How Georgia Long Term Care Ombudsman Help Nursing Home Residents

Dive into the controversy surrounding nursing home residents’ rights in Georgia – do they have the support they deserve? Uncover the pivotal role of the Long Term Care Ombudsman in addressing issues, empowering residents, and ensuring quality care. In this week’s episode, nursing home abuse attorney Rob Schenk welcomes guest Ms. McNeil to talk about the impactful advocacy work of the Georgia Long Term Care Ombudsman, shedding light on the crucial support system for our elderly population.

Schenk:

How can the Georgia Long Term Care Ombudsman program help nursing home residents stick around?

Schenk:

Out there, welcome back to the nursing home abuse podcast. My name is Rob, I will be your host for this episode. And in today’s episode, we are talking all about the Georgia Long Term Care Ombudsman Program, what they do, who they are, how they can help nursing home residents, personal care home residents, basically long term care residents all over the state of Georgia. We’re going to have Melanie McNeil on here in a couple of minutes, where we’re having an awesome conversation all about the long term care ombudsman program here in the state of Georgia. 

Melanie McNeil, Esq. is an attorney and she is a part of the Georgia State Long Term Care Ombudsman Program. Prior to taking on the role of the state Long Term Care Ombudsman. She was the manager of Medicaid and special medic manager of Medicaid and special populations for Kaiser Permanente in Georgia. 

Melanie came to Kaiser Permanente from the National Association of State Units on Aging in Washington DC, where she was Director of Public Policy. Before moving to Washington, she spent 10 years with the Georgia Council on Aging advocating on behalf of older adults with executive and legislative branches in Georgia, an honors graduate of Western Illinois University and Cum Laude graduate of Georgia State University College of Law, which is where I got my law degree, Melanie has admitted to practice and law practice law in both Georgia and Colorado when again, we are so happy to have her back on the show. Melanie, welcome to the show.

McNeil:

Hi, Rob. Thanks for having me.

Schenk:

All right, I guess I should say Welcome back. We were talking off camera before the show that it has been a number of years since we’ve had you on the program to talk about the ombudsman program in Georgia. And I’m so glad it’s overdue. Glad we had Glad to have you back a lot, a lot of great questions that I want to ask you a lot of information and I want to get from you. 

Who are the Georgia Long Term Care Ombudsman?

The first thing is for any listeners that you know are new or don’t feel like going back several years and in our archive of episodes to find out what the long term care ombudsman does. Can you just kind of explain who you are, who the organization is and what the mission is?

McNeil:

Sure. So I’m the State Long Term Care Ombudsman. Every state, the District of Columbia, Puerto Rico and Guam have a state Long Term Care Ombudsman and an ombudsman program authorized by the Federal Older Americans Act. And in Georgia, there’s also some state law related to the long term care ombudsman program. We’re advocates for people who live in long term care facilities. And for us that means nursing homes, personal care homes, assisted living, community living arrangement homes for individuals who have developed ICF IDDS is what We call them and we visit regularly at those facilities quarterly, actually, in most instances, there are approximately 88,817 facility beds in Georgia. 

So that’s a lot of people. And we don’t see them all, all the time, we don’t. But we do try to visit each of the facilities. So there’s about 369 nursing homes and 2000. And some don’t have the right number for the other kinds of entities. So we try to just be at the facility, we talk with residents, we try to find out how things are going. Lots of facilities are good facilities, and they provide good care for the residents, and they don’t have complaints. 

More about the program and its mission can be found on Georgia’s official ombudsman site.

Sometimes, you know, when people live together, there is somebody who’s going to have an issue, you know, it might not even be that it’s the facility issue. It might be a roommate issue, because often, especially in nursing homes, people have rooming. And so I sometimes, you know, it’s personal preference. Like, you know, I don’t like fried chicken, can you help me so that I don’t have to have fried chicken or, or I don’t want to get up as early as they want me to get up. It can be things like that. But it can also be more serious. 

They’re not giving me the right medication or I’m not getting it on time, or, or I need to go to the doctor and I can’t seem to get the transportation arranged. You know, it runs the gamut from not so hard to fix to facilities that are timing problems that are more complicated.

To learn more about what the Georgia ombudsman does to help people in nursing homes, listen to our insightful discussion in Episode 29: Who Are Georgia Ombudsman and What Do They Do?.

What is the authority of the Georgia Long Term Care Ombudsman?

Schenk:

That’s why I love this show is because I get to learn so much. This is something that I didn’t realize. Talk to me more about the regular visits to the nursing homes, because I was under the mistaken impression that the ombudsman basically visited upon a complaint or upon the desire of the resident. But it sounds to me like you’re saying that a part of your everyday process is to go to the nursing homes, even if you haven’t heard from anybody. So tell me more about that. How does that work? And what are I guess the rounds, so to speak of how?

