Claudette Royal NYS Long Term Care Ombudsman Lisa Newman Director Region 15 Long Term Care Ombudsman Lindsay Heckler Staff Attorney Center for Elder Law amp Justice NYS Ombudsman Program Structure ID: 1041698
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1. Ombudsman Partnerships with Legal Services: Enhancing AdvocacyClaudette Royal, NYS Long Term Care OmbudsmanLisa Newman, Director, Region 15 Long Term Care OmbudsmanLindsay Heckler, Staff Attorney, Center for Elder Law & Justice
2. NYS Ombudsman Program StructureState Office: State Ombudsman, Senior Assistant State Ombudsman, 3 Assistant State Ombudsman, 1 Clerical, 1 Half-time Legal Counsel 15 Regional Programs: 14 Not for Profit Agencies, 1 AAA (Approximately 35 full-time and 15 part-time staff statewide) Volunteers: Recruited/trained in each region (Approximately 560 statewide)
3. NYS Ombudsman Program MissionTo serve as an advocate and resource for older adults and persons with disabilities who live in long-term care facilitiesNYS LTCOP provides services to Nursing homes, Adult Care Facilities and Family Type HomesApproximately 1500 facilitiesOver 160,000 residents New York City encompasses about 1/3 of all homes and residents
4. NYS Ombudsman Program Overview
5. NYS Ombudsman RegionalizationPrior to regionalization 34 local programs Post regionalization 15 local programsRegion 15 contracting agency-People Inc Subcontract with Center for Elder Law and Justice
6. People Inc. Region 15 LTCOP Host AgencyBuffalo, NY non-profit People Inc. was created in 1970 by a small group of parents wanting to address intellectual disabilitiesNow over in 9 counties, 200 residential sites, day programs, and regional offices with nearly 4000 employeesIn 1993 People Inc. expanded to include senior living apartments; also, the agency operates a Senior Companion ProgramWhen NYS LTCOP regionalized in October 2015, People Inc. looked to add the Ombudsman Program; talking with Center for Elder Law and Justice, there was mutual interest and the partnership was formed
7. NYS Region 15 LTCO ProgramMost western region in the state and includes 4 counties totaling 5,543 square miles: Erie, Niagara, Chautauqua, Cattaraugus60 skilled nursing facilities (SNF), 8826 beds; 60 adult care facilities (ACF), 5512 beds; 9 family type homes (FTE); 14,338 total residents70+ volunteer ombudsmen covering 78 facilities, some covering more than one, some share a facility, some are “roving” ombudsmenCurrently 2 program staff and 1 contracted legal liaison Assign volunteers to SNF first as priority, focusing on 1-2 starsComplaints that are of legal matter are navigated to Center for Elder Law and Justice legal liaison
8. Center for Elder Law & Justice (CELJ)-PartnerCivil legal services agency in Buffalo, NY serving 8 WNY Counties.Provide free legal services to older adults, people with disabilities, and the low income population.Mission is to use the legal system to help clients live independently and with dignity.Services help people maintain the essentials of life:Access to health care;Access to safe and affordable housing; Access to sufficient income; Protective services to improve overall quality of life.
9. Similar missions and same coverage areaPrior partnership: Western New York Pooled TrustSame goal: improve quality of care in WNY nursing homes and assisted living facilitiesContractual relationshipForming the Reg. 15 LTCOP-CELJ Partnership
10. Role of the Legal LiaisonReferring (“navigating”) the client (resident) between LTCOP and CELJ.Training:New ombudsman certification training presentationsCurrent ombudsman in-service presentationsFacility training and presentationsCommunity presentationsGuidance and research support – “in-house” legal supportLegislative advocacySystems advocacy* Legal Liaison should (must) become a certified ombudsman! *
11. Common Referrals to CELJDischarge/eviction appeals: nursing home and assisted livingMedicare Appeals: Jimmo (skilled therapy); Coverage DenialsMedicaid Appeals: Institution vs community budgetingNAMI/Spenddown-budgetingDenialsRepresentative Payee: facility is named representative payeeFinancial Abuse: power of attorneySubstituted Decision Making (power of attorney; health care proxy)Medical Bills
12. Training: Example Health Care ProxyBasic resident right: right to make health care decisions Situation: staff determination a resident ‘lacks capacity’ if they disagree with the resident’s decisions or if the resident has an outspoken family member who is the Agent.Solutions: Legal Liaison prepared NYS Health Care Proxy resident rights handout explaining the law; With Region 15 LTCOP staff support, provided training to volunteer ombudsmen how to utilize the handout to advocate for the resident’s right to make own health care decision.Joint CELJ/Region 15 LTCOP education to facility staff.
13. Ombudsman Advocacy and Legal Services Working TogetherEnsuring residents receive skilled therapy servicesSituation: nursing home states therapy services will be cut off because Medicare will not pay for as resident is “not showing improvement or “plateaued”. Reg. 15 LTCOP-CELJ Partnership: goal is to keep therapy goingLegal Liaison: ombudsman and facility training on proper standards/Jimmo; connect resident to CELJOmbudsman: works with resident and facility to keep therapy going or to get it re-startedCELJ Attorney: handles the Medicare AppealDischarge to the communitySituation: resident is caught in the middle of ‘facility said’ ‘insurance said’ Ombudsman: discharge care planning CELJ Attorney: investigates and handles insurance issues, Medicaid, other potential legal barriers
14. Nursing Home DischargesFederal regulatory requirement to send discharge/transfer notices to LTCOP.Reg 15 LTCOP receives the notices from regional nursing homes. Legal Liaison-a certified ombudsman-: reviews and tracks the noticesPotential inappropriate discharges (i.e. to homeless shelters; different nursing home for “LTC”) and connect resident to CELJ for appeal assistanceTrack patterns amongst ownership groupsShare information with State LTCOP for state-wide trends and potential future action
15. Assisted Living EvictionsNew York Law:30 day written notice is requiredFacility responsibility to assist in safe transfer Facility must commence a special court proceedingProblem:Facility pressure on resident to leaveFacility bears cost of bringing the litigation.Ombudsman and Attorney pressure on facility to follow the law30 day written notice?Care plan meeting to discuss alleged change in condition?Safe transfer?Resident object to 30 day notice?
16. Reg 15 LTCOP and CELJ Partnership Current/future systems advocacy initiativesMeetings with elected officialsProposing and supporting legislation to improve quality of carePublic hearings Comment on regulationsMedia InterviewsPublic EducationEmerald South White PaperResident Empowerment Initiatives
17. Considerations when forming a partnership with a Legal Services OrganizationResearch potential partnersDo they share similar mission with LTCOP? Goals? How will the partnership benefit the LTCOP client? Will the partnership further the goals of both the organizations?Determine the type of partnership: contractual partnership vs memorandum of understandingDefine roles and expectations: i.e. Legal Liaison – CELJ staff attorney responsible for ensuring residents are connected to appropriate legal service.Develop conflict of interest and confidentiality policies
18. Questions/Thank you