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Monday, September 30, 2019
Volume 6, Issue 1
National Ombudsman Reporting System (NORS)
The National Ombudsman Reporting System (NORS) is a collection of reports from Ombudsman programs that includes activity information such as facility visits, complaints received and investigated, information and assistance provided, and community education and training provided. NORS data is available on the Administration for Community Living (ACL) website here and here and on the NORC website.
The process for NORS data collection was recently updated and goes into effect on October 1, 2019. The goal of this revision is to enhance ACL’s ability to understand and report on Ombudsman program operations, experience of long-term care facility residents, and changes in long-term supports and services policies, research, and practices.
To assist with the transition to these revisions, NORC updated the four-part NORS training materials to reflect the updated codes, definitions, and activities and instruct programs on how to record the work they do. NORC also held a five-part webinar series on these changes, webinar recordings and materials can be found here.
A revised NORS FAQ page was developed with input from members of the Workgroup to Improve NORS Consistency (WINC) and in coordination with ACL. View these FAQs in a PDF here.
An additional webinar was held to address frequently asked questions about the revised data collection. Presenters responded to feedback about NORC’s revised training materials and quested raised during the webinar series. The recording and PowerPoint slides from the webinar can be found here. Watch your inbox for information about upcoming open technical assistance (TA) calls about NORS and if you have questions about NORS, please contact ombudcenter@theconsumervoice.org.
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New and Updated NORC Resources
NEW! LTCOP Reference Guide - Trauma-Informed Care: Nursing Home Requirements and Ombudsman Program Advocacy
The purpose of this Reference Guide is to introduce Ombudsman programs to trauma-informed care principles and related advocacy strategies and to outline nursing home responsibilities in accordance with the revised federal requirements. Additional information on trauma-informed care is available here.
NEW! July, August, and September 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 July issue highlighted resources for supporting LGBT elders, the August issue reviewed the important agencies and organizations in the Ombudsman program network, and the September issue described updates to the National Ombudsman Reporting System (NORS). If you would like to sign-up to receive the NORC Notes, email NORC.
NEW! NORS FAQ Webinar
The recording of the webinar Asked and Answered: Frequently Asked Questions About the Revised NORS is now available. Presenters responded to feedback about NORC’s Revised NORS Training Materials and questions asked during the webinar series. Attendees also learned about additional opportunities for technical assistance regarding NORS. Presenters included Louise Ryan, Ombudsman Program Specialist, ACL; Amity Overall-Laib, Director, NORC; and Maria Greene, NORC Consultant.
NEW! Advocacy Tools for Protection from Nursing Facility Discharges Webinar
The recording from the webinar Advocacy Tools and Successful Practices to Protect Residents from Nursing Facility Discharges is now available. During this webinar presenters provided an overview of the Ombudsman Learning Collaborative to Protect Residents Against Nursing Facility-Initiated Discharges project; showed how to use federal nursing home regulations and surveyor guidance to address three common complaints about discharge; shared examples of legal services and Ombudsman program collaboration; and highlighted available resources. Presenters included Robyn Grant, Director, Public Policy and Advocacy, National Consumer Voice for Quality Long-Term Care; Eric Carlson, Directing Attorney, Justice in Aging; and Jamie Freschi, NORC Consultant.
UPDATED! Updated Medicaid Bed Hold Policies by State
A Medicaid Bed Hold policy requires nursing facilities to maintain the room and/or bed of a Medicaid-recipient who had to leave their facility to go to the hospital or another treatment facility and is expected to be back. The updated document contains such policies for each U.S. state.
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News from the Network
Michigan State Long-Term Care Ombudsman Program and the Michigan Department of Health and Human Services (MDHHS) Leadership Visited Nursing Homes Together
Robert Gordon, MDHHS Director, Kate Massey, Deputy Director of Medical Services Administration and Medicaid Director, and Brian Barrie, Interim Bureau Director were escorted by Salli Pung, Michigan State Long-Term Care Ombudsman and Alison Hirschel, Legal Counsel to the LTC Ombudsman Program to visit three nursing homes. They visited a variety of facilities including Star Manor of Northville, a 37-bed facility which only participates in Medicaid and specializes in Dementia and Alzheimer care. Director Gordon tweeted about the visits.
