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HEATHER HILL
THE MID-COUNTY MEMO
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| Ombudsman Merle Gauthier visits Friendship Health Center and Harbor Care Reedwood once every 10 days to listen, observe and act on behalf of residents. Here she visits Sophie White, resident at Harbor Care Reedwood, her home in Southeast Portland for the last four-years. |
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| Holding his weekly delivery of magazines is Roger Farmer, a Harbor Care Reedwood resident. Argay resident Merle Gauthier, a retired nurse and now a volunteer ombudsman deliver the magazines. Ombudsmen serve as the eyes, ears and voices of the institutionalized elderly. |
| MEMO PHOTOS: TIM CURRAN |
With a mission “to enhance the quality of life, improve the level of care, protect the individual’s rights and promote the dignity of each Oregon citizen residing in a long-term care facility,” the Office of the Long-Term Care Ombudsman came into being as a patient advocacy amendment to the 1978 federal Older Americans Act, which stipulated that states create the office in order to receive the act’s funds. The current Oregon office was established by the legislature in 1981. Independent from other state agencies that handle licensing or abuse cases, the ombudsman program coordinates citizen volunteers to visit facilities, listen to the concerns of residents and campaign for human needs sometimes waylaid by corporate interests and bureaucratic governance.
The Office of the Long-Term Care Ombudsman, located in Salem, consists of Meredith Cote, the current state ombudsman filling a four-year term; Kathy Walter, the program administrator; two office support staff and six deputy ombudsmen who oversee a statewide cadre of trained volunteers currently monitoring Oregon’s 141 nursing facilities, 228 residential care facilities, 205 assisted living facilities and 1,590 adult foster care homes.
The agency recommends volunteer ombudsmen visit large facilities at least every two weeks and grants them 24-hour access to choose when to do so. Gauthier visits the Friendship Health Center and Harbor Care Reedwood once every 10 days or so, usually dropping in during mealtimes to inspect the most common bone of contention — the food — or on weekends when the senior staff cede operations to the second string. On a typical visit she meets with residents and inspects the facility for cleanliness or signs of neglect. Such evidence could later corroborate licensing committee reviews or validate resident complaints. She tries to forge a rapport by introducing herself to each new patient and ensures they understand the complaint reporting procedures, which the law dictates each facility post in a conspicuous location along with the ombudsman’s home phone number.
A sense of home
Ombudsmen foster a sense of self-determination akin to the empowerment residents once enjoyed in their own homes. Though entrusted in the care of others, long-term care residents retain all the rights granted to every United States citizen, including but not limited to: privacy, personal property, treatment information and decisions (including the right to refuse treatment), equal care and freedom from discrimination, and to remain at the home unless they violate publicized regulations. Gauthier reminds residents and staff that whatever citizens have a right to do in their own homes, a long-term care resident has the right to do in the facility.
“Whether it seems like an outlandish request or not, it is that resident’s right to request it,” she said, from popcorn to porn.
Gauthier always encourages residents to assert their concerns to the staff before calling the ombudsman to mediate. “Everything that we do is driven by the resident,” she said. “If they complain but say they don’t want us to go to management, then we can’t go to management. A lot of them are fearful that they will be retaliated against.” She tries to ease their concerns by defining her role: “to make their life better, (so they) have some dignity and (don’t) feel like they don’t have any rights, because they have every right that you and I have.”
Gauthier addresses concerns to facility management through the deft use of her three f’s: be firm, be friendly and be fair. “I’m not here to cause trouble,” she says. “I’m just here to make it better for the resident, and that should be their goal also.”
Gauthier also oversees six adult foster care homes, which she visits quarterly. With approximately five residents per home, foster care offers private rooms and home-cooked meals at an affordable price. Though she praised her foster homes, Gauthier cautioned families to thoroughly research their options before placing a loved one. While foster home sponsors complete a minimum of 20-30 hours of training to achieve certification, former geriatric or nursing experience is not a prerequisite.
Regarding issues of long-term care, only the few publicized abuse cases attract widespread community concern. The majority of complaints fielded by ombudsmen involve basic quality-of-life essentials, issues unlikely to hit headlines but nonetheless distressing to patients. Gauthier believes conflicts between business owners (often large corporations) and residents bear the brunt of the blame. Cost-cutting measures, such as regimenting schedules and the standardization of services, may sometimes override the preferences of residents.
“I can see that there is a bottom line of making a profit,” Gauthier said, “but not at the expense of the dignity of these people who have to be here. This is their home.”
