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Tackling Nursing Home Complaints With Ombudsman Programs

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Laura Nichols, Director at Northern Virginia Long-Term Care Ombudsman Program at her office.
WAMU 88.5 Photo/Lauren Landau
Laura Nichols, Director at Northern Virginia Long-Term Care Ombudsman Program at her office.

Laura Nichols has heard it all -- everything from broken air conditioning in the middle of the summer to diapers not being changed for hours at a time. She is with the Long-Term Care Ombudsman Program that covers Alexandria, Arlington, Fairfax, Loudoun, and Prince William counties, serving 119 facilities and 12,000 beds. WAMU 88.5’s Northern Virginia reporter Michael Pope interviewed Nichols at her office in the Pennino Building at the Fairfax County Government Center. Following are highlights of their conversation.

Nichols on a particularly memorable site visit:

“There was a site visit a number of years ago. The resident was requesting help in the middle of the night, but couldn't raise anybody to respond to his request for help, so he ended up calling 911, and police came out. We did go out a couple of nights later to see what was going on in the night shift. We did find staff sleeping. We did find that medication wasn't stored correctly, and that their call system was not working, so they weren't getting assistance at night.

“There were a lot of meetings. In that case, we ended up working with corporate to get an answer about what they were going to be doing. Obviously they needed a new call system. There was some staff fired in that case. We, of course, cannot guarantee that something is not going to happen again. But we do try to negotiate with them and get it where they see it's to their benefit to do things the way they should be done.”

On the power of negotiation:

“We have a complaint log on our website, and it's all the formal investigations done by our paid staff over the last 12 months. Facilities do not like to see their names on that list. And that resolution is not our determination, not the ombudsman's determination -- that resolution is the complainant's determination.”

On researching a nursing home:

”We always recommend that people go to the facility at least two times. On the first visit, you'll get the marketing visit where they take you on the tour. And then we suggest you drop in unannounced, usually in the evening or weekends because staffing is different during those times.”

On serious complaints:

“I think for each family or each resident, every complaint is serious. Obviously there are ones that are medically more significant. Even hydration -- that's one big thing that happens in a lot of facilities, and people may not think, ‘Oh, you know, so they don't have a glass of water sitting by the bed.’ But if you can't get out of bed to get your own water, that's a huge thing, and it has repercussions because not being hydrated affects your whole health. But that's a major piece. People may not think about it. And, to be fair to staff, a lot of times they don't have enough staff at the facilities to do everything that they are supposed to do. And a lot of the staff at the facilities work two or three jobs just to be able to live in this area. So the wages in the area, especially for the direct caregivers, aren't really ones they can live off of for their family.”

So there are problems on both sides. There are staff that maybe don't care as much as they should. But there is a lot of staff that really do care, and they are trying to do their best. It's just they don't have enough staff there to do it.”

On the major causes for abuse and neglect:

”I would say lack of training. Either they don't know how to do something they should know how to do, and that may be how to deal with a dementia resident who is acting out -- has anger issues or something, and how to deal with that person to settle them down. Obviously confronting them is not the right answer, if someone does not understand. So training is a big issue.

I would also say exhaustion and frustration. Hopefully you don't have anybody in there that does things intentionally. But once in a while there is somebody who's not in the job that they should be in, and it's not the right fit for them.”

On the title ombudsman:

It's originally a Swedish term for "citizen's advocate." Usually an ombudsman is an impartial person, but obviously we are not impartial. We do try to be nonjudgmental, as best as anyone can be. But we are obviously working on the side of the resident or their decision maker. So we do take everything into consideration. We don't just go storming in and say, ‘You're neglecting this person.’ We would interview all the pertinent staff. We would do a records review, and then with all that information pulled together, we would say whether it was verified or not verified, and then work toward the resolution.”

On the unsettling parts of the job:

“We have to be able to go home and not take it home with us. I think the first few years on the job that was hard for me, to be really honest. I hope I haven't become cold and callous. But you have to learn to leave it at work. The first few years, there's a lot of sleep lost and wanting to be able to fix things I couldn't fix. And I still have that, but I think you learn to try to keep a little bit of separation there.”

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