McNeil:

Sure, well, first of all, but I should tell you is I work at the state office. And so through the Department of Human Services, which is where our office is located, we contract with six nonprofit agencies. And those nonprofit agencies hire What are described as ombudsman representatives, they’re representing my office. So in their assigned different areas, states are divided into six areas, and then those on the bottom representatives are assigned the facilities in their area. And part of their contract says they need to visit each facility in their assigned area at least once a quarter. 

We’ve had some issues with keeping staff. And so in some areas, especially if there haven’t been any complaints, they might not visit quarterly. But generally, when we’re fully staffed, our folks just make a visit every quarter. Now, you know, your listeners may not be aware that nursing homes usually have at least 100 people, but 100 residents, sometimes fewer, but sometimes they have more than that. So when an ombudsman representative visits, they’re not going to see everybody in that nursing home, but they you know, their walk the halls, or what they might do is if it’s a big nursing home, in one quarter, they might walk on a call and visit with the residence on the A hall. And the next time they go, they’ll visit the residents in the B Hall. And the next quarter is in this C Hall, you know, so they’re trying to see most of the residents at least once a year just to talk to you. 

And just to check in just to let them know we’re available. Some facilities, personal care homes, especially can be pretty small. And so our investment representatives might see those residents every time they go, you know, it just depends. We saw our ombudsman representatives are sometimes in facilities more often than quarterly if we get complaints. And a lot of facilities will have someone who has a complaint, it’s some facilities we don’t, you know, the people aren’t there. They figure out for themselves how to fix the problems. And so, you know, they don’t call us to ask us for help, but most facilities will get a call from time to time from the residents themselves or from their family saying, you know, something doesn’t seem right. Or my mom or my dad, you know, something’s not right for them. So we’d like you to take a look. 

This authority is further detailed in the Georgia Long Term Care Ombudsman Program description.

What is the typical issue that the Long Term Care Ombudsman resolves?

Schenk:

That’s great. So it’s almost tough when you’re talking about these quarterly visits, it’s like outreach, it’s like you might not like me now, but here’s my card. Here’s who I am. If you do need me, you can call me. I think that’s fantastic. So it’s, it’s a consistent reminder that there is a resource for these residents of nursing homes and in personal care homes, etc. Can you walk me through? What are you mentioning? Obviously, interpersonal issues, perhaps roommate issues, and medication issues. But what are some of the typical, like some of the more typical issues that your office and the resources that your office provides, are resolving or attempting to resolve for these residents?

McNeil:

Well, our number one complaint, and I’ve been the ombudsman since 2010. The number one complaint all the years I’ve been in the state ombudsman is involuntary discharge, usually, usually that’s in nursing homes. And some of the time the reason for that involuntary discharge is that there’s a problem with the facility getting paid. Sometimes families don’t understand that, even if their loved one is in the nursing home, and Medicaid is a bit helping to pay for their long term care, that they still have to make a payment. Sometimes families don’t understand that. And so facilities have to get paid, they can’t stay open, if they don’t get paid. And so that’s our number one complaint. And we try to help resolve that. So we help residents understand, you know, you have to pay something and help their families understand, you know, you have to pay something that’s part of the rules. That’s our number one complaint. 

Learn more about who investigates a nursing home abuse case.

But another very often complaint is not getting requests for assistance are not answered. So, you know, what we hear from residents is, well, I put my call light on and the CNA came and said, I’ll be back in a minute, and then they never come back. Or they don’t respond to the call light at all, it just stays on. And part of the reason we think that happens is that sometimes facilities just don’t have enough staff. And so, you know, they’re the direct care workers trying to help everybody. And so, you know, sometimes they give short shrift to the ones that are just asking for some assistance, like, I can’t reach my water, I’d like to have some water or I don’t have any water, could I have some water? Or sometimes, you know, we hear this from residents who need assistance with going to the bathroom. 

And that’s kind of a complicated and time consuming process. And so what happens sometimes is it’s in a maybe well, meaning Yes, I’ll come back, but they don’t. And that’s that, you know, that’s a dignity and respect issue. That’s a care issue. That’s a skin breakdown issue. And there’s lots of things involved with that. 