According to the 2007 agency report, ombudsmen performed almost 14,000 facility visits last year and responded to 4,991 requests for assistance. All complaints are filed on the public record. Though 91 percent were promptly resolved, the public record only discloses the number of claims made against a facility. It omits the amends taken or even evidence of any substantiation. Still, the accusation total alone provides a strong indicator of patient contentment. The most common claims, as cited by Gauthier, included resistance to strict schedules such as dictated bedtimes, mealtimes and visitors’ hours; neglect to residents who have few to no visitors; exorbitant charges for routine services; mobility restrictions and the denial of foods that may compromise a patient’s recommended diet. Issues concerning diet are a fairly common complaint said Gauthier. Many residents are placed on special diets to help remedy their health conditions, for example, diabetics have a low-sugar diet. Even though candy bars may compromise their health, they have every legal right to eat candy bars if they want and the facility cannot legally deny them a candy bar if they request it. Most facility staff will resist the patient on this point, as it is a liability to them. The ombudsman must then step in and argue for the rights of the patient, including upholding their right to request something that may cause them harm. More severe complaints such as symptoms like bedsores may qualify as abuse, which the ombudsman would refer to the abuse hotline (1-800-ABUSELINE).
Improving the quality of care
The Oregon Department of Human Services (Seniors and People with Disabilities Division) has recently taken steps to help address some of the most chronic problems by raising the mandatory ratio of nurses to patients in nursing facilities. By 2009, nursing home staffing requirements will mandate one nurse or certified nursing assistant for every seven patients on a day shift (as opposed to 1:10 formerly), one nurse per 11 (versus 1:15) on evening shifts and one per 20 (versus 1:25) on night shifts. The state estimates the new regulations will require 500-700 new CNAs by 2010.
Though Gauthier approves of the new legislation’s ambitions, she noted that more nurses are not necessarily better nurses. She remarked that the preliminary push toward filling this quota has so far resulted in overworked nurses and the employment of more temporary agency aides, whom the residents characterize as both diffident and unaccountable. She countered that facilities that offer their staff more benefits and better wages have fewer resident complaints overall.
Though biweekly ombudsmen visits cannot compensate for inattentive personnel, Gauthier noted that complaints have declined since she first started visiting her facilities, subtle proof of the program’s impact.
“Being an ombudsman is keeping management on their toes,” she said. “That is why it is so important that we get more volunteers. If every facility can have an ombudsman, it would be wonderful.”
With 42,230 beds in Oregon’s long-term care facilities and only 137 certified ombudsman volunteers to monitor them, the agency — and the vulnerable population it serves — could benefit from more people like Gauthier. According to the 2007 report, volunteer and staff shortages accounted for the fact that only 72 percent of nursing facilities, 48 percent of assisted living facilities and 17 percent of foster care homes received quarterly visits last year. This actually surpassed expectations based on the numbers of volunteers and demands on their time.
The agency also oversees 62 volunteers of the Friendly Visitors program. These volunteers donate a minimum of four hours a month attending to the many long-term care residents who suffer from the effects of increasing isolation. Though not certified in issue resolution, the friendly visitors bring necessary human interaction and concern, as well as another outside eye, into residents’ lives.
This September, the Office of the Long-Term Ombudsman will hold two training sessions for new recruits. Friendly visitor training will take place on Sept. 28. Ombudsman certification will take place Sept. 12, and it generally lasts for six days. Afterwards, ombudsmen must complete 10 hours of continued education annually to maintain certification. They also attend monthly ombudsman meetings to discuss ongoing issues. Attendance at these meetings is not required but, according to Gauthier, “they (Office of the Long-Term Care Ombudsman) like you to go.”
Though many certified ombudsmen have backgrounds in social service, gerontology, nursing or paralegal work, the agency welcomes any dependable and reliable adult over the age of 21 (19 for friendly visitors) with good communication and problem-solving skills, an assertive personality and an objective outlook to apply.
In recent weeks, several new ombudsmen have entered our service area: Ron Savitt, monitoring the Evergreen Portland Health and Rehabilitation Center; Deborah Clough, observing at the Sellwood Landing Assisted Living Community; Patricia and Ralph Evans, serving as advocates for the residents of Glisan Care Center; Marilyn Jones, serving as the ombudsman for residents of Johnson Assisted Living, an annex of Oregon Baptist Retirement Homes; and Karen McCarthy, who will serve the residents of Menlo Park Health Care.
Each new ombudsman will also visit three to five Northeast Portland adult foster care homes, chipping away at a large chunk of the hitherto unvisited facilities in the Mid-county area.
In addition to these certified long-term care ombudsmen, two Resident Associate Program volunteers have been added as well. RAP volunteers visit residents of long-term care facilities to reduce isolation and increase social interaction. Marianne Chase will visit residents of Fernhill Estates, and Alice Hull will call on residents of Park Forest Care Center.
Through friendly visits and persistent vigilance, ombudsmen have the power to improve the quality of others’ lives while enriching their own and improving the state of our institutions in the process. If a society is measured by the treatment of its elders, ours still has a long road to perfection, but these intentions are in the right direction.
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