable to report abuse because of their diminished capacity, and they fear retaliation, including the threat of eviction by the facility’s staff. The regular presence of an Ombudsman increases complaint and abuse reporting by residents, family, and facility staff.1 Regular visits by Ombudsmen also save the State of California money by detecting and resolving complaints before they escalate into crimes requiring the involvement of law enforcement, regulatory deficiencies requiring the involvement of licensing agencies, or serious harm to the resident requiring costly medical services. Elder Abuse is Under-­reported The National Elder Abuse Incidence Study conducted in 1998 estimated that only 1 in 14 cases of elder abuse came to attention of authorities.2 A more recent study in New York State on the prevalence of elder abuse found that for every elder abuse case known to programs and agencies, 23.5 cases were unknown. The same study found that for each case of financial exploitation that reached authorities, 44 cases went unreported. 3 With regular facility visits, the LTCOP could help identify many of these unreported cases of abuse and neglect in long-­‐term care facilities. More importantly, with regular visits, the LTCOP can prevent many abuse cases from occurring at all. Background Despite the important work of the LTCOP, Governor Schwarzenegger eliminated all $3.8 million in the General Fund for local LTCOPs in 2008. Since the General Fund elimination, Ombudsman representatives have worked tirelessly to secure alternative funding, streamline services and create systems that are more efficient. Despite these efforts, total State funding for local LTCOPs in 2014/15 ($2.99 million) is 44% lower than in 2007/08 ($5.34 million). In response to funding cuts, California’s local LTCOPs were required to reduce operating days/hours and scale back services to residents in long-­‐term care. Since the cuts to their budget, the local LTCOPs have had to greatly reduce the number of long-­‐term care facilities they visit quarterly. There were 5,769 facilities in California that did not receive regular quarterly visits from an Ombudsman in FY 2012/13. This left approximately 100,000 residents in those facilities without an advocate and at increased risk of suffering from abuse and neglect. The requested funding will allow the LTCOP to once again meet their federal and state mandates, and will be an important first step to rebuilding the State’s commitment to protecting vulnerable residents of LTC facilities. 1 California Senate Office of Oversight and Outcomes (2009) California’s Elder Abuse Investigators: Ombudsmen Shackled by Conflicting Laws and Duties (http://www.canhr.org/reports/2009/OmbudsmanReportSenateCA20091030.pdf); Institute of Medicine (1995) Real People Real Problems: An Evaluation of the Long-­‐Term Care Ombudsman Program of the Older American’s Act. (http://www.nap.edu/openbook.php?record_id=9059). 2 National Center on Elder Abuse, Westat, Inc. (1998). The National Elder Abuse Incidence Study: Final report. Washington D.C.: Authors. 3 Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University. & New York City Department for the Aging. (2011) Under the Radar: New York State Elder Abuse Prevalence Study. New York: Author. http://ncea.aoa.gov/Resources/Publication/docs/NCEA_WhatYouMustKnow2013_508.pdf CLTCOA California Long-­Term Care Ombudsman Association