Residents Have Rights

Our long-term care Ombudsman program has many volunteers who walk through facilities to visit with the residents. The volunteers see how the residents are doing, observe the physical appearance and watch interactions with the staff members.

Last month one of our volunteers had gone to an Assisted Living facility. Just before the volunteer arrived a resident named Barbara had fallen. Barbara was still on the floor when the volunteer walked in. By this time the staff had met with the resident who was shaken from the fall but physically alright. The volunteer observed the Assistant Director come in to do a final check over and said, “I am going to have to let your son know you had another fall”. Barbara asked the Assistant Director to not call her son because she did not want him to know. The Assistant Director said he was sorry but he had to let him know.

Residents have rights. Even if Barbara has assigned her son to be her power of attorney, she has the right to say she does not want him to be informed of her fall. Many family members, as well as long-term care facilities, are not aware that a person can revoke a power of attorney at any time. These are issues the Ombudsman discuss and educate facilities about on a regular basis.

A few days after the incident an Ombudsman went back to speak with the Assistant Director about Barbara’s right to say “no”. The Assistant Director stated he always respects the resident’s wishes and he would never make a call if he was told not to. Regardless of whose account of the conversation is accurate the Assistant Director was educated on Resident Rights. The Ombudsman will always respect and promote the resident’s right to self-determination.

Physical Restraints

A few weeks ago I went to a long-term care facility to investigate a case. While walking down the hall I heard a woman weakly yell, “Help me! Help me!” Staff members were walking up and down the hall but didn’t stop to help the woman. I poked my head into her room to see what the problem was. There on the bed was a white haired elderly woman crunched up against her bed rail unable to move. Through her whimpers she explained she had been sleeping and somehow rolled over and couldn’t move. Her call light was out of her reach. I explained that I could not move her, but would push her call light and go find someone to help. After I promised I would be right back, I went out into the hall to find someone, but was unable to. Finally, I found a Social Worker who immediately jumped into action to meet the needs of this resident.

It is still upsetting to me when I think about this woman: scared, hurt, and ignored. She had been physically restrained and the results could have been disastrous had she waited much longer.

In recent years, the health care community has recognized that physically restraining residents can be dangerous. There are benefits of bed rails which include: aiding in turning, providing a hand-hold for getting in or out of bed, and a feeling of comfort and security. However, there are many potential risks of bed rails that include: strangulation, suffocation, bodily injury or death when residents are caught between rails or between the rails and bed. There are increased incidences of bruising, cuts and scrapes as well as serious injuries resulting from falls when residents climb over the rails. Bed rails also contribute to the resident feeling isolated or unnecessarily restricted and they prevent residents, who are able to get out of bed, from performing routine activities such as going to the bathroom.

Fortunately, the potentially disastrous situation with the white haired elderly woman was diverted. The next day I had a meeting with the facility to discuss the situation with administration. Since the incident, the resident no longer is using a bed rail and the long-term care facility is making more of an effort to listen for their residents and answer their call lights in a timely manner.

Insist on Optimal Care

During a routine walk through of a long-term care facility, I came across an elderly woman who is severely physically challenged. Her body is so contorted that she is unable to reach for items around her she may need. During my previous visits to the facility I noticed that her water had been placed on the opposite side of the table and her can of Ensure was set even further away than the water. The last time I saw her she had a pill sitting in her mouth that she was unable to swallow because her water was out of reach. She was discouraged, thirsty, and unable to take her pills. This makes it painfully clear that this woman requires assistance from staff members that need to be more aware of her needs.

Another gentleman resident expressed his frustration that his portable urinal was not emptied on a regular basis. Instead, the urinal sat on his bedside table getting full as the day goes on. The last time we spoke he reported that the nurse accidently dropped his urinal, which dumped all of its contents on his bed and table. Disgusted, the man exclaimed, "I told the nurse that if the urinal was taken care of like it should be, this would not have happened!"

It appears many staff members are approaching their jobs mechanically, hurried, and are not stopping to check on the needs of the resident that aren't always obvious, but are certainly fundamental to providing quality care. It is so important for family members to be involved with their loved one's care. Take time to observe the actions of staff and insisit the resident is having their needs and wants met. It can have a positive effect on the life and care of your loved one as well as other residents in the long-term care facility.

