Long-Term Care Ombudsman FAQs

While the global impact of this virus is not what it once was, our neighbors in long-term care are the most vulnerable to the virus due to factors such as close proximity to one another, age and compromised immune systems. There are still some infection prevention and control recommendations in place from the Centers for Disease Control and Prevention and the Indiana Department of Health, especially if there is an active outbreak in a facility or county.

Find the latest CDC guidance here and IDOH guidance here.

Anyone concerned about someone living in an Indiana nursing home or a licensed assisted living facility resident can contact the long-term care ombudsman. Most often we are contacted by residents of these places themselves, relatives or friends of residents and facility staff.

As soon as you have a question or concern about the rights of an Indiana long-term care resident you can contact the long-term care ombudsman. We do have some restrictions, however. We can only advocate for those residing in an Indiana nursing home or licensed assisted living facility. We are not a referral resource for independent living facilities, hospitals or group homes. Because we work with and for long-term care residents, we also cannot advocate for a resident that has passed away.

Sometimes it is helpful to try some of these steps before contacting the long-term care ombudsman:

• Talk directly to staff and/or leadership at the facility
• File a written grievance with the facility
• Request a care plan meeting with the facility to discuss changes to care
• Voice your concerns at the facility resident council meeting or family council meeting

While these actions can be helpful, they are not prerequisites for contacting the ombudsman. You can contact the ombudsman before taking steps on your own and the ombudsman can also support you in taking any of the above measures.

The services of the long-term ombudsman are supported by state and federal funding. Engaging your long-term care ombudsman is always free and confidential.

You can contact either your local or state ombudsman. Most often the state ombudsman delegates complaints to a local ombudsmen, so it may be quicker and more direct to begin with your local ombudsman.

In normal circumstances the long-term care ombudsman reviews all complaints within 2-3 business days. If you are contacting the long-term care ombudsman about someone else, the first thing the ombudsman will do is reach out to the resident about whom you are calling. At this point the ombudsman is working directly with the resident, and you as the complainant may not hear back from the program. The ombudsman will work with the resident and anyone else the resident wants involved to resolve the issue. If the resident does not want any action taken, the ombudsman will not act. Because we are resident-directed, everything we do is by expressed wishes of the long-term care resident.

Resident-directed means the ombudsman acts only with the permission of the resident and only in a way that has been agreed upon with the resident. It also means the ombudsman works to resolve complaints to the satisfaction of the resident and the resident’s expressed desires. The ombudsman will advocate for the resident’s wishes, even when those wishes go against what other people may see as the resident’s best interests.

The responsibility of the long-term care ombudsman is always primarily to the resident. If a resident cannot express themselves, the ombudsman may communicate with the guardian to collaboratively work for the resident’s rights and interests, but the desires of the resident should always be considered, even when a guardianship is in place.

A family council is a group of family members of residents at a particular facility who meet to discuss ways to better support residents, work towards resolutions to concerns or ideas for improvement, and form connections. They have certain rights under Indiana law. For example, the facility must provide a private place for them to meet on facility grounds and delegate a staff member to respond to concerns and suggestions submitted by the family council. Similarly, under federal law facilities that accept Medicare and Medicaid payments must provide a meeting space, cooperate with council activities and respond to group concerns.

While family councils are an important resource, many facilities do not have them. Family councils are generally family-organized and so it takes an enterprising individual and a team of dedicated council members to get and keep a council going. You can ask the facility administrator or executive director if your facility has a council of this kind. If not, you have the right to start one.

You can find information about how to do this and useful resources from the National Consumer Voice for Quality Long-Term Care’s Family Council Center here.

Care or service plan meetings are one of the first tools we use as long-term care ombudsmen to get all concerned parties in a room together to see how the resident’s needs or preferences are currently accounted for, if it is working, and if there are any things that need to be changed.

When a person enters a nursing home or assisted living facility it is often to benefit from the care that such a place can provide for their unique needs. A plan for how to provide that care must be established by the facility right at the beginning in collaboration with the resident and resident representatives. This plan must be reevaluated periodically – quarterly for nursing home residents and twice a year for people living in assisted living facilities. It should be reviewed more often if something changes with the resident’s needs, or as requested by the resident or facility.

The running of care or service plan meetings varies depending on the circumstances. They are often run by the individual or individuals who requested the meeting. We find a great way to begin is to review the current care or service plan. The facility staff should be in possession of it and can share it with the other parties in the room. Then the plan can be evaluated, suggestions made and concerns addressed among the group. The meeting should end with a new or revised plan that incorporates topics discussed during the meeting. The care or service plan meeting is centered on the resident’s needs and choices and resident participation is a vital part of these meetings.

Yes, always.  There are only a handful of reasons a resident of a nursing home or assisted living facility can be involuntarily discharged or transferred from their home; these include:

• The resident’s needs have changed such that they cannot be met by the facility
• The resident’s health has improved such that they no longer require long-term care
• The health or safety of individuals in the facility is endangered
• The resident has failed to pay or have Medicare/Medicaid pay for the stay after reasonable and appropriate notice
• The facility ceases to operate

Even when one of the above conditions is met there is a formal process for an involuntary discharge. This should begin with a discharge planning meeting to ensure continuity of care when the resident leaves and to determine what the next step is for the resident. Except in cases of emergency, the resident must be given a completed Notice of Transfer or Discharge (State Form 49669) 30 days before the discharge would take effect. This form includes, among other things, information about a resident’s right to appeal an involuntary transfer or discharge via a Notice of Transfer or Discharge Request for Hearing (State Form 49831), which the facility must include with the Notice of Transfer or Discharge.

Whether the facility has followed all the appropriate steps for an involuntary discharge or not, you can always contact your long-term care ombudsman to advocate for the rightful process or to accompany a resident through the appeal process. In fact, the contact information for the state and local ombudsman should be listed on the discharge notice itself.

The care a facility provides can be as unique as the needs of the individuals living and working there. There is no one-size fits all facility. However, we have found one of the things that makes the greatest difference in the lives of residents is the facility staff. Unfortunately, we often encounter staffing shortages. Indiana law does not stipulate specific nurse staffing minimums for long-term care facilities. However, we should be seeing federal staffing minimums soon.

In the meantime, you can find information on local facilities by reading the Consumer Reports from the Indiana Department of Health or using the care compare tool from the Centers for Medicaid and Medicaid Services.

• Consumer reports
• CMS Care Compare

Because we are resident-directed it is impossible for us to act when the resident who would be directing us has passed away. Your complaint would be better suited for the Indiana Department of Health, the Better Business Bureau or an Elder Care attorney.

Visit your loved ones often and at different times of the day and encourage residents to speak to staff and the ombudsman if they are having problems with the facility. You provide valuable eyes in the facility; if you see something untoward, say something to the facility’s administrator, social services staff or director of nursing. If you are uncomfortable using these avenues or do not find them fruitful, you can always contact the ombudsman for additional assistance or information on how to handle concerns you witness.

• Adult Protective Services
• Area Agencies on Aging
• INconnect Alliance
• Centers for Medicare and Medicaid Services
• Consumer Reports
• Consumer Voice
• Indiana Department of Health Long-Term Care Division
• Indiana Legal Services
  • Senior Law Project
  • Legal Assistance for Victimized Adults