Wisconsin Ombudsman Program Volunteer Newsletter
The Wisconsin Long-Term Care Ombudsman Program published a newsletter capturing their 25th year anniversary of the Volunteer Ombudsman Program Celebration event. Other stories include an acceptance of the 2019 Louise Abrahams Yaffe Volunteer Ombudsman Program Award, as well as other volunteer Ombudsman spotlights. Click here to read the full newsletter.
Maryland State Long-Term Care Ombudsman and the Office of the Attorney General Worked Together to Combat the Abuse of Older Adults in Unlicensed Assisted Living Facilities
Maryland Attorney General Brian E. Frosh announced that three Baltimore residents would face a total of 128 charges for abuse and neglect of a vulnerable adult, financial exploitation of a vulnerable adult, embezzlement, theft, fraud and operating a combined total of 10 assisted living facilities without licenses. “The hope is that this tragic situation will raise awareness of the importance of choosing a licensed assisted living facility to ensure quality of care and quality of life for those that need assistance,” said Stevanne Ellis, Maryland State Long-Term Care Ombudsman, in a statement. Click here to read the full statement.
Ombudsman Programs and Facilities Participate in Residents’ Rights Month
Six Ombudsman programs and facilities submitted signs of themselves explaining why they “Stand for Quality” in celebration of Residents’ Rights Month. Participants include the New Jersey State Long-Term Care Ombudsman Office; Iowa Buchanan County Health Center; Missouri Lutheran Home and the Missouri State Long-Term Care Ombudsman Office; Kentucky Shady Lawn Nursing and Rehab; Wisconsin Volunteer Long-Term Care Ombudsman program; and the Ohio Ombudsman program. View their photos here. Let us know how you are recognizing Residents' Rights Month by emailing pictures, stories, activities for us to include on the NORC website, contact ombudcenter@theconsumervoice.org.
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TA Hot Topic
Resident and Family Councils
The Federal Nursing Home Regulations give residents the power to determine who can attend resident council meetings. They also give the residents the right to attend family council meetings, while family members (or representatives of the resident) can attend resident council meetings only with the permission of that council.
The regulations also say that facilities must provide private space to meet and assist with publicizing the meetings.
When assisting a current council or starting a new one, making sure residents and families understand their rights is a good place to start. For additional guidance and resources, visit the NORC website.
F565 §483.10(f)(5) The resident has a right to organize and participate in resident groups in the facility.
(i) The facility must provide a resident or family group, if one exists, with private space; and take reasonable steps, with the approval of the group, to make residents and family members aware of upcoming meetings in a timely manner.
(ii) Staff, visitors, or other guests may attend resident group or family group meetings only at the respective group's invitation.
(iii) The facility must provide a designated staff person who is approved by the resident or family group and the facility and who is responsible for providing assistance and responding to written requests that result from group meetings.
(iv) The facility must consider the views of a resident or family group and act promptly upon the grievances and recommendations of such groups concerning issues of resident care and life in the facility.
(A) The facility must be able to demonstrate their response and rationale for such response.
(B) This should not be construed to mean that the facility must implement as recommended every request of the resident or family group.
§483.10(f)(6) The resident has a right to participate in family groups.
§483.10(f)(7) The resident has a right to have family member(s) or other resident representative(s) meet in the facility with the families or resident representative(s) of other residents in the facility.
Recruiting Volunteers Online
Although face-to-face conversations are best when recruiting volunteers, the following information may assist with getting the word out that you are looking for volunteers.
Take a moment and write down everywhere you have information posted regarding your interest in having volunteers (e.g., flyers, posters, website, social media).
If the call for volunteers is posted on your website:
- How many clicks does it take to find the information?
- Do you explain why your program is worthy of that person’s time?
- Is your message short, simple, and direct, communicating the need for the volunteer's service and the good he/she can do?
- Is there information on who to contact if interested?
- Can they complete an online form expressing interest?
Recruitment messaging should provide the real job information and not just entice people to volunteer.
Have you sent letters or emails to churches, community leaders, and other potential sources? Are you attending health fairs or speaking to community organizations, and if so, do you mention the need for volunteers?
There are many organizations who can help match volunteer opportunities with potential volunteers. Below are the some of the most widely used volunteer matching sites:
NORC has many resources on our website. Check them out!
If you are a volunteer manager and are not on the NORC listserv, contact Carol Scott, Ombudsman Specialist, to be added to the list with over 130 people from across the country.
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Quick Tips!
Trauma-Informed Care
Trauma-informed care is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma. Trauma-informed care also emphasizes physical, psychological and emotional safety for both consumers and providers, and helps survivors rebuild a sense of control and empowerment.
