|June 2022 | Volume 8, Issue 4
In this issue:
On June 29, 2022, the Centers for Medicare & Medicaid Services (CMS) released revised long-term care surveyor guidance. The CMS memo, QSO-22-19-NH, provides an overview of the revisions, links to the updates and changes in regulations and guidance, and a link to guidance training for nursing home surveyors and providers in the Quality, Safety, and Education Portal (QSEP).
Highlights of the changes include:
- Revised Surveyor Guidance
- Phase 2 and 3 Requirements: Clarifications and technical corrections of Phase 2 guidance issued in 2017, and new guidance for Phase 3 requirements which went into effect in November 28, 2019.
- Arbitration Requirements: Guidance on the new requirements which became effective September 16, 2019.
- Effective Date: Surveyors will begin using this guidance to identify noncompliance on October 24, 2022.
- Complaint and Facility Reported Incidents (FRIs): CMS revised the guidance in Chapter 5 and related exhibits of the State Operations Manual (SOM) to strengthen the oversight of nursing home complaints and FRIs. CMS also revised its guidance for all Medicare-certified provider/supplier types to improve consistency across the State agencies in their communication to complainants.
- Psychosocial Outcome Severity Guide: CMS revised guidance to clarify the reasonable person concept and examples across the different severity levels.
Links to memo and materials:
Stayed tuned for additional information from Consumer Voice and/or NORC regarding the revised guidance.
Learn more »
New and Updated Resources
NEW! Virtual Office Hour
NORC will begin hosting a virtual open office hour the last Wednesday of each month at 2:00 pm ET starting in July. We will focus on volunteer management for the first few months. These Zoom calls do not include a structured presentation and are open to all State Ombudsman and their program representatives. It is an opportunity for Ombudsman program representatives to ask questions, share information, and have open conversations. These calls will not be recorded. We invite all State Ombudsmen and program representatives to attend and ask us your burning questions about volunteer management.
NEW! Fact Sheet on Representing Residents During Nursing Facility Discharge Appeal Hearings
The purpose of the fact sheet, Representing Residents During Nursing Facility Discharge Appeal Hearings: The Basics, is to provide a basic overview about residents’ rights in appealing nursing facility discharges and tips for Ombudsman program advocacy considerations before, during, and after an appeal hearing.
NEW! Webinar Recording and Materials on Long-Term Care Ombudsman Programs and Legal Services
The National Long-Term Care Ombudsman Resource Center (NORC) and the National Center on Law & Elder Rights (NCLER) hosted the webinar, Long-Term Care Ombudsman Programs and Legal Services: Working Together to Protect Residents from Nursing Facility-Initiated Discharges, that discussed the roles and responsibilities of the Long-Term Care Ombudsman program (LTCOP) and legal services and how they can work together to protect rights of residents in nursing facilities.
NEW! Technical Assistance (TA) Talk Materials on Investigating Complaints Involving Allegations of Abuse
To increase direct access to technical assistance (TA) and peer support, NORC hosts quarterly live technical assistance dialogues. The June 29 TA Talk discussed Investigating Complaints Involving Allegations of Abuse, view the recording and materials here. The next TA Talk will be September 21, 2022. Have questions, an idea for a future topic, or examples of training, consumer education, or successful advocacy? Email NORC at email@example.com.
NEW! Webinar Recording and Materials on the Treatment and Workplace Conditions for Direct Care Workers
This discussion was an opportunity for State Ombudsmen and Ombudsman program representatives across the country to share their observations related to workforce conditions in long-term care settings and how it impacts the quality of life and care of residents. ADvancing States shared information from their recent work regarding workplace conditions, specifically about the treatment of direct care workers in long-term care settings. Directly related to the workforce issues, Consumer Voice staff shared information regarding the opportunity to comment in response to the Centers for Medicare & Medicaid Services request for information about the implementation of a minimum staffing standard in nursing homes.
NEW! Webinar Recording and Materials on Recognizing the Importance of Volunteers
This webinar focused on volunteer representative recruitment and retention. Volunteer representatives discussed why they stay with the program and Ombudsman programs shared state and local level examples of successful recruitment and retention activities.
