What it Means to be the State LTCO

New SLTCO Orientation Webinar

Wednesday, November 28, 2012

Participants

Esther Houser (OK); Louise Ryan, Ombudsman Program Specialist, ACL/AoA (former WA SLTCO and Assistant SLTCO); Becky Kurtz, Director, Office of LTCOPs, ACL/AoA (former GA SLTCO); Teresa Teeple (AZ- 12/3/12 is her first day); Deanna Clingan-Fischer (IA); Kimberly Baker (KY); Shelley Hitt (CO); Sharon Wilder (NC); Arlene Franklin (IN); Joan Erhardt (ND); John McDermott (HI); Joe Rodrigues (CA); Victor Orija (DE); Jerry Blasingame (TN); Barbara Hickert (KS); Don Rabun (NH); Anniece McLemore (MS); Patricia Hunter (WA); Lori Smetanka (NORC); Amity Overall-Laib (NORC); Alia Murphy (NORC); Sara Hunt (Consultant).

Introduction

Amity Overall-Laib reviewed the purpose of the webinar and agenda and introduced the presenters.

Presentations

Becky Kurtz, Director, Office of Long-Term Care Ombudsman Programs, ACL/AoA

Louise Ryan, Ombudsman Program Specialist, Office of Long-Term Care Ombudsman Programs, ACL/AoA

Becky and Louise reviewed their PowerPoint and we captured the following notes.

Becky Kurtz:

  • The LTCOP is one of the programs receiving a formula grant under OAA.
  • State Plans: The 10 AoA Regional Offices conduct the review of the SUA’s State Plan. This year, the plans ask states to discuss how what they do reflects “person-centered” services. In the FY 2014 plans, elder justice is a new focus area.
  • Current OAA regulations are from 1988, prior to the creation of Title VII. We are working on guidance and regulations for the LTCOP. We are hoping that these will make it out of HHS and go to OMB for publishing.
  • We are working on common technical assistance (TA) questions to post on the AoA website. There are FAQs (frequently asked questions) on the AoA website, most do not pertain to the LTCOP, but we are also working on adding responses to FAQs regarding the LTCOP.
  • Appropriate use of Title VII funds: There’s an old PI on this topic. You need access to this if you don’t have it.
  • Frequently asked questions of AoA: Responsibilities of SLTCO, one additional responsibility that is not on the slide is legal counsel for the LTCOP.

Louise Ryan:

  • Louise began her presentation with the slide regarding Program Evaluation of the LTCOP. We have been working with the NORC of Chicago. They are in the home stretch of pulling all of this together. In the next step, we hopefully will have some work done to evaluate LTCO approaches, get some feedback regarding what’s working, areas for improvement, some documents to help measure LTCOP outcomes and measures to help bolster the effectiveness and importance of the LTCOP which can be used with state legislators and federal level people/Congressmen.
  • NORS: December 4 is the next webinar on ORT. You should have received an invitation from Harmony. ORT has had an update.
  • Who to call when? Don’t be afraid to call. Rule of thumb: NORC if you are looking for best practices and information on LTCOPs, how and what they do. There are a lot of resources through NORC and on their website, including the NORS training.
  • In contacting AoA: It’s fine to start with your regional AoA liaison, they’ll keep Becky and me in the loop. It’s OK to call us also. For data questions, coding, ORT, data community, call Louise. If it’s an interpretation question regarding NORS coding, I’ll bring the WINC into the loop.

Becky Kurtz:

  • What should you expect from AoA/ACL (last slide): You should expect us to help you do your job better, to back you up. We have regular dialogue with NASOP and NALLTCO. We find this a wonderful way to stay informed on what you do and to keep you informed about what we’re doing. The more you keep us informed (ACL folks who are involved in your work, your associations), the better able we are to keep you and your issues in our forefront as well as the work you’re doing on behalf of residents.
  • At ACL/AoA, we are able to comment on the work of other federal agencies. It helps us when we have internal opportunities to provide comments, if you keep us informed of your comments on/to other federal agencies.

Question and Answer for Becky and Louise

Question

  • John(HI): Question about proposed rule-making: Your statement about rule-making, will this include anything about a staffing ratio within the LTCOP? Is this being considered, especially for those states that are considering doing more with HCBS and following individuals who leave facilities and go into the community?

Answer

  • Becky: After HHS and OMB review our proposed rules, the proposed rule will be published in the Federal Register and there will be an opportunity for public review and comment. Our job is to review the comments, publish a response, make any additional changes, then publish the rule in final form. The AoA has never had a minimum requirement/recommendation for staffing for the LTCOP. You’re correct about the recommendation in the IoM report. Unfortunately, I cannot make a comment on what may be/will be included in the proposed rule for the LTCOP because the rule is not public and changes may be made between what we proposed and what is published.

Question

  • John(HI): Sometimes we have access issues in personal care homes, especially with unannounced visits.

Answer

  • Becky: Providing access to residents in PCHs is a state responsibility, not a federal one. However, as part of the state plan, the state and the governor must sign off on a statement saying they have compiled with the responsibilities of the OAA, including providing access. There are no federal requirements governing PCHs, which makes the issue difficult for OAA to do anything other than require states to provide access.
  • Louise: If PCH’s accept Medicaid funds, there may be some other avenues to pursue regarding access.

Question

  • John (HI): We are not allowed to go into Veteran’s homes although we meet with the social workers in those facilities twice a year.

