relocating nursing home residents in closures
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RELOCATING NURSING HOME RESIDENTS
in CLOSURES
Tom La Duke; Relocation Ombudsman Specialist
State of Wisconsin-Board on Aging and Long Term CarePO Box 180, Kenosha, WI 53141
(262) 654-4952 (phone) (262) 654-6194 (fax)Tom.Laduke@wisconsin.gov
Wisconsin’s Ombudsman Program
Wisconsin statutes authorize the Ombudsman program to
Investigate complaints concerning improper conditions in long term care
Serve as mediator or advocate to resolve disputes
Promote public education to improve conditions Monitor laws, regulations, and policies Publish materials and initiate legislation to
correct inadequacies
Wisconsin’s Ombudsman ProgramRegional Assignments
PAUL SOKOLOWSKI
Volunteer Ombudsmen Program
90 volunteers in SNF’s in 3 regions of the State and 15 in select CBRF’s
Training-orientation and quarterly training
Responsibilities-weekly visit to assigned facility. Monthly written reports to a volunteer coordinator that shared with the assigned Regional Ombudsman
Wisconsin Statistics
90 Nursing Home closures and/or down-sizings, since 1999
Since the project began in March, 2006, there have been
6 Nursing Home closures and 1 Nursing Home down-sizing which have affected
hundreds of residents who’ve had to relocate 3 replacement relocations that involved the moving of
another 350 residents as well as Numerous down-sizing and closing of ICF’s-MR and
CBRF’s
3 Types of Relocation Activities in which a Nursing Home files a Plan in Wisconsin
CLOSURE- everyone must leave
DOWN-SIZING- some must leave
REPLACEMENT*- everyone must leave, but have a new place for everyone to move to.
Wisconsin State Statues require that a facility file a RELOCATION PLAN when:
The Facility is closing, intends to close or is changing its type or level of service or means of reimbursement
and
Will relocate at least 5 or 5% of the residents whichever is greater
JOB DESCRIPTION
Title:Relocation Ombudsman Specialist
Status: Temporary Project Position (March, 2006-March, 2009)
Funding: Civil Money Penalties
GOAL: To advocate focusing on quality of Care and
the protection of rights while residents relocate from closing nursing homes
JOB DESCRIPTION-continued
OBJECTIVES:
– Inform, educate and assist residents and their families (develop informational materials and present to Resident and Family Councils)
– Participate in Relocation Team meetings to represent the interests of the resident and promote preferences for alternate placement
– Participate in Discharge Planning Sessions as authorized
Follow up on residents after having relocated
– Monitor closing facilities (communicate concerns about care) Provide technical assistance to staff
– Identify deficiencies related to the facility closure and resident relocations. Advocate for changes in public policy. Advise the State Ombudsman and Board
WORKING with OTHER OMBUDSMEN
Relocation Specialist
-Sits on Relocation Team-Refers to Regional Ombudsman-Monitors conditions-Advises staff-Reports on processes
Regional Ombudsman
-Does Case work -Takes Complaint referrals -Assists with appeals -Monitors conditions
Work with Volunteers
Volunteer at the Closing Facility to
Monitor general conditions Report concerns for
conditions Introduce program and
offer services Communicate
developments to residents and families
Take referrals for questions/complaints
Volunteers at the Receiving Facility to
Follow up on residents that relocate from a closing facility
Introduce program and offer services
Report on adjustment to new facility
Take referrals for questions/complaints
INFORMATION and ASSISTANCE to
RESIDENTS and their FAMILIES
Touring and introducing the Ombudsman Program to Residents
Participating at Resident and Family Informational Sessions
Setting up and maintaining a Resource Room.
Providing written information on residential options and services, funding, directories of nearby facilities and contact lists for agencies and programs. Brochures on the Ombudsman program, resident rights and recommendations for discharge planning
Presenting to the Resident and Family Councils
More Touring and meeting to maintain contact with residents
EDUCATION to FACILITIES
Reviewing elements of their Relocation Plan Reviewing a Roster of Residents to identify
potential obstacles for relocation (clarifying legal status, diagnoses, special needs.)
Recognizing and addressing Transfer Trauma Providing Discharge Planning and Orientation Working with the Relocation Team and
understanding Processes (screening for funding, etc.)
Understanding Ombudsmen’s and other agencies’ roles
RELOCATION TEAM
Wisconsin Statutes assign responsibility the state DHFS
– Offer relocation assistance to the resident– Prepare removal plans and transfer trauma mitigation care
plans– Assure safe and orderly removal from the facility– Protect the resident’s health, safety, welfare and rights
Wisconsin Statutes authorize the state DHFS to
– Place relocation teams in any facility for any reason for the purpose of implementing removal plans and training staff of transferring and receiving facilities in transfer trauma
mitigation.
RELOCATION TEAM
The DHFS Coordinator directs the activities of a “relocation team” that’s made up of representatives from the
Facility (Social Worker, Director of Nursing, Nursing Home Administrator) County (Resource Centers and Care- Management Organizations) State (Relocation Coordinator) Advocacy (Ombudsmen and the Protection and Advocacy Organization
TRANSFER TRAUMA
Relocation Stress Syndrome, also called Transfer Trauma, is a formal nursing diagnosis and defined as “physiologic and/or psychosocial disturbances as a result of transfer from one environment to another.” It is otherwise defined as “the combination of medical and psychological reactions to abrupt physical transfer that may increase the risk of grave illness or death.”
