State Support hosts a regular webinar series to share more about the work of legal services organizations statewide. The aim of the series is to foster connections and referrals between programs by taking a closer look at each program’s work.
On September 24, 2020, the series featured Genevieve Gaboriault, Deputy Ombudsman with The Office of the Ombudsman for Long-Term Care (OOLTC). The OOLTC is a program of the Minnesota Board on Aging and a part of the Minnesota Department of Human Services. It serves all adults receiving licensed long-term care services and supports in Minnesota. The central intake number is 651-431-2555 or 1-800-657-3591. Here are excerpts from that conversation.
Are there any qualifications to receive assistance from the OOLTC?
Only that the person be a resident receiving home care from a licensed facility in these settings: nursing homes (about 360 statewide), assisted living establishments (about 2,000 statewide), hospice, adult foster homes and home care. There is no income restriction, no citizenship requirement, and no fee for our assistance. We receive many calls from family, friends, facility staff and residents.
How does the OOLTC operate?
We are client advocates. We’re unique in that we go to the bedside where clients reside, asking what a person wants and how we can help them get that. It is about their choice, we don’t make decisions for them, rather we are helping them live their best life and get what they want. The program is part of the Federal Older Americans Act, which funds things like Meals on Wheels.
We have Regional Ombudsmans who are out in the field. They conduct visits (in non-COVID time) and connect in person with residents in their district. As a result of legislation, we are increasing the number of regional ombudsman from 14 to 25. We also have volunteers who are located at a single facility as a local point of contact. The state is divided up to have roughly equal numbers of facilities and residents for each ombudsman.
We are not an emergency service, we work regular hours, 8:00 a.m. – 4:30 p.m. People should call the Minnesota Adult Abuse Reporting Center (MAARC) if they have abuse concerns. For advocacy, call us.
Can you share an example of how this works in practice?
Someone calls and says “I didn’t get my medication last night” and they want to know what happened. They call central intake, we enter that information into a database, and the ombudsperson for that area would call them and get more details. We ask the resident “what would you like me to do?” Clients direct the staff on what to do. If they want to know their rights, for example to file a grievance, we do what they wish.
Part of the work is educating clients about what their rights are in the facility and empowering them. These include things like getting your care plan followed, which includes getting medication on time.
We ask if they want us to get involved. If so, we get informed consent to talk with the facility on their behalf. We plan with them about what to do next. Their goal might be “get my medication, because it helps me sleep.” We might learn that the doctor’s orders changed, but it didn’t get communicated to the resident. We find out if there is more follow up needed. If there was a staffing problem, we see if there is another plan to put in place and ask how the resident can advocate. We problem solve to make sure the resident gets what they want, based on their request.
What are other types of calls you get?
A lot of calls come from people with some level of decision making power. We always work for the resident. We ask what the resident wants. Anyone can call us with a complaint or concern, but we work for the resident. Even for residents with dementia or impairments, we don’t avoid talking to them because of a capacity diagnosis. We can ask them questions they can understand.
Disability-related behavior is a common source of problems. We spend a lot of time working with facilities on accommodation. It might be making a safety plan or trying to figure out what can make things better for the resident to be successful there, too.
Staffing has been a statewide concern for years. This is still a frequent concern we hear from residents. We can view logs of wait times and try to problem solve that.
Individuals want choices and autonomy. They may not want to go to bed at 8:00 pm, or may want breakfast earlier because they are awake. We can help improve and make it more like a home rather than a place you have to stay.
At the end of the interaction, our standard is: Are they (the resident) satisfied with what happened?
What about evictions?
Eviction and notice-to-vacate issues are another type of problem we get contacted about. When an assisted living facility wants to evict someone, we can often figure out why the facility wants them to leave and work it out and help them stay. Kind of like a settlement. Often there are financial problems, or the family hasn’t applied for assistance that may help the person pay.
Board on Aging has a legal assistance developer who is helping grow connections with legal aid so if a hearing is needed we can more quickly connect the resident with support. We frequently help with nursing home discharge in administrative law venues.
Right now, assisted living facilities cannot evict because they are landlords and are covered by the eviction moratorium. They may be able to end services, since that’s a separate contract, and that is not considered covered by the moratorium. The AG’s office has enforced the eviction moratorium against some nursing homes trying to discharge.
You also work on systemic advocacy, can you share an example of what that looks like?
A big success was the Elder Care and Vulnerable Adult Act of 2019, which we worked on with many other partners. Essentially, there was a realization that the current assisted living situation with a lease and separate contract for services was not the best way to support people living in those facilities. The law went into effect in 2019 and that’s part of what funded growth in our office. It also set up an assisted living license that will go into effect in 2021. That will include some good protective elements, including due process if the facility wants to discharge or evict someone, and it sets dementia training standards. It really is a holistic package to improve care and quality of life.
On a more regular basis, regional ombudsmans can bring a systemic case, if they observe or see a pattern or a policy that is affecting the whole facility and is not person-centered. We need to be careful not to share identifying information of any individual resident, but can use information about patterns to advocate for a group. We work best in partnership with facility staff, not being adversarial but coming in to improve care.
What impact has COVID has on your work?
During COVID we have had to work remotely. There has been tightening on visitors in facilities so we have not been driving and doing in person visits. All of the new rules coming out from Medicare & Medicaid Services and the Minnesota Department of Health for congregate settings have led to more questions and needing to understand how those affect residents.
Since facilities were locked down for visitors, we’ve had a huge volume of calls with residents who feel isolated or who aren’t doing well because of the separation. It shows how many family members have been informal caregivers for residents. Maybe they were helping with meals or other support and there’s been a decline in well-being in a lot of residents without that assistance. Part of our advocacy has been for safe ways to give more access for residents to see their families. At some facilities they can now do window visits, outdoor visits, or essential caregiver visits to allow some to come in with PPE and screening.
It has been very challenging to balance congregate care setting protections with COVID risks. For residents it’s not just that you can’t go out, but a lot of the group activities have been limited.
For more about the OOLTC, listen to the entire recording of this interview through GoToWebinar. You will be asked to enter a name and e-mail address to access the recording.