And so we try, if we get that complaint, we go to the facility, if we get the residents permission, then we try and work with the facility on, you know, doing a better job, we don’t have any enforcement power, we can’t make a facility do the right thing that goes through the Department of Community Health, they’re the enforcers and the regulators. But a lot of times facilities will work with us because they’d rather not have the regulators in the building. Because what could happen, they might find not only that there’s a problem with not answering the call lights, but there might be some other issues. And so it’s helpful, if we can work with the facility and get them to fix the problem. And a lot of times they will.

Involuntary discharge emerges as a prevalent issue, underscoring the complexities surrounding payment and resident rights. Learn more about the Georgia Long Term Care Ombudsman program guide.

Schenk:

Let’s take for example, that second category of the most prominent or the most likely calls you’re gonna get and which are responses to call lights, which can lead to a whole bunch of other different negative outcomes potentially. Can you walk me through what your office, what the individual elements have been, might do? In these particular situations? I would imagine that there’s a protocol like, Well, okay, we’ve seen this so many times. And here’s how we’ll, here’s the first approach, we’ll have a second approach. Can you just walk me through how a call light dignity issue might be handled by the ombudsman to resolve the issue?

McNeil:

Well, first of all, we have to have resident permission. So whether the resident calls us and says my call doesn’t work, we still have to say so is it okay for us to take some action here some ideas? Sometimes it’s a family member, or friend or someone else who calls and says, The Call Logs aren’t being answered. So we would go and talk to residents and see if anyone would give us permission. So then what we might do is, first of all funny you should mention this because I had an email just this week about a facility that had put in a new call light system. But they didn’t put the call light system in every residence room. And so the ombudsman got a call, why don’t you have a call light in my room. And behold, as the ombudsman was, you know, going through the facility, she was identifying there were a number of those. 

So of course, we have to have the resident permission, but then we would go depends on what department so in this instance, we probably go to the administrator test is probably the administrator that sort of overseeing this to say, hey, you know, you don’t have colleagues in all the rooms Okay, so the fix that for some, if the caller is in the room, and they’re not answering the call, like what our ombudsman would do, again, with permission from a resident, they might say, Okay, put the call light on, let’s see how long it takes them to react. 

So sometimes it’s 10 minutes, sometimes it’s 20 minutes, sometimes it’s a half hour. And you might be thinking, well, can the ombudsman representative really spend that time, but we do, because, you know, sometimes problems just take time to resolve. 

Learn more about Using the Long-Term Care Ombudsman for Reporting Problems at a Nursing Home.

And then the ombudsman representative, again, with permission from the resident might again, go to the administrator or the director of nursing, you know, because the director of nursing kind of oversees that drug care workers, and say, you know, I was in this room for the last 30 minutes, the resident would call light on right when I went into the room, and nobody came. So what’s going on? You know, this isn’t acceptable, you know, that, Oh, well, you know, then the director of nursing will, you know, tell us what action she’s gonna take. It’s a somewhat chronic problem. So, you know, it might get solved for a while, for that resident, or maybe for some other residents, it’s like a lot of things, you know, you start doing better, and then well, not so good. And then, you know, you’re back to square one. 

I think that’s the reason it’s a, it’s a common problem, because every resident has the right to tell us how to approach it. So if that resident said, No, I don’t want to talk to you, they do and I don’t have a good relationship with the director of nursing. I don’t want you talking to them. But I do want this fixed. So we might go to the administrator then and say, Well, you know, this resident has raised this concern, or the resident might say, You know what, I’m very worried about what’s going to happen. So I want you to know about this problem, but I’m not going to give you permission to take action yet. 

I’m a little worried about, you know, whether there might be retaliation, although presidents don’t often say it that way. They might say, I’m afraid, I’m not so sure I want you to do anything, because I’m kind of afraid. So then we would go back maybe in another week or two and say, Oh, is it any better? Well, no. Okay. Well, could I help you with it? So sometimes, if a resident is reluctant, we might say, again, with permission from the so we might say to a resident, you know, I helped Mary Smith down the hall from you, because she had an issue. And she told me it was okay to tell you that we successfully resolved her problem. 

Oh, well, if you could do that, for Mary, I guess you could do it for me, you know. So sometimes, part of the reason we visit regularly is that people get to know us, and they understand what we do when they trust us. Sometimes it helps if, if we can say, you know, we helped your neighbor down the hall. And so, you know, they know that neighbor, and they, then they’ll, you know, be more willing to trust us. But the bottom line is, we all know this. And bison representatives are only in the building for a certain amount of time. We’re not there all day, we’re not there overnight. You know, we’re not even there weekly usually. 

And so we know residents are concerned about, you know, whether the CNA is gonna be mad, because they mentioned there’s a problem. So, you know, we just kind of try we work with a resin to see if we can figure out a way to resolve the problem so that they don’t feel afraid, and that the staff, but we’re not trying to call out particular staff, we’re just trying to get the we’re just trying to get the right care for the resident.