Ensuring that residents who have experienced trauma receive culturally competent, trauma-informed care is one of several new federal requirements which will go into effect when Phase 3 of the revised federal nursing home regulations are implemented November 28, 2019.
70% of adults have experienced some kind of traumatic event. Therefore, it is likely that a large majority of residents may be affected, and a best practice would be to approach all residents assuming they have experienced something in their life that may trigger a response.
Signs of trauma include, intrusive thoughts of an event that may occur out of the blue, nightmares, visual images of an event, loss of memory and concentration abilities, disorientation, confusion, or mood swings.
Recommendations for Implementing Trauma-Informed Care
- Admission: When speaking with residents and/or their representative about their life history ask if they experienced an event that would impact their care needs.
- Resident driven decision-making: Ensure the care plan considers possible trauma for each resident (e.g., if not comfortable in the dark, ensure a night-light is available in the room).
- Facility Environment: Train all staff to be sensitive to individuals (residents or staff) who are responding to a situation due to past trauma and understand how to support them.
- Policies of the organization: Promote a culture based on beliefs about resilience, recovery, and healing from trauma (e.g., include language about being an organization that practices trauma-informed care in mission statements, staff handbooks, and policies and procedures).
Ombudsman Program Considerations and Advocacy regarding Trauma-Informed Care
As resident advocates, the skills Ombudsmen use daily such as active listening, empowerment, and resident-centered advocacy serve as a solid foundation in working with all residents, including those that have experienced trauma. Ombudsmen can use those skills, their knowledge of federal and state requirements, and awareness of community resources to advocate for and share information about trauma-informed care.
- Consider events that may be traumatic to residents (e.g., transfer trauma after facility closure or discharge, their roommate dies, they experience or witness abuse, neglect or exploitation while in the facility) and check in with residents that may be impacted.
- Connect residents with resources and advocate for services to support their needs (with resident permission). Ombudsman should be aware of local victim advocacy services.
- Advocate for comprehensive care plans and individualized, resident-centered care, which involves understanding any past trauma a resident may have experienced.
- Remind facilities of their responsibilities regarding federal and state requirements for person-centered, individualized care, including trauma-informed care.
- Share information about trauma-informed care with facility staff, residents, family members, and the community.
- Encourage the use of consistent assignment and other methods to ensure staff know the residents they are caring for and their needs.
View the new Ombudsman program Reference Guide Trauma-Informed Care: Nursing Home Requirements and Ombudsman Program Advocacy for more information. Also, earlier this year NORC held a webinar on trauma-informed care. This webinar discussed trauma-informed care, the new federal requirement, how trauma-informed care relates to resident-centered care, and what this means for Ombudsman program advocacy and communication. View the recording and PowerPoint slides here.
For additional information on trauma-informed care, visit the NORC website.
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October is 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. The theme for this year's Residents' Rights Month is, “Stand for Quality” emphasizes the importance of quality in all aspects of residents’ experiences – quality care, quality of life, quality services, and quality choices – to name a few. Residents’ Rights Month is an opportunity for staff, families, Ombudsman programs, residents and other advocates to work together to stand for and promote quality long-term care.
Use these promotional materials and activity ideas to plan your own Residents’ Rights Month event and email Consumer Voiceyour plans to be featured on this page.
News and Events
The Pennsylvania Long-Term Care Ombudsman Program has social media plans for Resident’s Rights Month 2019. The program created three social media accounts that are meant specifically for facility staff to use and follow during October. Here is the email sent to the Ombudsman network. The Ombudsman program created a grouping of materials including videos from residents called Just 1 Thing, and a Call to Action for Ombudsmen directly from the survey conducted with the residents. Here are the pocket card instructions for Ombudsmen and pocket cards with the social media accounts listed for Ombudsmen to hand out.
Resident’s Voice Challenge Submissions
Resident’s displayed their writing or artistic skills by submitting essays, poems, artwork, drawings, or video related to the theme “I Stand for Quality” as part of the Resident’s Voice Challenge. View their submissions here.
Residents’ Rights Posters, Door Hangers, and Buttons are Available in the Consumer Voice Online Store
In celebration of 2019 Residents' Rights Month, Consumer Voice has created several new residents' rights-related products. These products are great as volunteer gifts and as giveaways during Residents' Rights Month and can also be used year-round to raise awareness for residents' rights.
For more information about Residents' Rights Month and activity ideas, visit the Consumer Voice website.
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