What is an Ombudsman?
“Ombudsman” is a Swedish word meaning citizen representative. An Ombudsman in this program is an advocate or friend for residents of Long Term care facilities.
A Long Term Care Ombudsman serves as a mediator who seeks to resolve complaints made by or on behalf of people living in Long Term care facilities. The Ombudsman provides a way for people to voice their concerns and have their complaints addressed. The Ombudsman works with all parties to resolve a problem.
What Does An Ombudsman Do?
- Advocate for Residents when their legal rights have been violated or they are not receiving proper care or assistance.
- Investigate Concerns from LTC residents, or from others on their behalf, as they relate to resident’s rights, services, and benefits. Complaints may be against facilities, government agencies or programs, or other service providers.
- Provide Residents’ Rights training to nursing home and adult care home facility staff.
- Provide Technical Assistance to residents, families, and staff in areas including: care planning, family and resident councils, resident transfer and discharge, long term care placement, etc.
- Promote Elder Abuse Awareness within the community.
- Monitor long term care facilities to ensure residents’ rights are not being violated.
- Educate the public on long term care issues and promotes increased community involvement in long term care facilities.
- Provide Training and Technical Assistance to Community advisory Committee volunteers appointed by County Commissioners.
What To Do Before Calling the Ombudsman
- Be prepared. Be organized and have your concerns written down to help you be more effective and ask the right questions.
- Keep your own records. Take notes or keep a journal. Remember to record dates, times, and people you spoke with regarding your concerns.
- Be pleasant. Getting angry or rude never helps to solve the problem.
- Utilize the facility complaint or grievance procedure system. If possible, try and solve complaints through the facility first.
What are Community Advisory Committees?
The Ombudsman works in conjunction with Nursing Home and Adult Care Home Community Advisory Committees in each county to serve residents in long term care facilities. Community Advisory Committees are volunteers appointed by the county commissioners who visit facilities, interact with residents, and advocate for quality care in the homes. Members must reside within the county that they serve and serve terms from 1-3 years. Contact your County Commissioners to obtain an application to serve.
- Advocate for residents of long term care facilities and work on the local level to resolve complaints.
- Visit facilities to ensure that the Resident’s Bill of Rights is being followed.
- Promote elder abuse awareness.
- Must reside within the county they serve and cannot have an immediate family member in a facility within the county.
What are the Different Levels of Care?
Assisted Living residence means “Any group housing and services program for two or more unrelated adults, by whatever name it is called.” N.C. Division of Facility Services, 1998
The assisted living program makes available at a minimum one meal a day, housekeeping services, and provides personal care services directly or through a formal written agreement with one or more licensed home health agencies. Nursing services provided to an individual in an assisted living residence may not exceed those allowed under Medicare home health regulations.
Continuing Care Retirement Communities
Continuing Care Retirement Communities provides hands-on personal care services and nursing services, which are arranged by housing management and are provided by a licensed home care or hospice agency through an individualized care plan. The N.C. Department of Health and Human services maintains a registry of these facilities. CCRCs are not licensed or monitored.
There are two types of assisted living residences that are monitored by ombudsman:
Adult Care Home
Adult Care Home is an assisted living residence in which the housing management provides 24-hour scheduled and unscheduled personal care services to two or more residents, either directly or through formal written agreements with licensed home care or hospice agencies. Formerly called Domiciliary Homes, adult care homes are commonly called “Rest Homes” and are licensed by the North Carolina Department of Health and Human Services to provide assistance with activities of daily living and are monitored by county Department of Social Services for compliance with minimum regulatory standards.
Family Care Home
Family Care Home is a small adult care home that cares for two to six unrelated residents in a family-like setting. The homes are often found in residential communities and have around the clock or live-in staff that prepare meals, give medications and provide help with activities of daily living. They are licensed by the North Carolina Department of Health and Human Services for compliance with minimum regulatory standards.
Nursing Homes, provide extensive and professional health care, personal care, food service, and activities to people of all ages. For reimbursement purposes, residents in the nursing homes are classified as needing skilled nursing care or intermediate nursing care. Those receiving skilled care have acute medical needs that require constant (24 hour) professional nursing or licensed staff monitoring. Residents in intermediate care have needs that require the services of a professional nurse at least 8 hours a day.
- Many nursing homes have special units to care for:
- Residents who can benefit from rehabilitation
- Residents with dementia
- The cost of nursing home care often seems overwhelming, with most facilities charging from $3,000 to $4,500 a month.
- The cost covers around-the-clock care, room and board. Some therapies require additional charges. There may be fees for laundry, haircuts, personal items and supplies.
- Prescriptions are not covered in the monthly charges.
How Can I Find Out More About A Facility?
Adult Care Home Rating System
The North Carolina Star Rated Certificate program for assisted living facilities, also called adult care homes and family care homes, was established in response to requests of North Carolina citizens for increased availability of public information regarding the care provided in adult care facilities. The rules are based on General Statute 131D-10 , and were created by the N.C. Medical Care Commission with input from residents and families in adult care homes, advocacy groups, providers, and others. Click here to access the ACH Star Rating System.
Nursing Home Compare
The Nursing Home Compare Website features a rating system that gives each nursing home a rating between 1 and 5. Nursing Home Star Ratings compare nursing homes with one another. The ratings are based on minimum standards. Click here to access the Nursing Home Compare Website.
Links to Payment Sources
Medicare (for Medicare covered services) ACH Assistance Medicaid