Schenk:

It sounds like to me, what you’re saying is that the method of resolution employed by the ombudsman is to almost act as the mediator, an independent party between the resident and the facility to say, hey, we’re not blaming you. We’re not We’re not saying this has been done on purpose. But what can we do to achieve what the resident was within the rights that the resident has as being a resident of a facility? So that’s really interesting. It’s like, you have to be able to communicate in a way that both the resident and the facility want to hear and would execute change. So I think that that’s really interesting.

McNeil:

But actually correct, you’re not really the mediator. And the reason I say that is, we’re going to advocate on behalf of the residents. So we want to work with a facility to make things happen correctly, but you know, if we need to call them out, we’re going to call them out, you know, but as the saying goes, you know, you get more you get better results with honey than with vinegar. And so, you know, trying not to be. I don’t know if aggressive is the right word, but it is trying to say to the facility, look, here’s the problem, and we just want to resolve it. So what can we do?

Schenk:

Right, thank you for correcting that. Yeah, you’re right. And I guess, I guess one of my point would be that you have to walk a very fine line. I’m sure that’s very difficult. To understand that the resident has fears of retaliation, or maybe not retaliation and in a terrible sense, but you don’t want to be a snitch, I guess and but you want to get your you want to get your issue taken care of, and then you have to go and you have to walk the fine line of how do I approach this with the facility without them getting aggressive with me or you just resolving the issue? So I can, I can see how that can be very difficult for the ombudsman. 

You mentioned something very interesting to me, which is the word authority, like what authority the Long Term Care Ombudsman has to force her to make the nursing home do something. But also you’ve continued to mention we get permission from the resident. Can you explain, is there anything that the Ombudsman can do that the normal citizen couldn’t do? If they had permission from the resident? In other words, can they be the ombudsman under your mandate? Are you allowed to walk into the administrator’s office when the normal person couldn’t? Or is there anything that you can think of that an Ombudsman can do that a normal person, not normal, but a non ombudsman could do? 

McNeil:

Well, under the federal and state law, we have access to residents, and they have access to us, anytime, day or night, where family members might encounter that facility will say, you know, what, we have set visiting hours and visiting hours are from eight until four. So if you want to visit with your resident, you can between eight and four, well, state law says we should try and visit during, you know, certain normal business hours. But if the complaint is that we have a problem at 10 o’clock at night, we have authority to go into the building at 10 o’clock at night, they can’t keep us out. So that’s a difference that we have. 

We as it relates to resolving a problem. Probably the difference between us and a family member or a friend who comes to visit is that we’ve seen a lot of issues. And so we have so we have a maybe a better idea of what might work and what wouldn’t work, or what’s causing a problem more than just someone who, you know, just put their mom in a personal care home, for example. And, you know, they’re just totally new to the whole process. So, you know, that’s probably something that we can do that a normal citizen can’t.

Schenk:

Sure that makes sense.

McNeil:

Part of the reason we visit regularly is so that the facility gets to know us. 

Schenk:

And so that they that was actually that’s Thank you for saying that, because that was gonna be my next question on the regular rounds. And I don’t even know what the right term of art is for rounds, but we’re on the quarterly visits. 

Do Ombudsman maintain working relationships with nursing home administration?

And more often than that, is it important for the ombudsman to obviously not only make themselves known to the residents, but what are they doing in terms of building relationships with the actual administration of the facility? If any?

McNeil:

Yeah, so we’re required to let the administrator or the person in charge know when we come to the facility. And so it might be that the administrator comes out and greets us, the administrator might say, oh, you know, what, Mary Smith has been having an issue, or we have a concern about John Jones, you know, so they, they might tell us that, sometimes we have to remind facilities that even though they’ve made us aware, we can’t talk to them about it, like we might go and visit with those residents. 

But we can’t talk with him about that visit unless the resident gives us permission. So but often we’re talking with the director of nursing, if it’s a care issue, or we’re talking to the social worker, if it’s an issue related to, you know, more social things like residents have the right to leave. And that’s probably more of a social worker issue, we might be talking to the social worker about, you know, how it might be possible for, let’s say, 

It’s Mary Jones, who wants to get outside and she’s in a wheelchair, so but that doesn’t seem like she’s having much luck getting outside, maybe she needs a power wheelchair. So we might, if that’s what Mary wants, we might advocate with a social worker about how we can get Mary Smith to power wheelchair. So we might be talking to the social worker about that. 

