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If you, or a loved one, is a resident of, or is considering, assisted living, or a nursing home, a long-term care (LTC) ombudsman may be able to help. LTC ombudsman help resolve residents’ complaints, provide information and assistance, advocate for residents’ rights and quality of care, and advocates for system and legislative changes. The LTC ombudsman has the power, based on federal and state law, to protect residents’ rights.

Resolving Residents’ Complaints

The long-term care ombudsman can help residents of LTC facilities who have concerns and complaints about their care or services they receive. LTC ombudsmen have a standardized classification scheme for the types of cases that they handle. The seventeen major categories are listed below and are instructive of the kinds of issues that residents may face in LTC settings:

• Abuse, Gross Neglect, Exploitation
• Access to Information by Resident or Resident’s Representative
• Admission, Transfer, Discharge, Eviction
• Autonomy, Choice, Preference, Exercise of Rights, Privacy
• Financial, Property (Except for Financial Exploitation)
• Care
• Rehabilitation or Maintenance of Function
• Restraints – Chemical and Physical
• Activities and Social Services
• Dietary
• Environment/Safety
• Policies, Procedures, Attitudes, Resources
• Staffing
• Certification/Licensing Agency
• State Medicaid Agency
• System/Others
• Complaints About Services in Settings Other Than Long-Term Care Facilities or By Outside Provider

According to the Administration on Aging, for the most recent year available (2007), “Care” has the greatest number of complaints; about 27%. Care is a broad category that includes accidental or injury of unknown origin, falls, improper handling, failure to respond to requests for assistance, failure to follow plan or physician orders, improper administration of medicines, personal hygiene, and toileting/incontinent care among others.

Environment (air/temp, cleanliness, building, etc.) comes in second with about 11%, closely followed by Autonomy (et al.) at 10% and dietary at about 8%. Detailed statistics, both national and by state, are available from the Administration on Aging LTC Ombudsman National and State Data page.

Information and Assistance

Ombudsmen do more than handle complaints. If you have questions on alternatives to nursing home care, or about your rights in a LTC facility, or on alternatives in long-term care, an ombudsman may be able to help you. Some provide witnessing services for advance health care directives. An ombudsman may be able to attend a resident care plan meeting, or a resident or family council meeting.

Advocates for system and legislative changes

State and regional ombudsman programs work with other advocacy organizations to recommend legislation and regulatory changes that affect LTC residents. They routinely serve on boards and committees of other organizations and actively advocate for policies to promote quality of care.

The National Long Term Care Ombudsman Resource Center is a great place to get a start in understanding what an ombudsman can do for you. Probably the most important page is the ‘Ombudsman Locator‘  where you can find state and local help.

Related Links

• Detailed description of ombudsman complaint codes (MS Word)
• Senior Help Forum – State and Local Resources Page

As of December 1, 2008 the pension can pay as much as $23,396 for aid and attendance for a veteran and their spouse, assuming that medical expenses, including necessary medical care, consumes all of their income. The amount varies based on need. You can see some examples of how the pension is calculated here.

In order to qualify for the pension, there are a number of service, medical and financial requirements that have to be met. According to the VA site:

Pension is a benefit paid to wartime veterans who have limited or no income, and who are age 65 or older, or, if under 65, who are permanently and totally disabled. Veterans who are more seriously disabled may qualify for Aid and Attendance or Housebound benefits.  These are benefits that are paid in addition to the basic pension rate.

Generally, you may be eligible if:

* you were discharged from service under conditions other than dishonorable,

AND
* you served at least 90 days of active military service 1 day of which was during a war time period. If you entered active duty after September 7, 1980, generally you must have served at least 24 months or the full period for which called or ordered to active duty (There are exceptions to this rule),

AND
* your countable family income is below a yearly limit set by law (The yearly limit on income is set by Congress),

AND
* you are age 65 or older, OR, you are permanently and totally disabled, not due to your own willful misconduct.

If qualified based on service, the financial situation of the veteran and whether there is still a spouse in the picture will determine how much the government is likely to pay.

You can read more about it on the Department of Veterans Affairs site.

I’ve heard from some that it can take as much as 12 months to be approved for the pension. The catch is that the veteran often has to be incurring assisted living, or nursing home, costs to qualify for the pension, meaning that those expenses have to be funded out of pocket until (if) the pension is approved. One approach is to apply for the pension before it is needed financially in order to determine that the veteran qualifies based on the military service first. Assuming that they were rejected for financial reasons only, they can reapply for the pension once they move into a care facility.

The only advice that SHF gives to veterans with regard to the pension is to see a Veteran Service Officer near you. They are trained to give veterans the guidance they need.

One such article ran in the October issue of Kiplinger’s, called Helping Your Parent to a New Life, chronicles the journey of the author’s mother from her home of 30 years to an independent living community. As with many stories of this type, it starts with a vague recognition of additional need, or increased risk in the existing living situation. Even though consideration is given to alternate living situation, no decision is made until a crisis event forces their hand. In this case, the mother has a heart attack and during her recovery, the father dies of cancer.

Disbelief was my first response to the New York Times blog post by Jane Gross discussing Dr. Cheryl Woodson’s book, To Survive Caregiving. The post notes that Woodson asserts that assisted living, a popular solution for elderly people who cannot live independently, is a “myth, a place for people who don’t exist.” Woodson’s take appears to be: at the moment when our parents need more help in their homes than we can provide ourselves, assisted living if it works at all won’t suffice for long. You may no longer have to cut the grass, or cook some meals, but soon parents need additional services and the bills will grow briskly.

Woodson makes a good point, but arguably at one end of the spectrum of possible outcomes. If we’ve put off the decision, or a parent is aging quickly, assisted living may indeed be soon insufficient for their needs. For others, assisted living may be appropriate for a good number of years. However, unless the parent dies suddenly, additional care decisions will ultimately need to be addressed.

It seems as though many of these decisions follow a general pattern:

1. Vague recognition, but no immediate commitment
2. Growing momentum, but still no commitment
3. Crystallizing event
4. Search in earnest with hurried arrangements
5. The move
6. Fallout & Recovery

While it may not be possible to avoid the ‘no commitment’ period, doing your homework and being prepared will help avoid costly and painful mistakes when the time comes to make a decision for change.