Meet the Unsung Nursing Home Hero — the Longterm Care Ombudsman

“I haven’t seen this kind of crisis before,” says Patricia Hunter, NASOP president, long-term care ombuds for the state of Washington and a 30-year veteran of this field of work. “People are not getting their needs met,” Hunter says. “The funding is just not adequate.”

Ombudsmen also face challenges due to limitations on their authority. They can advocate for residents but have no regulatory power to fine or decertify a facility. For serious matters, or when a facility fails to remedy an issue, ombudsmen can bring in state regulators partnering with the Centers for Medicaid & Medicare Services, or they will work with state or federal law enforcement. To push for any kind of reform at the state or federal level, ombudsmen make recommendations to lawmakers and lobbyists, another part of their job.

Some facilities do an excellent job providing care, Teeple says, and at many, ombudsmen are viewed as partners. Staff at other facilities see the program as adversarial and at times use code words to announce an ombudsman’s arrival.

AARP

‘I thought I had seen the worst’

Lunday, 54, is a Nashville native with a gentle Southern accent. She draws inspiration, she says, from her parents, now in their 80s. Her mother was a determined advocate for her younger brother with special needs during the 1970s, when inclusion efforts were rare. “I saw how she was able to network, to interact and to talk to other people,” Lunday says. “Mom was my hero.”

She is a recognized face to several residents at her assigned facilities and if she’s not, she shares flyers to explain her role. She moves briskly down hallways in short black heels but is careful to not rush conversations with residents.

Some facilities can consume half of Lunday’s day, increasingly so as complaints become more egregious and complex. To help get an authentic view of operations, she may start her visits early in the morning or delay them to late evening. She eats a packed lunch in a facility parking lot most days, as texts and calls from residents, their family members and her colleagues roll in. Along with two other paid ombudsmen, Lunday covers about 175 long-term care facilities in 13 counties.

With a background investigating child sexual and fatal abuse, Lunday assumed she had seen most forms of mistreatment. “I thought I had seen the worst in human beings,” she says. “I have not seen it all.”

In one facility, after she reported understaffing, an unsupervised resident died after mistaking cleaning chemicals for juice. Another resident hadn’t had a shower in a year until Lunday intervened. Residents complain to her about waiting hours, or even spending an entire night, in soaked or soiled briefs. She has also dealt with reports of physical abuse and rape. “There are some days, you sit there and go, 'How can people be this way to other human beings?' ” she says.

‘Treat them with dignity and respect’

On an August morning visit to an assisted-­living and memory-care facility, Lunday walks through the halls, chatting easily with a group of residents about the eggs, bacon and hash browns on their plates.

“This is the ladies’ table, I can tell,” she says, greeting four women. “Coffee is the best part, isn’t it?” She adds, “Coffee is my favorite part of the day.”

At another table she comments on a woman’s dog-themed pajamas, providing an excuse to show the group a picture of her brown Yorkshire terrier, Louie.

As she engages the residents in the dining room and hallways, she takes mental notes typical of her visits: How do the hallways smell? Are used briefs on beds or are they thrown away? What kind of activities are available to the residents? How accessible is the dinner menu, and are snacks and water available? How many caregivers are on duty? How long did it take for someone to respond to the call light?

Pushing open a laundry room door left ajar, she points out a container of laundry detergent. In memory-care units, residents should not be left around toxic chemicals or have access to rooms they could trap themselves in, she explains. She asks a staff member to close the door. When she sees a room of nearly a dozen unsupervised memory-care residents waiting for a caregiver to wheel in someone else, she pulls out her notepad.

“When you get that many people together, it’s always good to have a caregiver there,” she says. A resident might be aggressive or another might be unstable on his feet, she says. “There could be so many ‘what-ifs’ that come up.”

Patricia Augustus, 55, who has been recovering from heart surgery at a Nashville rehab facility and has a worn-out knee, is one of the people who have Lunday on speed dial. In April, Augustus became faint with low ­hemoglobin and pulled a cord in the bathroom for help. It took several hours for someone to respond and take her to a local hospital’s critical-­care unit. There, a concerned case worker called Lunday, who began investigating the length of time Augustus had to wait for care, Augustus says. When, at a later date, Augustus was at the hospital after an injury to her toes, Lunday checked in with her by phone.

Augustus describes Lunday as both an advocate and a friend. “She has had to tell them what they can and what they can’t do,” Augustus says. “If it wasn’t for Melinda being around and you didn’t have anyone to stand up for you, the facility could get by with whatever they want.”

The facility sought to discharge Augustus in June, she says, which would have rendered her homeless. But Lunday came to the facility and pointed out the statutes preventing discharge when Medicaid applications are pending; that secured Augustus more time to find an alternative group or assisted-living home. Augustus, who also has lupus, fears staying in a shelter could impede the health progress she has made in the past year. “[Lunday] said, ‘Look, that’s what I’m here for. You relax. You have a heart condition,’” says Augustus. “She keeps on telling me that. ‘Let me handle the hard part.’ ”

Seeing her impact with clients such as Augustus, says Lunday, gives her the fuel she needs for her more challenging cases. Prayer helps, too, along with encouragement from her colleagues.

“Every time I feel like I just can’t do it anymore, I’ll have a resident say, ‘You are my guardian angel,’ ” Lunday says. “These are people who have laid the foundation for our generation to build upon,” she says. “You have to treat them with dignity and respect and also give them a good quality of life. They deserve it.”