The strategic relationship-building with facility administration is crucial for effective advocacy and issue resolution, echoing the guidance provided in Georgia’s assisted living regulations.

We might be talking to the dietary folks, if there seems to be a problem with the food. Like if the resident tells us, you know, I’m not supposed to have dairy products, and they keep giving me dairy products, and I don’t eat them, but, you know, they shouldn’t even be giving them to so we might go talk to the dietary director, so. So we do want to build relationships with facilities so that they know we’re not going to come in guns blazing, we’re going to come in saying, you know, here’s a problem, and it’s been a continuing problem. And you’ve told us you were gonna fix it. You haven’t. So you know, I don’t, you know, we do it. We can and then if the issue doesn’t get resolved to state law says then we can refer to the regulators. What do we do when we need to? 

Are the Ombudsman ever called to testify in Court?

Schenk: 

And when we say regulators, that would be the department of community health, the health care facility regulation division. So is, I mean, I guess, are the ombudsman ever, like, you know, hauled into court like to testify like Does that ever happen, like is anybody subpoena or hearings? 

McNeil:

We sometimes get subpoenas. And most of the time, we’ve only had a few of those, when we have, we usually try to quash them. Because most of the time other people have been witness to whatever the issue is, or if a resident asks us to be there. So if there’s an involuntary discharge hearing, and the resident asks us to be there to be present, we sometimes do that if we have the time, if we can do it. But again, most of the time, we’re not really needed. Someone else can testify, someone else can be a support person. What we try not to do is get involved in situations where someone else is making the decision. 

And we’ve had, even if it’s a tangential part, then people are thinking like a guardianship issue. We don’t get involved in guardianship issues, because we don’t want residents to think we’re part of taking the rights away. And so when people ask us, we say no, sorry, we can’t participate in that process. Other people can testify to the residence abilities or disabilities, you don’t need us. And so yeah, if we’re subpoenaed, most of the time, we try to not have to.

Learn more about how nursing home neglect lawyers advocate for victims.

Schenk: 

This is all fantastic information. So other than if you’re a nursing home resident or a family member of a nursing home resident, other than just waiting for that quarterly visit. 

What are the ways that someone can reach out to the Georgia Long Term Care Ombudsman Program?

McNeil:

Well, first of all, every facility, personal care, home assisted living nursing home should have our poster. And ombudsman is kind of a funny word. But the posters all have an ombudsman at the top, and they’re red and gray and white, and they’re pretty big. And it has our contact information. So for family members or friends who are coming to visit, look for that ombudsman poster, see if you can find it. When our folks make their routine visits, they leave a brochure that has their name and phone number on it. So if your loved one doesn’t have a brochure, it might be that it got lost. But a neighbor might, you know, someone in the next room might have it or roommate might have it. We also have a website. We’re not on social media, otherwise, but we have a website. It’s www dot and then it’s GA spelled out. And then ombudsman, which is a hard word, but it’s just you spelled just the way it sounds, OMBUDSMAN, so Georgia ombudsman.org. 

And so people can contact us confidentially on their website, or they can give us all the information, they could say, you know, I’m the daughter of Mary Smith, here’s my phone number. She’s got a problem. Here’s what it is. It’s all confidential. We’re the only ones who see it. Nobody else on our website can see that. And so people can contact us that way. And then what we do is route that person to the ombudsman representative for that area. I should also mention there’s an 800 number. So it’s (866) 552-4464. And you just have to wait, I think it’s option five, that it’ll say, you know, if you want help with food stamps, if you want help with Medicare, but if you just wait, I think I think we’re option five, and that will get people in touch with us. 

Schenk:

Thank you so much, Melanie. That’s great information. We really appreciate you once again, coming back on the show to share with the long term care ombudsman doing Georgia. 

McNeil:

Can I just say one last thing? Sure. Absolutely. I just encourage everyone who knows someone in the long term care facility don’t visit.

Schenk:

That’s great advice. Thank you so much. 

McNeil::

Thanks for thinking of me. Thanks for having me on. And, uh, so yeah, good luck with everything, Rob and, you know, call me or. You know, let me know if you have issues or, you know, if, if you, if you know about people in facilities that are having issues, you know, just let me know and we’ll see what we can do.

Learn more about the role and impact of the LTC Ombudsmen.

Schenk:

I feel like sometimes when talking to people like Melanie, it’s like she does more for the aging population in this state than I do in years and years. And I just, it’s hats off to her. For, for her years of advocating on behalf of individuals living in long term care in the state of Georgia. We just have immense respect for what she does. Well, that’s going to complete the episode this week, everybody.

For personalized advice or to discuss your specific situation further, don’t hesitate to contact us today.