Specialized Information for:

Nursing HomesAssisted Living/Board & Care Home and Community Based Services

Ombudsman Outlook: December 2022

In this issue:

Federal Updates

Read below for a few federal updates since our last Ombudsman Outlook issue

New Guidance to Reduce Spread of COVID-19 in Assisted Living

The Centers for Disease Control and Prevention (CDC) released new guidance to help reduce the spread of COVID-19 within congregate settings, including assisted living facilities. This guidance does not apply to skilled nursing facilities and does not apply to healthcare services being provided in congregate settings, both of which are governed by this guidance. The CDC is encouraging facilities to balance COVID-19 prevention with the impact of reducing access to daily services and programing. 

To assess COVID-19 risk in assisted livings and group homes, facilities should monitor COVID-19 community levels and consider: the vulnerability of their residents, facility characteristics that could accelerate COVID-19 spread such as poor ventilation and high volumes of visitation, and whether COVID-19 is actively spreading in the facility.

To mitigate risks, facilities can consider several strategies including: increasing and improving ventilation, expanding the use of masks, implementing screening testing, moving activities outdoors, creating physical distance, and enhancing cleaning and disinfecting protocols.

Guidance for Masking During Visitation in Nursing Facilities

On September 23, 2022, the Centers for Medicare and Medicaid Services (CMS) updated their guidance for masking during visitation in nursing homes. 

Recommendations for masking in nursing homes are based on community transmission levels which are the number of new COVID-19 cases in a particular area in the previous seven days. When community transmissions levels are high, masking is recommended in all health care settings, including long-term care facilities. When community transmission levels are not high, and the facility is not experiencing an outbreak, a facility could choose to not require visitors to wear a mask or face covering.

Review the Consumer Voice fact sheet for a simple explanation of this guidance. 

DOH Report Identifies Residents at Increased Risk of Discharge from Nursing Homes

A recent report by the U.S. Department of Health and Human Services used Medicare data to identify certain characteristics or risk factors that placed nursing home residents at an increased risk of discharge. 

These characteristics included:

  • Residents with severe behavioral symptoms.
  • Residents with psychiatric and mood disorders. 
  • Residents with impairments that required more staff time. 
  • Residents transitioning to Medicaid.

Residents with these risk factors were more likely to be discharged from for-profit nursing homes. 

The report highlights issues with inappropriate discharges that echo concerns shared by Ombudsman programs as complaints about discharge continue to the leading complaint for Ombudsman programs across the country. Review the Consumer Voice summary of this report for more information. 

NORC has several resources to assist Ombudsman programs in responding to discharge complaints, including webinar recordings, on our transfer/discharge issue page.

New and Updated Resources

NEW! Technical Assistance (TA) Talk Materials on Family Councils
To increase direct access to technical assistance (TA) and peer support, NORC hosts quarterly live technical assistance dialogues. The December 14 TA Talk discussed Family Councils, view the recording and materials here. The next TA Talk will be in March 2023. Have questions, an idea for a future topic, or examples of training, consumer education, or successful advocacy? Email NORC at ombudcenter@theconsumervoice.org

NEW! What is a Routine Access Visit? Making the Most of Your Facility Visits
Routine access visits are critical to ensuring regular and timely resident access to Long-Term Care Ombudsman program (LTCOP) services. This pocket guide describes a variety of activities that would constitute a routine access visit. This pocket guide also provides a checklist to ensure routine access visit activities are conducted as well as warning signs and red flags of potential abuse, neglect, and/or exploitation.

NEW! Webinar Recording and Materials Available from the National Ombudsman Reporting System (NORS) Q&A
This Q&A was an opportunity to have your National Ombudsman Reporting System (NORS) questions answered. If you have additional questions, watch the September NORS TA Talk or review the updated FAQs.

UPDATED! Documents in the Initial Certification Training Curriculum for Long-Term Care Ombudsman Programs
NORC made minor revisions in Module 6 of the Initial Certification Training Curriculum for Long-Term Care Ombudsman Programs regarding routine access and observation in order to match the text in the new Routine Access Visit guide. The specific edits are noted on the curriculum webpage

TA Hot Topic: Protecting Resident Information

What does the Older Americans Act say about sharing resident information?

The Older Americans Act (OAA) imposes strict requirements for protecting the confidentiality of Long-Term Care Ombudsman program (LTCOP) information including the identity of residents, complainants, and investigation information.  Human services agencies have confidentiality provisions; however, the LTCOP is distinct because of the narrow limits the OAA puts on the sharing of resident specific information even with other government agencies or departments. All records and information obtained by the LTCOP during conversations with residents and complainants must be held in confidence. It is important to explain to residents and complainants that the information they share with the program is confidential, meaning the information will not be shared (disclosed) with anyone outside of the Ombudsman program without their permission. 

Adhering to these confidentiality provisions may be challenging at times. However, the credibility of the LTCOP relies on residents and families trusting the LTCOP to keep their information confidential unless they give permission. 

