Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, June 8, 1995 TAG: 9506090001
SECTION: EDITORIAL PAGE: A-9 EDITION: METRO
SOURCE: CARROLL ESTES
DATELINE: LENGTH: Medium
After you reach 65, your chances of being admitted to a nursing home are greater than 40 percent. The states designate ombudsmen to represent the interests of the elderly in nursing homes or other long-term care facilities. These advocates can be godsends to people who are too ill or frail to stand up for their rights.
The ombudsman program is a good example of how an innovative, federal-state partnership can make a real difference in people's lives.
In 1993, about 1,000 paid staff and 7,000 volunteers handled almost 200,000 complaints lodged by people across the United States. Ombudsmen kept residents of long-term care facilities from being discharged against their will, reduced the use of physical restraints, improved building and safety standards, reduced the excessive use of medication, improved the licensing and quality of staff, and increased the use of advanced directives for medical care.
But the program is too small, fragmented and strapped for funds to do what needs to be done. An Institute of Medicine committee that I headed found many who need assistance do not have access to the services of an ombudsman. In parts of the country, ombudsmen do not or cannot visit facilities frequently. Many residents of long-term care facilities do not know the program exists.
In other cases, the program is not easy to use. Residents in some states must call a central, toll-free telephone number to contact an ombudsman. But some elderly are too impaired to make such a call.
Besides acting as advocates for individuals, ombudsmen address broader sources of problems. They evaluate laws and regulations, educate the public and the staffs of nursing-home and other facilities, disseminate information about programs, and give support to groups concerned about long-term care.
This additional role highlights the potential for serious conflicts of interest. Many ombudsmen are state employees who work for the very agency they are monitoring. And if they are relatively junior members in a governmental hierarchy, they can have great trouble working for systemic change. Ombudsmen should not be employed in agencies that compromise their ability to carry out their jobs.
Legal services are another problem. Most states do not ensure that ombudsmen and residents have legal counsel available when they need it. The states and the federal government should work with other groups to foster a variety of legal assistance for residents of long-term care facilities.
Other reforms are needed to realize the full potential of the ombudsman program. The federal government, which pays about 60 percent of the costs of the program, has the responsibility to monitor how well states are implementing it. The federal government also should support research into how the ombudsman program can more effectively meet residents' needs.
The need for ombudsmen will continue to grow. In 1981, Congress expanded the program to cover not only nursing homes but also board-and-care facilities - also known as rest homes, assisted-living facilities, homes for the aging, and domiciliary-care homes. But the program in many states is not big enough even to cover people in nursing homes.
The ombudsman program has demonstrated its ability to help residents of long-term care facilities. Now we need to think creatively about how we can use it more effectively.
Carroll Estes is professor and director of the Institute for Health and Aging at the University of California at San Francisco.
- National Academy Op-ed Service
by CNB