Ombudsman Program cut dramatically in California. With these cuts, you need to be more proactive about protecting your loved ones in nursing homes.

I don’t know if you know about a service that is provided free of charge to our nursing home residents. It is something called an ombudsman. (I have used the services of the Ventura County Ombudsman program when my aunt was in a nursing home.) The ombudsman is a specially trained person who protects the resident from being forced to sign something they don’t understand, protects them from elder abuse and protects them when they are receiving sub-standard care. I will be interviewing Molly Davies from the Los Angeles County Ombudsman Program, The WISE & Healthy Aging Long-Term Care Ombudsman Program, in August but I just wanted to let people in the Los Angeles area know about the effects of the budget cuts today. The office is down to 10 people who are protecting the 73,000 nursing home residents in Los Angeles County nursing homes. If you have a loved one in a nursing home in California, you need to be even more diligent about visiting and checking on your loved ones for the rest of this year. Hopefully, next years budget will better but for now, we all have to take on the role of the protector for our loved ones. Here is the statement from the Los Angeles County office.

Long-Term Care Ombudsman Program
Impact of the Governor’s Budget Reduction

The impact of the enacted 49% State budget cut to the local Long-Term Care Ombudsman Program (LTCOP) in California is devastating to the integrity of the services that are delivered and will negatively impact the residents that we serve. The WISE & Healthy Aging Long-Term Care Ombudsman Program is the sole contractor of Ombudsman Services in the City and the County of Los Angeles. The impact to this local program has been the loss of $1,109,783 in funding retroactive to July 1, 2008. In response we have eliminated 22 positions resulting in the reduction of staff from 32 to 10, and we have closed our Lancaster, Downtown LA, Burbank, and San Dimas regional offices. All remaining staff received a reduction in salary.

The following are conservative projected estimates of the reduction of our capability to deliver service to residents in long-term care.

Over 12,000 unannounced visits to nursing homes and board and care or assisted living facilities will not be conducted during this fiscal year, and every year thereafter.

Over 11,500 cases, including allegations of abuse and neglect will not be investigated during this fiscal year, and every year thereafter.

The LTCOP in California has three currently unfunded mandates that include the investigation of elder and dependant adult abuse investigations that occur in long-term care settings; the witnessing of advance health care directives for residents in skilled nursing facilities; and responding to the 24-hour State Ombudsman after-hours crisis line. Although these are unfunded mandates, we have managed to take on these tasks with out further compensation from the State of California, but may not be able to sustain these activities without restoration of our funding.

In the last fiscal year the WISE & Healthy Aging Ombudsman Program responded to 2,086 abuse complaints. Many elder abuse cases are identified during unannounced visits conducted by Ombudsmen, which will decrease proportionally with these enacted budget cuts.

The WISE & Healthy Aging Long-Term Care Ombudsman Program is the largest in the nation providing service to more than 1,816 facilities that have the capacity to care for 73,486 residents. The Ombudsman Program advocates for the rights of residents in long-term care facilities, and for many residents we are the only outside support they receive. The impact of these cuts effectively silences the voices of our most vulnerable constituents, residents in long-term care.

You may want to support the pending legislation AB 394 (Feuer and Jones) Protecting Vulnerable Seniors from Abuse and Neglect by Restoring Ombudsman Funding
AB 392 would use penalties paid by substandard nursing homes to help restore monitoring and advocacy by ombudsman programs. It is fitting that the penalty funds be used to support the ombudsman programs given their critical role in protecting residents’ health and safety.
Current law allows the penalty funds to be appropriated for ombudsman services. AB 392 would require that at least half of the penalty funds be allocated to local ombudsman programs each year in accordance with an existing formula.
Support AB 392 is co-sponsored by CANHR and the following organizations: AARP, Bet Tzedek Legal Services, California Alliance for Retired Americans, California Association of Area Agencies on Aging, California Senior Legislature, California Commission on Aging, Catholic Charities of California, Congress of California Seniors, and Ombudsman & HICAP Services of Northern California. Additionally, it is supported by local ombudsman programs and many other consumer organizations.

You may want to write or call your state senators.

Want More Information?
Use www.leginfo.ca.gov to find contact information for your Senator • and Assembly Member
and to keep track of AB 392’s progress.
• Visit CANHR’s website (www.canhr.org) for updates on all of CANHR’s legislation and to find
out how to become a CANHR Advocate.
• Call CANHR @ (800) 474-1116.

Have a kind and respectful day.

AB 2747 – End-of-Life Obligations and Communication

There are two parts to this California legislation. The first part addresses your obligations when your values limit what valid medical options you are willing to offer. The second part addresses when and how you should communicate about end-of-life choices.

The bill states that some patients and families suffer from a bad death since some physicians will not offer valid medical options. For example: If you your morals/values will not allow you to withdraw support or to write a DNR, then you are allowed to not participate in procedures you are morally opposed to. But according to AB 2747, you are not allowed to impose your values on the patient by not telling the patient about the other medical options. The law states that:

If a health care provider does not wish to comply with his or her patient’s request for information on end-of-life options, the health care provider shall do both of the following:
(a) Refer or transfer a patient to another health care provider that shall provide the requested information.
(b) Provide the patient with information on procedures to transfer to another health care provider that shall provide the requested information.

This has been the ethical standard for many years, but now it is the law. If you don’t want to talk about end-of-life issues, then by law, you must help the patient transfer to another doctor.

This brings me to the second part of the law. When a health care provider makes a diagnosis that a patient has a terminal illness or has less than one year to live, the health care provider shall, upon the patient’s request, provide the patient with comprehensive information and counseling regarding legal end-of-life care options. If the patient indicates a desire to receive the information and counseling, the comprehensive information shall include, but not be limited to, the following:

(1) Hospice care at home or in a health care setting.
(2) A prognosis with and without the continuation of disease-targeted treatment
(3) The patient’s right to refusal of or withdrawal from life-sustaining treatment.
(4) The patient’s right to continue to pursue disease-targeted treatment, with or without concurrent palliative care.
(5) The patient’s right to comprehensive pain and symptom management at the end of life, including, but not limited to, adequate pain medication, treatment of nausea, palliative chemotherapy, relief of shortness of breath and fatigue, and other clinical treatments useful when a patient is actively dying
(6) The patient’s right to give individual health care instruction pursuant to Section 4670 of the Probate Code, which provides the means by which a patient may provide written health care instruction, such as an advance health care directive, and the patient’s right to appoint a legally recognized health care decision maker.

It has always been ethically appropriate to have meaningful end-of-life conversations which discuss all the valid medical options including the option of having a good death. But now it is the law. You must have these conversations and offer all of the above options.