UPDATED! Fact Sheet on Residents’ Rights and the LGBTQ+ Community
The fact sheet, Residents’ Rights and the LGBTQ+ Community: Know Your Rights as a Nursing Home Resident, was updated. This resource highlights federal residents' rights and nursing home requirements that may be of particular importance to lesbian, gay, bisexual and transgender (LGBTQ+) residents and provides options for complaint resolution, information for reporting abuse, and resources regarding long-term care and LGBTQ+ advocacy.
UPDATED! Resident-to-Resident Mistreatment In-Service Training Guide and PowerPoint
The Preventing and Responding to Resident-to-Resident Mistreatment in-service training includes a training guide and PowerPoint with presenter notes. The materials are intended for use by Long-Term Care Ombudsman programs to provide in-service training for staff of nursing facilities and residential care communities on the topic of resident-to-resident mistreatment (RRM). By the end of the training attendees will be able to define RRM; provide practical solutions to prevent incidents of RRM; understand the importance of individualized, resident-centered care; and know how to report incidents of RRM.
UPDATED! PowerPoint on The Who, What, Where, Why, and How of the Long-Term Care Ombudsman Program
This presentation has been updated to include 2020 NORS data and it reviews the Ombudsman program responsibilities required by federal law so the information is applicable in every state. This presentation explains what the Ombudsman program does, who the Ombudsman program serves, and how to contact the program. Ombudsman program representatives can use this presentation when training potential program representatives, during Resident Council and Family Council meetings, community education, and in-services for facility staff. View the slides as a PDF or PPT.
TA Hot Topic: Avoiding Drugs as Chemical Restraints - Changing the Culture of Care
What do I do if a resident is being pushed to take antipsychotic drugs?
Everyone who enters a nursing home has a right to individualized, person-centered care. Some nursing facilities, however, are giving residents antipsychotic drugs, not to treat a medical diagnosis, such as Schizophrenia or Bipolar Disorder, but rather to control the resident’s behavior or for the staff’s convenience. When used this way, as a chemical restraint, these drugs pose special risks for older people and increase the risk of death in persons with dementia.
Consumer Voice developed materials to assist residents and their families in combatting the inappropriate use of antipsychotic drugs. Long-Term Care Ombudsman programs are encouraged to become familiar with these resources and share them with residents and families.
Learn more »
National Ombudsman Reporting System (NORS) Corner
When should the Ombudsman program be the complainant?
The Ombudsman program may be the complainant in a variety of circumstances. The most common examples include general observations about the facility environment that need attention; this may include circumstances where residents agree with the problem and want it addressed but do not want to be the complainant of record. The Ombudsman program may be the complainant when a resident needs assistance but is unable to communicate informed consent and has no resident representative available.
See quiz question #8 in the Part I Case, Complaint, Complainant, and Information and Assistance Quiz Answer Sheet for additional information.
The Ombudsman program rule at 1324.19(b) (1)&(2) encourages resident participation regardless of the complainant and affirms that the Ombudsman program can be the complainant.
(1) With respect to identifying, investigating and resolving complaints, and regardless of the source of the complaint (i.e. complainant), the Ombudsman and the representatives of the Office serve the resident of a long-term care facility. The Ombudsman or representative of the Office shall investigate a complaint, including but not limited to a complaint related to abuse, neglect, or exploitation, for the purposes of resolving the complaint to the resident's satisfaction and of protecting the health, welfare, and rights of the resident. The Ombudsman or representative of the Office may identify, investigate and resolve a complaint impacting multiple residents or all residents of a facility.
(2) Regardless of the source of the complaint (i.e. the complainant), including when the source is the Ombudsman or representative of the Office, the Ombudsman or representative of the Office must support and maximize resident participation in the process of resolving the complaint.
It is typical for the Ombudsman to educate a resident about their rights and share an observation about the individual resident’s health, safety, or welfare. This discussion may result in the resident requesting Ombudsman assistance to resolve the complaint.
In this example, the process of educating the resident encouraged the resident to request assistance; therefore, the resident is the complainant.
See quiz question #10 in the Part I Case, Complaint, Complainant, and Information and Assistance Quiz Answer Sheet for additional information.
Visit the NORC website for additional NORS Frequently Asked Questions.