Answer

  • Becky: I am optimistic that we will have this issue settled in the near future, based on our ongoing, internal work with the VA.

Esther Houser, OK SLTCO

  • The SLTCO role in key meetings (e.g. how to assert yourself as the advocate for residents and deliver their message, how to get into meetings if you are not initially included)
  • Be clear in your role.
  • There are many different meetings you need to attend. Your role is to represent the interests of LTC residents. Sometimes the key is finding out about the meeting as well as trying to be heard or to speak. You may use open meeting laws and internal sources to learn about meetings and how to get into them. Learn about the different public bodies, what they do, work groups, etc., to learn which ones you may need to attend.
  • Keeping residents as first at all times is the basic starting point. Keep your focus on residents, their needs and wants will get you rather far in this work. It is not about you, it is about the residents.
  • Don’t worry about who gets credit. If something gets fixed, we can all celebrate.
  • Keep the focus on residents. Keep harping on the topic. You are hired to help residents get their needs identified and addressed.
  • Sometimes you have to get to know people and work with them, even when you don’t want to, but you must in order to represent residents.
  • Get into meetings: ad hoc subcommittees, boards, work groups, Medicaid Agency Governing Board, advisory board, rate setting commissions, etc. Look at the Secretary of State’s website. If there’s an open meeting requirement to post meeting agendas, look at these. Learn what you need to do to ask a question or to make a comment, what’s the process?
  • Sometimes it is not in the meetings that you make the most progress, it may be after the meeting. You may talk with people in the meeting, let them know what you do, what you found interesting in their remarks.
  • Don’t be asking permission all of the time. You are hired to represent residents. Do it. It is your job.
  • The need to continually remind the SUA and others about SLTCO role and responsibility:
  • What an opportunity to annoy people and it is your job. Your whole job is to remind people of the needs and concerns of individuals in LTC facilities. The Primer is a good resource for educating and informing others about your role. Insert the needs of LTC residents into the discussion. Seek necessary funds for the LTCOP. Know the funding requirements for Titles III and VII, insert yourself into the budget process.
  • How to develop a LTCOP agenda:
  • I see this as a moving target. The agenda for your LTCOP may change from year to year. You may expand the agenda or contract it as necessary. Gather information from statewide staff, individuals in the LTCOP, what do they need? Bring needs and interests of residents that you hear from them into the overall agenda for the program.
  • Use resources from NORC, tools, manuals, information pieces. Avail yourself of these things.
  • How to lead the LLTCO team (staff and volunteers):
  • Technical information: Do you have the tools you need to lead this program? Do you have the authority that you must have such as designation of individuals and entities? Ability to withdraw designation? Training agenda and curriculum that you set?
  • Leadership: Your willingness to defend and support your staff. Also your willingness to listen to and learn from your staff. Meet with your staff, develop camaraderie, time for problem and idea sharing, confidential discussion of local issues, including issues with their host agency, piling on of additional tasks, money issues. It is important that you listen to them and protect them and seek the resources to enable them to do their job. I recommend that you look at the notes from the NORC Orientation call in February 2012 regarding how to develop relationships with AAA and LLTCO, Mark Miller and Sondra Everhart. Look at the Esprit de Corps paper as a good resource.
  • Quote from Becky during her tenure as SLTCO: “Ombudsman equals tension. If there is not tension, something is not happening.”
  • Every day, this program gives me the opportunity to either feel ignorant or stupid. The difference is that stupid is forever, ignorance is not.

Question and Answer for Esther, final questions for all speakers and dialogue

  • Victor (DE): Just when you think you know it all, you learn something new. You never know it all. Everyone out there is a resource for you. This network is there to help you. Also, get to know the industry and others: the ombudsman volunteers, staff, as well as the administrators and facility staff. Get out of the office and get to know other people.
  • Louise: To echo what Victor and Esther said, when you’re feeling overwhelmed or out of touch, go out and make some visits with your volunteers, answer some calls and directly help people.
  • Arlene (IN): This is one of the most frustrating and rewarding jobs I’ve ever had and I’ve had several. There’s nothing better than hearing a resident say, “Thank you. You’ve saved my life.” We have a listserv where ombudsmen can post questions. We also have a list of specialists where ombudsmen can go to ask questions (is this correct?).
  • Joe (CA): As a SLTCO you have to be an advocate for yourself. Don’t be afraid to assert yourself and your role. The law gives you this responsibility and it’s your job to be that advocate.
  • Sharon (NC): For me the most empowering part of my job is to train other people, regional ombudsmen, other people, everyone, that older citizens’ voices are heard at every table I can get to in NC when policy decisions are being made that impact their lives. It is great to be able to go directly to the individual whose life may be impacted/is impacted and get information from them and make sure their voice is heard. We do have a mentor program and I’ll be glad to share the information with others.
  • Victor (OR): Data is very, very critical. The OAA is also important, I call it my bible. About 2 years ago, I had a situation within the state. I read it every night to make sure that what I was doing was right. If you don’t do what the law says you are to do, then you have let the resident down.
  • Louise: A final reminder. It can feel very lonely to be a NSLTCO. Don’t hesitate to reach out. There is no such thing as a “dumb” question.

Closing

Amity Overall-Laib reminded participants that the webinar and accompanying materials will be posted to the NORC website in the near future and sent in a follow-up email.

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