During their work, it is often necessary for Ombudsman representatives to have access to protected health information, personal identifiable information, and confidential information. Residents and families trust their sensitive personal, medical, and financial information to Ombudsman representatives. For this reason, it is crucial that all representatives ensure the security of paper and electronic documents, as well as electronic equipment.

LTCOPs have state policies and procedures for ensuring confidential information is not emailed or shared outside the program without either de-identifying the resident or encrypting the information. Take the time now to review your state's policies, and/or ask your supervisor or State Ombudsman for guidance.

Personally identifiable information (PII) identifies or describes an individual. Ombudsman representatives protect this information in the same way that they protect confidential information. PII cannot be disclosed without consent or authorization from the appropriate people.  

Here are tips for safeguarding information:

  • Do not leave documents containing confidential information out in your work area when you are not there. Make sure that they are kept in a locked file drawer or cabinet that is not accessible to others. 
  • Do not leave documents in your car. When you return from a facility visit or other meeting, take inside any documents containing confidential information and place them in a secure, locked drawer or cabinet.
  • Once information is uploaded to your database, consider shredding the paper copies rather than recycling or throwing the paper away.
  • Check to ensure you are using encrypted emails when sending confidential information, even if the email is to someone else in the Program.
  • Ensure that your computer or laptop is secure and that a password is needed to access your files. 

For more information on "Confidentiality and Disclosure of Ombudsman Program Information," go to Module 5, Section 3 of the Initial Certification Training Curriculum for Long-Term Care Ombudsman Programs and review the Long-Term Care Ombudsman program Frequently Asked Questions (FAQs) by the Administration for Community Living (ACL).

National Ombudsman Reporting System (NORS) Corner: Verification

Question: If the resident is the complainant or the resident agrees with the complaint from another complainant (e.g., their family member), does that mean the complaint is verified?

Each complaint must have a verification status. Verification is the last step of Stage 1. Intake, Planning, Investigation, and Verification (see table) of Ombudsman program complaint processing. 

A complaint is verified if after interviews, record inspection, observation, etc., you can confirm “that most or all facts alleged by the complainant are likely to be true” (per NORS Table 1 definition of complaint verification). 

Verification is simply a matter of:

  • reviewing the facts; 
  • ensuring that you have proper documentation; and 
  • deciding if the information supports the allegations in the complaint.

Sometimes complaints cannot be verified, but the resident’s perception of the problem still exists. For example, a resident with dementia may believe that someone stole their jewelry and reports the theft daily when they never had that jewelry in the facility. The LTCOP can work with the resident, facility, and a family member to come up with a solution for the resident to not feel the stress of having their jewelry stolen. It could be that the family agrees to bring the jewelry in for the resident to see during their visits or that the resident is provided with inexpensive jewelry to wear. These types of responses can provide a solution which resolves the resident’s concern to their satisfaction, even though the complaint is not verified.

A complaint is not verified when, after investigation, the circumstances of the complaint are found to be untrue. For example, a family member complains that the resident is not getting good care, but the resident is satisfied with the care received and there is no evidence to indicate otherwise. Based on the resident’s perspective and the representative’s observations this complaint cannot be verified. 

The purpose of the investigation is to determine whether the complaint is verified and to gather the information necessary to resolve it. Ombudsman program representatives use interviews, observations, and documents to gather factual, objective information about a problem.

Review Part III Verification, Disposition, Referral, and Closing Cases of NORS Training and Section 5. Verification of the Initial Certification Training Curriculum for Long-Term Care Ombudsman Programs for additional information about verification. 

Click on the table to view a PDF version.

News from the Network

South Carolina Ombudsmen Referred Financial Exploitation Case to Attorney General Resulting in Criminal Charges 
A South Carolina woman is accused of defrauding an assisted living resident out of nearly $310,000. She was charged with financial transaction card fraud and 11 counts of exploitation of a vulnerable adult. She used her position as power of attorney to defraud the victim out of funds and assets. The case was referred to the Medicaid Fraud Control Unit of the South Carolina Attorney General’s Office by the Appalachian Council of Governments’ Long-Term Care Ombudsman. Read the full article »

Lisa Pollock, Arizona State Long-Term Care Ombudsman, Interviewed During a Walk to End Alzheimer’s
Lisa Pollock, Arizona State Long-Term Care Ombudsman, was interviewed during a Walk to End Alzheimer’s on the purpose of the Ombudsman program and how the program can assist those diagnosed with Alzheimer's. Watch the interview »

Texas Ombudsmen on a Podcast Answering Questions About the Ombudsman Program
Suzanna Sulfstede and Lauren Smith answer questions on the Manchester Living podcast about the Long-Term Care Ombudsman program. They discuss what an Ombudsman is and what they do, how they advocate for loved ones in a facility, and the types of issues an Ombudsman investigates. Listen to the podcast »

