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Ombudsman Outlook
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December 2019 | Volume 6, Issue 2

In this issue:

Training Standards Released by ACL

The Administration for Community Living (ACL) sent a letter to all State Ombudsman and State Units on Aging on November 27, 2019, outlining the training standards for representatives of the Office of State Long-Term Care Ombudsman (representatives) in each state. Ombudsman programs are required to meet these training standards by September 30, 2021.

The letter from Edwin Walker, Deputy Assistant Secretary for Aging, Director, Office of Long-Term Care Ombudsman Programs, for the Administration for Community Living, and the standards can be found here. Learn more »

New and Updated Resources

NEW! October, November, and December NORC Notes
NORC Notes is a monthly email reminder of available resources on the NORC website and tips for how your program can use them. The October issue highlighted Residents’ Rights Month resources, the November issue reviewed trauma-informed care resources, and the December issue provided an update on phase 3 of the revised nursing home regulations. Sign-up to receive NORC Notes.

NEW! 2018 NORS Data
The 2018 NORS data has been posted to the NORC website.

NEW! NORS FAQ and TA Open Dialogue Webinars
A new webpage was created to hold all NORS related webinars that were not part of the five-part training series. These webinars include the Asked and Answered: Frequently Asked Questions about the Revised NORS webinar held in September as well as the three-part NORS Technical Assistance Open Dialogue Webinars. All of the recordings, slides, and additional materials are located on the NORC website.

TA Hot Topic: Advocating for a Resident Who is on Hospice

Occasionally there will be a miscommunication or misunderstanding between nursing home staff and a hospice provider that negatively impacts a resident’s care. Understanding the federal requirements nursing homes and hospice providers must follow is vital in successfully advocating for residents. Questions to consider asking when investigating a case involving a hospice providing services to a resident in a facility, applicable federal regulations and surveyor guidance, and successful practices are below.

Questions to Ask

  • Is the resident able to make care decisions? If not, who is the resident representative that can assist with medical decisions and are they using the resident’s history to guide decisions? If so, what are the resident’s wishes?  
  • Is there an advance directive or other paperwork regarding end-of-life care? 
  • What is in the care plan and how are the resident’s needs met by both the nursing home and hospice provider? What are the care responsibilities of the hospice provider compared to the nursing facility?  NOTE: Per federal requirements, the nursing home retains primary responsibility for providing care not related to the duties of hospice (e.g., 24-hour room and board, personal care, and nursing needs).

Important Information to Know

If a resident wants to have hospice services, the nursing home must have a written agreement with a Medicare-certified hospice. Federal regulations say that nursing homes do not have to work with one or more hospices. It is up to each nursing home to decide if they want to have an agreement with one or more hospice providers. Learn more »

NORS Corner: NORS Frequently Asked Questions (FAQs)

This page on the NORC website contains answers to frequently asked questions regarding the revised National Ombudsman Reporting System (NORS) - effective October 1, 2019. The answers were developed with input from members of the Workgroup to Improve NORS Consistency (WINC) and in coordination with the Administration on Aging/Administration for Community Living. The FAQs are organized by topic such as complainant, complaint coding, disposition, information and assistance, opening and closing a case, referral, survey participation, verification, and visits.

View these FAQs in a PDF here. View the Asked and Answered: Frequently Asked Questions (FAQs) about the Revised NORS webinar recording which is based on the first round of FAQs. If you have questions to suggest for additional FAQs, please email

News from the Network

California Ombudsman Program Representative, Molly Davies, is Interviewed by NBC on Nursing Home Evictions

East Texas Ombudsmen Promote the Volunteer Program

Kentucky Ombudsman Certified Volunteer, Gloria Peach, is Inducted into the Hall of Fame

Texas Ombudsmen Provide Tips for Family Members After Their Loved Ones Enter Long-Term Care

The Harris County Ombudsman Program in Texas Discusses the Importance of Being an Ombudsman

California Ombudsman Program Representatives quoted on Medi-Cal Coverage Denials

Volunteer Management: All You Need to do is ASK!

Recruiting volunteers can be challenging, but there shouldn’t be any fear as it really is just a matter of making “the ask.”

The ask should happen at any time, any place...whether to one person or to a group. We challenge you to put on your recruitment hat at least once every day. Here are some tips for daily recruitment activities:

  • Have your "elevator speech” ready to go and use it! An “elevator speech” is a 30-45 second speech to catch someone’s attention and explain the role of the Ombudsman program and how they can become involved as a volunteer. 
  • Carry your business cards with you and hand them out at every opportunity. 
  • When talking to people, ask them if THEY know anyone who might be interested in advocating with, and for, residents. 
  • Identify libraries, community centers, churches, newspapers, and other local entities near the long-term care facilities that need volunteers. Contact the local groups and ask them to share information about your program and call for volunteers. 
  • During holiday gatherings this season or other events share an example of how you’ve helped a resident and how volunteers could do the same. Learn more »

Quick Tips: Access to Resident Records

When investigating a case, if a resident gave a representative of the Office consent to review their medical records but wanted to remain anonymous, the representative may have asked the facility to pull several resident records to conceal the complainant’s identify. Using this strategy, the representative would only review the records for the resident that gave consent, not the additional records that were pulled.

However, with the additional clarification provided by the federal State Long-Term Care Ombudsman Programs Final Rule (LTCOP Rule), the Ombudsman program must have the permission of the resident (or their representative) to view their medical records and cannot request records for other residents that didn’t provide consent. Therefore, the strategy to request multiple records to conceal the identity of the complainant that did provide permission is not in compliance with the LTCOP Rule.

Ideally, when working a case that requires reviewing medical records the Ombudsman program representative would review them with the resident and/or resident representative. Also, as part of the investigation process, the representative should explain to the resident and/or resident representative that a resident’s identity cannot be anonymous since the representative has to ask the facility for their medical records and share other options for addressing the complaint (e.g., the resident and/or resident representative could ask for the medical records and then review them with the representative). Learn more »

Read past issues of the Ombudsman Outlook on the NORC website. If you did not receive this email directly and would like to sign-up to receive NORC emails please fill out the form on our website. If you would like to receive The Voice (the Consumer Voice weekly e-newsletter) automatically sign-up on the Consumer Voice website. If you have any questions, challenges, or article suggestions related to long-term care Ombudsman advocacy and program management, please let us know.

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