Ways that the NJ Ombudsman can be helpful in nursing home problems

New Jersey has a state-level Long-Term Care Ombudsman (LTCO), previously known as the Ombudsman for the Institutionalized Elderly whose mission is to protect the rights of individuals who reside in facility settings which are nursing homes (skilled nursing facilities), assisted living facilities, group homes and continuing care retirement communities. Each of these facilities is highly regulated under state and federal statutes and regulations. Residents’ rights are established by law and readers of this blog are aware of many of these rights. When there is a dispute with the management of a facility which isn’t getting solved informally by the representative of the resident (whether that’s the resident’s spouse, adult child, guardian or lawyer, for example) and the internal lines of communication just don’t seem to be working, sometimes the answer is to contact the Ombudsman for intervention.

The process generally begins by making a phone call to the Ombudsman’s toll-free number which is 1-877-582-6995. Prepare a very concise version of the story so as to focus the Complaint. An example from a case I handled many years ago was this: “the resident lives in XYZ nursing home and wishes to move out to a different nursing home in another county, and she  has repeatedly requested that medical records and summary sheet be faxed to the potential new facility but the XYZ Director refuses to honor the resident’s request.” One call to the Ombudsman’s office got that problem solved in a flash.

There are many useful publications that they can provide to you. Click here.

Keep in mind that the role of the Ombudsman’s office is to solve disputes between residents and facility management or staff so as to safeguard the resident’s rights vis-à-vis the facility’s policies or conduct. Don’t expect the Ombudsman to be able to intervene in inter-family disputes, which sometimes do occur related to visitation, access and fiduciary responsibilities. For problems like that, a different strategy will be needed and mediators, family counselors, trusted advisors and attorneys may all play a role.

Call us for advice and assistance on elder care and long-term care planning and quality of life planning ………. 732-382-6070

New federal rating system for nursing homes could show drop in scores

On February 20th, the federal Centers for Medicare & Medicaid Services (CMS) launched a new rating system for nursing homes which is based on factors that go beyond self-reported data, and will reflect auditing of self reports. Staffing levels must be reported quartely, and will be cross-matched against payroll records to verify accuracy. The use of antipsychotic medications will now be a factor in the evaluation, and the standards to be met to achieve the top 5-star rating have been improved.  The consumer website is Medicare.gov NursingHomeCompare. Since the methodology has changed, you may not be able to accurately compare 2014 with 2015 when it comes to the issues that have changed. Scores may drop because of the new requirements. In NJ, roughly 25% of the nursing homes have achieved a 5 star rating in recent years.

There are 373 nursing homes in New Jersey.  They are inspected by both the NJ Department of Health and the federal government through CMS. New Jersey inspects most of them every year. Explanations about the state’s inspection program can be found at  the Department of Health Facilities Licensing and Evaluation website.

Complaints concerning nursing homes may be filed with the Department of Health particularly on level of service, violations of specific regulations,  or structural issues. Complaints concerning alleged infringement of residents’ rights can be filed with the NJ Ombudsman for the Institutionalized Elderly.

In selecting a nursing home, you will always want to visit the premises on several occasions (different days of the week including weekends, and days as well as evening), along with looking at data available through governmental websites. After all you’d be selecting a new home for yourself or your loved one.