Have a Nursing Home Complaint? Meet Your Long-Term Care Ombudsman

In addressing complaints, “we're always going to try low-level problem solving first,” says Hunter. “That might entail literally just a phone call or email, or it might involve getting everyone together — the resident, their family member, nursing staff, physical therapist, whoever needs to be involved — to implement a plan going forward that is going to support the resident and their needs.”

If that doesn't work, or if a facility refuses to cooperate, or if a complaint is particularly egregious, ombudsmen can refer complaints to higher-level regulatory or enforcement agencies with permission from the resident. Ombudsmen lack enforcement power, but they can refer cases to the state's health department overseeing nursing home licensing, adult protective services, the police or the courts.

Problem-solving in a pandemic

The pandemic is making ombudsmen's jobs much harder. Like families, friends and representatives of senior care residents, they've been barred by the federal government from entering facilities in most cases, to protect residents and staff. Ombudsmen also want to protect themselves — most volunteers for the program are older, putting them at greater risk for COVID-19.

"It's a huge hurdle,” says Miller. “Generally, when you do any investigation, you're physically there getting eyes on the situation, looking at records, interviewing staff. Trying to solve the issue telephonically is much more difficult."

Nonetheless, complaints keep coming in and investigations continue.

In New York, for example, many families are struggling to reach facilities with questions about their COVID-19 response plans. So ombudsmen there are requiring facilities to fill out questionnaires asking “how they're managing during the crisis, how they're interacting with residents, what activities they're providing, how they're managing meals, how they're managing with” personal protective equipment, says state ombudsman Claudette Royal.

Ombudsmen relay the information back to families, sometimes arranging virtual follow-up meetings between families and facilities, Royal says.

In D.C., residents are calling in feeling scared or lonely, Miller says. So ombudsmen are conducting weekly telephone or FaceTime calls with residents, asking a series of questions about their care and facilities’ infection-control practices. They're also scheduling window visits with residents.

Washington's office is receiving complaints about facilities refusing to allow hospice services in, Hunter says. “There's a potential violation of rights there,” she says, “so we're looking at all the legal options … and I'm not afraid to use them if I have to."

Advocating for systemic fixes

Beyond handling individual complaints, many ombudsmen advocate at local, state and national levels for systemic improvements to long-term care. Each state's priorities vary amid the pandemic, but many are advocating for more timely reporting from facilities on their confirmed COVID-19 cases.

"It's everyone's top question right now: What's the level of outbreak?” Miller says. “And the lack of transparency and public information about that is concerning.”

AARP is pushing for states and the Centers for Medicare & Medicaid Services to require the names of facilities with confirmed cases to be made public daily.

"We believe that data shared on a daily basis, coupled with virtual visitation, will allow both ombudsmen and families to gain a better insight into what really are the circumstances within those facilities,” says Elaine Ryan, AARP vice president for state advocacy and strategy integration.

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• AARP fights for transparency in nursing homes amid crisis