As Ombudsmen, we go into long-term care facilities, meet with the administration and address these types of systemic issues. The woman, who has difficulty reaching her water, is now receiving a cup holder to put on her wheel chair so she can reach it more easily and staff is receiving more training to meet her needs. As for the gentleman, the staff are now receiving training to ask the resident if there is anything else they can do before they leave the resident's room. This addresses the issue of a full portable urinal that needs to be emptied, and issues such as bedding that needs to be changed or a resident who has not been dressed for the day. After approximately a week, I'll go back and see what progress has been made and how communication and care has been improved. It is our hope that these issues are resolved quickly and the quality of life for the residents will be optimal.

A Living History

During my last facility visit I met a woman named Ruth. Born in 1913, Ruth came across as rather cantankerous at first, but as our conversation continued, Ruth warmed and took me on a journey of days gone by.

Ruth couldn't remember what she had for breakfast that day or if she takes medications on a regular basis, but the mist over her memory lifted as she recalled her childhood with clarity. Ruth took me back to the 1920's. I could hear the smooth rhythms of the band play as she spoke of the dances in her farming community. I felt the salt on my skin as she regaled me with stories of swimming with her friends in the Great Salt Lake, and the dirt under my fingernails as she described the labor and joy of digging sugar beets with her father.

I will remember that day with great fondness as I sat and talked with Ruth about her early years. There were no complaints made that day, just a reminder that there are valuable sources of history living among us.

To the reader of this blog, I challenge you to take an afternoon and visit with an elderly person. Through their story you might just find you are swept away to a different place and time.

SAGE

Salt Lake County Aging Services is teaming up with SAGE Utah. SAGE is an organization that works with the 50+ Lesbian, Gay, Bisexual, Transgender, Queer population. SAGE stands for Services and Advocacy for the Gay Elderly. We, at Aging Services, are finding that the LGBTQ population is under represented and unaccounted for in the Long-Term Care (LTC) facilities throughout Salt Lake County.

Gayle was a lesbian who lived in a nursing home and had been diagnosed with the beginning stages of dementia. When Gayle first moved to a LTC facility, she socially isolated herself in fear of being "found out". Gayle had no friends or family and was completely alone. As she bacame more confused, she started losing sexual inhibitions. Gayle started to flirt with the other female CNA's and it was then that her "secret" was out. The staff began to make fun of Gayle and ultimately would not help her. Gayle, heavy hearted and depressed, retreated into isolation for the remaining days of her life.

It is very common for an openly gay person to go into the "closet" when they move into a LTC facility. Many LTC facilities have the "don't ask, don't tell" policy. LGBTQ long-term care residents are under represented and need a voice. We are developing this partnership with SAGE to help find that voice.

How to Become a Volunteer Ombudsman

An Ombudsman volunteer is a very rewarding experience. Although the work itself can appear heart breaking, our volunteers have found that they can make a difference in the resident's lives. Whether that difference is preventing future abuse from happening or simply being there for someone who needs a real person to talk to. The real reward comes from the resident when they say, "Thank you, you are the only one who has listened to me".

Do you want to make a difference in your life and the lives of others? Give me a call or send me an email. We can meet and talk more about the program. You must be over the age of 18, have no conflicts of interest related to nursing homes or assisted living facilities, be willing to fill out documentation in a timely manner, and pass a background check. Many of our volunteers comment on how this program has changed their lives for the better.

We provide a two day training and then train you in the field until you are ready to go. You decide what days and times work best for you. In addition, there are monthly roundtable meetings that feature additional trainings as well as help and support to make you a better volunteer.

We ask that you can:

• volunteer about 2 hours a week
• complete documentation in a timely manner
• make a one year commitment

This program is for the truly dedicated. If you are interested, please give me a call or email at 801-468-2853, cjjensen@slco.org.

"I Would Have Planned Differently"

While on a visit at a facility, I came upon an elderly woman named Claire. Claire could not remember how long she had been there but she was ready to leave. She felt very alone and had not made many friends. Claire had five children and only one would visit her on a regular basis. Throughout the conversation the one thing Claire would repeat was, "I took care of my mother and father until they died in my home. That was just the expected thing to do. I assumed that my children would do the same for me. Boy was I wrong!" Claire continued to say, "if only I had known, I would have planned for things differently."