Learn more »
News from the Network
Rhode Island State Ombudsman, Kathleen Heren, on Nursing Home Closures
Radio Interview with Edwin Walker, ACL, on Older American’s Month and Karen Morgan, Maryland Ombudsman Program Representative on Protecting Seniors from Scams and Fraud
Iowa State Ombudsman Angela Van Pelt Wants a "New Direction" for Office
Volunteer Management: Recruitment, Retention, and Recognition of Long-Term Care Ombudsman Program Volunteers
Survey of Volunteer Ombudsman Representatives
NORC invited Long-Term Care Ombudsman program volunteers to share their thoughts on the topics of recruitment and retention. We received 596 responses from 35 states and the District of Columbia! The information received will be very helpful to state and local programs as they continue rebuilding their volunteer base. Since FY 2015 there has been a dramatic decline in the number of volunteers, from 7,734 to 5,152 in FY 2020. That is over a 30% loss of volunteer representatives. The LTCOP was designed as a volunteer program and volunteers are needed to ensure regular, timely access for residents to program services. The following are some of the responses received.
View the responses »
Recognizing Volunteers and Appreciating Their Work
During the month of April, many Ombudsman programs celebrated their volunteers. Watch and share the message from Beverley Laubert, National Ombudsman Program Coordinator, Administration on Aging/Administration for Community Living, and messages and pictures from Ombudsman programs.
Learn more »
Quick Tips: Advocating for LGBTQ+ Older Adults
As advocates for long-term care consumers, it is imperative that Ombudsman programs are aware of the unique challenges facing LGBTQ+ older adults to ensure their rights are respected and they receive quality care. One way you can advocate for quality life and care for LGBTQ+ older adults is to share this information with your facilities.
Individuals living in nursing homes have the same rights to be free from discrimination and harassment as individuals living in the larger community. They have additional rights and protections provided by federal nursing home regulations and state and federal anti-discrimination provisions. The rights of all residents should be honored and respected, regardless of sexual orientation or gender identity or expression.
On June 15 President Biden issued an Executive Order granting protections and support for LGBTQI+ older people so that they may age with dignity and respect. The Executive Order directs the U.S. Department of Health and Human Services to publish a “Bill of Rights for LGBTQI+ Older Adults” and new guidance on the nondiscrimination protections for older people in long-term care settings. It also charges the U.S. Department of Health and Human Services with “exploring new rulemaking to establish that LGBTQI+ individuals are included in the definition of populations of “greatest social need” under the Older Americans Act."
The resources below will help Ombudsman programs develop better methods of advocating for LGBTQ+ consumers to ensure they receive care that is equal to all long-term care consumers.
Learn more »
Residents' Rights Month
October is Residents’ Rights Month, an annual event designated by Consumer Voice to honor residents living in all long-term care facilities and those receiving care in their home or community. It is an opportunity to focus on and celebrate the dignity and rights of every individual receiving long-term services and supports.
Being a part of a community is essential to our well-being. Throughout the pandemic, residents of long-term care facilities were disconnected from the resident and staff communities within their facilities when activities and group dining were limited. Residents were disconnected from the broader local community when visitation was restricted and many residents were unable to leave their facilities to participate in outside activities.
This year's Residents’ Rights Month theme - Inspiring Unity within Our Community - emphasizes the importance of fostering meaningful community within the facility and encouraging residents’ connection to their local community. Download promotional materials to start planning how your program is going to celebrate Residents' Rights Month.
Resident's Voice Challenge
Creative writing and artistic expression are meaningful and compelling ways to highlight the importance of residents’ rights and how these rights can be carried out in all long-term care settings. For the Resident’s Voice Challenge, residents are encouraged to submit essays, poems, artwork, drawings, or videos related to the theme. The deadline is September 1, 2022. See full rules and criteria for submissions.
September 21, 2022: Save the Date - Quarterly Technical Assistance (TA) Talk – Topic TBD | 3:00 - 4:00 pm ET
October 2022: Residents' Rights Month - Learn more »
November 14-16, 2022: Consumer Voice In-Person Conference at the Lord Baltimore Hotel - Learn more »
December 8-9, 2022: Consumer Voice Virtual Conference - Learn more »
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