Massachusetts Office of the State Long-Term Care Ombudsman Provided Assistance in an Investigation Over Pandemic Response Failures
The Massachusetts Office of the State Long-Term Care Ombudsman provided assistance in an investigation which resulted in an agreement with the Attorney General to permanently bar a nursing home owner from operating long-term care facilities in Massachusetts and requires the defendants to pay $175,000 to the commonwealth due to pandemic response failures. Read the full article »

Connecticut State Ombudsman, Mairead Painter, is Quoted on Medicare Advantage Plans Shortening Nursing Home Stays
Connecticut State Ombudsman, Mairead Painter, is quoted in an article by Kaiser Health News on Medicare Advantage plans ending coverage for nursing home and rehabilitation services before patients are healthy enough to go home. Half of the nearly 65 million people with Medicare are enrolled in the private health plans called Medicare Advantage, an alternative to the traditional government program. The plans must cover — at a minimum — the same benefits as traditional Medicare, including up to 100 days of skilled nursing home care every year. The private plans have leeway when deciding how much nursing home care a patient needs. Mairead Painter, Connecticut State Ombudsman, said, “People are going to the nursing home, and then very quickly getting a denial, and then told to appeal, which adds to their stress when they’re already trying to recuperate.” Read the full article »

Volunteer Management: Five Ways to Leverage the Senior Services Network to Find Volunteers

Tobi Johnson from VolunteerPro shares her expertise in a video for Ombudsman programs about five ways to leverage the senior services network to find volunteers.

Tobi spoke to over 60 Ombudsman representatives during the Consumer Voice conference. She and Laurinda Johnson (Ohio LTCOP) shared tips for recruiting and retaining volunteers. 


Quick Tips: Virtual Learning for Older Adults

The following tips are from The National Resource Center for Engaging Older Adults’ (engAGED) Manual, Implementing and Expanding Virtual Programming for Older Adults: Tips and Practical Strategies for Aging Network Organizations.

With virtual programming here to stay to reach older adults who are reluctant or unable to attend in person, engAGED developed a manual that provides tips, strategies, and best practices to help organizations implement and enhance virtual programming.

When deciding to adapt existing programs to a virtual format or to launch or expand virtual programming, the single most important aspect is preparation. The first question you should answer is which video conferencing platform to use. Once you have decided on a platform, here are questions to keep in mind when expanding virtual programming:

  • Are staff and participants familiar with the chosen platform (e.g., Zoom, WebEx, Microsoft Teams, Google Meet, GoToMeeting, etc.)?
  • Do (additional) materials need to be created to accommodate the virtual nature of the program or to supplement any elements that are not possible to replicate virtually?
  • How will you provide feedback or coaching, if necessary?
  • What aspects of the program (in person and virtual) will your participants find most engaging?
  • Do presenters have enough time to prepare?
  • How will you foster interaction and engagement throughout a session?

Best Practices for Presenting Virtual Programs

Before the session:

  • Think about your audio and visual presence.
  • Make sure your materials and examples are ready to use and accessible.
  • Have a back-up plan. For example, if you are planning to share a video as part of the session, have an alternative in case glitches in technology occur.

At the start of the session:

  • Introduce yourself and give time for participants to introduce themselves.
  • Review main platform features, including accessibility features, to help ensure that all participants, including those with disabilities, can get the most out of your session.
  • Establish norms. Ask that participants joining by phone or with video turned off identify themselves by name when speaking.
  • Review the session’s structure and goals and explain how participants can ask questions, access the chat and/or access any other materials shared during the session.

During the session:

  • Encourage participants to identify themselves before speaking so all participants, including those with visual impairments or those who are on the phone, know who is speaking.
  • Describe visual content when sharing your screen to help ensure that those with visual impairments or those on the phone have a similar experience.
  • Remember to stop sharing your screen throughout the session to allow for face-to-face interaction, especially during discussion or when the slide or visual is not necessary.
  • Check in frequently with participants—visually, verbally and via chat for reactions.

While organizations may have initially instituted virtual programming as an ad-hoc response to essential needs during the COVID-19 pandemic, it is now clear that many sectors, including the aging and social services sectors, will continue to host virtual events. As organizations look to the future and begin planning for the next several years, it is wise to embrace the necessity of virtual programming and the opportunities it presents. 


March 2023: Quarterly Technical Assistance (TA) Talk – Topic TBD | 3:00 - 4:00 pm ET

Last Wednesday of Each Month: Virtual Office Hour - Learn more »

Featured Resource

Fact Sheet - Nursing Home Abuse: How to Spot it and How to Get Help
All older people have the right to live free from abuse and neglect. Yet, thousands of nursing home residents experience mistreatment every year. A new fact sheet from Consumer Voice and the National Center on Elder Abuse (NCEA) provides information on what families can do to identify abuse and what to do if you suspect abuse is occurring.