Unfortunately, this is a common scenario for many long-term care facility residents. If you have not done so, please speak with your parents or your children about what you or a loved one's wishes are. This can be an uncomfortable conversation for some but a very necessary one.

There are many great resources on line; Google topics like "how to discuss end of life decisions". There is also the new Advanced Directive. This could be used as a guide for discussion while filling it out. However, REMEMBER that the loved one always has the right to change their mind about their care! Be prepared and know that even though documents have been signed and the Advanced Directive has been filled out, the loved one can still change it.

If you would like a free copy of the Advanced Directive, call me, Charise Jensen at 801-468-2853.

How to find a Long-Term Care Facility

Many times throughout the week we receive calls from frantic family members stating they have just been told mom or dad need to be put in a Long-Term Care (LTC) facility. The following is a list of the advice we give:

• Decide which area of the valley you would like your loved one to be.
• Start with about three facilities from that area.
• Visit the facility. Be sure to go at different times especially in the evening and on weekends as that is when we receive the most complaints.
• Print the nursing home guide on our website (it is under Ombudsman in the Salt Lake County Aging website). Use this guide as you are visiting the facility.
• Review the LTC facilities current State survey. It is usually at the front desk in a binder. If you can not find it, ask for it. This will give you an idea of the different types of complaints the facility has had with the state.
• Call us!!! We can give you additional information about any other complaints the LTC facility has received.
• We can also send you a 55+ book free of charge. This is a resource book of different services offered to people 55 years and older. The book also has lists of the different LTC facilities.

There is not one perfect LTC facility. Generally there is a consistent change of staff and administrators. The best thing to help with the care of your loved one is to visit on a regular basis. Get to know the staff and the other residents. Be aware of the care your loved one is receiving. If there are concerns and they are not getting addressed, call us! We can help you advocate for your loved one.

Unspoken

Being an Ombudsman volunteer is not just about "digging up the dirt" it's also about validating the resident. The majority of residents are lonely and do not have much interaction with the outside world. Our volunteers have opportunity to give the residents time to express themselves.

This is the experience of one of our volunteers during a Long Term Care (LTC) facility visit, he says, "I spent a few minutes in the "social room" with a resident who could not speak, so I don't know her name. She waved me in as I walked by. When I sat down she handed me a deck of cards. I shuffled them and handed them back. She dealt one down and one up to both of us. I realized we were playing blackjack; so I played until the deck was dealt through. I never could get the resident to speak to me, but she seemed genuinely pleased that I sat down and played."

Our volunteers are a listening ear even if no words are spoken. This resident was able to have a piece of time where she was not being talked over, ignored or rushed. She had a moment were she felt like a person again.

They Really Do Care

A Long-Term Care (LTC) facility contacted the Ombudsman office because a resident was refusing to take her medications or even get out of bed. She was viewed as a difficult resident and the staff was very frustrated. The Ombudsman spoke with the resident who reported that she felt as though the staff didn't care about her. She would not take her medications or get out of bed because they were not being kind to her. Furthermore, she was bored, had no way of communicating with her family who lived miles away, and the recreational activities offered were not of interest to her. There was a huge communication gap between the facility and the resident causing the staff to assume the resident's noncompliance was simply difficult behavior.

The Ombudsman spoke further with the resident and asked if she would be willing to use a computer to keep in contact with her family. The resident was thrilled with this idea.

The Ombudsman then spoke with the Administrator and suggested the LTC facility provide the resident with a computer. The Ombudsman suggested this could motivate the resident to work with the staff and give her a sense of purpose. The Administrator agreed.

A week later the Ombudsman completed a follow-up visit with the resident. The resident is now taking medications and getting out of bed. The Ombudsman spoke with the Administrator who stated that since the staff have taught her how to use the computer, their communication has improved greatly. Furthermore, the Administrator has decided to create a computer room for other residents to learn and use.

The resident showed the Ombudsman how she can receive pictures of her family and friends. More importantly, the resident feels as though the staff really care about her and ultimately renewed her sense of purpose.

Stepping outside of the box has opened new doors in regard to the way the Administrator addresses resident complaints. This has greatly improved the quality of life for the residents. The Administrator is to be commended for his willingness to try something new. He has discovered how important it is to communicate with residents and find what their interests are. The resident is happy, and staff is happy to see this resident motivated to participate in her care.