REDUCING TRANSFER TRAUMA
The involvement of familiar people, the maintaining of consistent daily patterns and routines, and assisting the resident in becoming acquainted with new surroundings can help minimize stress associated with relocation.
Slow and thorough discharge planning that provides the resident with an opportunity to tour alternate living arrangements and, most importantly, that asks the residents what it is that they want can help ease the adjustment of needing to move.
DISCHARGE PLANNING
F204 Orientation for transfer or discharge
A facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.
Wisconsin’s Transfer and Discharge Activities
HFS 132.53(3)(b)3.
Transfer and discharge activities shall include: Counseling Opportunity to visit potential alternate placement Assistance with moving Provisions for medications and treatments
Wisconsin Requirements for Discharge Planning Conferences
HFS 132.53(3)(b).
Prior to any involuntary discharge, a planning conference shall be held at least 14 days before discharge to
- Review the need for relocation- Assess the effect of relocation on the resident- Discuss alternatives placements- Develop a relocation plan
Post Discharge Plan of Care
F284 When a facility anticipates discharge a resident must have a discharge summary that includes : a post-discharge plan of care that is developed with the participation of the resident and his or her family, which will assist the resident to adjust to his or her new living environment
HFS 132.45(5) Documents, prepared upon a resident’s discharge, summarizing needed continued care and instructions
Notice and Appeal Rights
F203 Notice before transfer
Before the facility transfers or discharges a resident, the facility must notify the resident…of the transfer or discharge…in writing and in a language and manner they understand
Notice Timing and Contents
F 203 The notice must (usually) be made…at least 30 days before the resident is transferred or discharged and must include:
The reason for the transfer or discharge
The effective date of the transfer or discharge
The location to which the resident is transferred or discharged
A statement of the right to appeal the action
The name, address and telephone number of the State long term care ombudsman (or the protection and advocacy agency)
MONITORING CARE and TREATMENT
Staffing levels and Unmet Needs
Food and Menus
Activities
Certain Regulatory Standards of Care (for choice, notice, dignity, restraints and abuse.)
REPORTING CONDITIONS
To the facility
To the Department of Health and Family Services Relocation Coordinator
To the State Regulatory Agency
Other Duties as Assigned
Identify and report deficiencies in processes
Make recommendations to the department and the Board on Aging and Long Term Care
Assist in rewriting the State’s Relocation manual
Follow Up Activities
By the Facility By the County By the State By the Ombudsmen
– By the Volunteers– By the Regional Ombudsman– By the Relocation Specialist
Different Problems for Different Kinds of Relocation Activities
CLOSURES DOWN-SIZING
REPLACEMENTS Any/All of the ABOVE
PROBLEMS in CLOSURES
Stress of having to move (involuntarily.) Not having options or knowing they exist. Not being kept apprised of developments Moving before being ready Inadequate discharge orientation and planning Being Unaware of Notices and appeal rights Experiencing Subsequent relocations from
closing facilities
Recommendations in Closures
Keeping residents and families informed and up to date
Explaining options and facilitating discovery Repeated “mini” discharge planning sessions Develop adequate discharge materials
(summaries, post discharge plans.) Demand some kind of notice Follow up contacts and visits
Problems is Down-Sizing Facilities
Stress of possibly having to move (involuntarily) or to lose contact with other residents (survivors remorse)
Anger and resentment related to arbitrary decisions being made (unfair selection for being discharged.)
Loss of faith after being confronted with having to go through appeal process.
Recommendations in Down-sizings
Encourage facilities to plan ahead and to decrease census through attrition (to avoid involuntary discharges.)
Educate residents and families (and facilities) about the rights to notice and appeal
Monitor for violations of those rights and be prepared to assist in appealing a discharge decision.
Problems in Replacement Relocations
New buildings aren’t fully ready for occupancy (beds unavailable, call lights/electronic systems not operational.)
Residents/families unsure of details for the move Residents’/families’ preferences aren’t
accommodated (for room/roommate choice) Residents aren’t fully prepared (belongings not
packed or left behind.) Staff aren’t oriented to the new building (can’t find
equipment and supplies)
Recommendations in Replacements
Facilities should plan well in advance and expect the contractor’s dates to be off.
The regulatory agency should ensure the building is completely ready for occupancy well in advance of anticipated move date (and should require beds be made immediately available upon the residents’ arrival.) Plans should be required and monitored for implementation
Residents and families should be included in the planning and their preferences accommodated.
They should be offered tours and periodic updates on how the project is proceeding.
Belongings should be sent simultaneously and promptly unpacked
Staff should be oriented to the building and have access to all needed equipment and supplies.
Extra staff and volunteers should be on hand before, during and after the move.
Educational Materials
Business CardRights BrochureRights BookletAdmission Agreement BrochureWebsites
Ombudsman BrochureAvoiding Problems BrochureSurvey Brochure
Other materials include lists of area nursing homes, residential types, etc.
QUESTIONS
???
For more information, please call or write
Tom La Duke; Relocation Ombudsman SpecialistState of Wisconsin-Board on Aging and Long Term Care
P.O. Box 180, Kenosha, WI 53141(262) 654-4952 (800) 815-0015
Thomas.Laduke@wisconsin.gov
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