BY K. MCSTAY
HERALD DEMOCRAT
For many nursing home residents, someone to talk to is all they need. An ombudsman, a member of a group of volunteer patient advocates who work with nursing home residents, is just that someone.
Lindsey Bolin, the managing local ombudsman for the Area Agency on Aging, said the volunteer ombudsmen work with 36 nursing facilities. Each volunteer is paired with a facility, and visits that facility approximately once a month.
"We have 25 places that need volunteers," Bolin said. To train for the job, Bolin said each volunteer is given a book to review, and then visits facilities with Bolin until the volunteer is comfortable going solo. "We mentor them on how to speak with residents and handle complaints," she said. "They work at their own pace." The program requires one hour per week, she said.
Gail Reid, a 21-year veteran of the program, said the training was much more complicated when she joined. "You had to go to Austin and do a three-day training," she said. She was able to attend training in Arlington. "It's three days of extensive training."
At the heart of the program, Bolin said, is patient advocacy. "They go and visit with residents, and speak on their behalf with the staff there," she said. "It's about getting problems resolved before the state gets involved."
For example, she said, if a resident is complaining about not getting enough water, the ombudsman would discuss this with the staff, and correct any substantiated issue. Any issues that cannot be resolved at the local level goes to the state level, though Bolin said those circumstances are rare. "We resolved 85 percent of our complaints (this year)," she said.
"We're here to expedite things," said Maurine Gross. A certified volunteer ombudsman, Gross works with a Sherman nursing home and lives in Howe. For the residents of the nursing facilities, Gross said, that facility is home. "It's all they've got," she said. The job of an ombudsman, then, is to make sure the quality of care received is up to standard.
In addition to helping the patients, the ombudsmen ensure that nursing home issues can be taking care of before the problems ascend to the state level. "We're trying to help them have a better score," said Diane McGrath. Another local ombudsman, McGrath is just starting her tenure with a nursing home in Gunter. "We're not out to nail them." Gross agrees. "It's easier for them to tell us now ... we can work the bugs out so much easier."
Gross and McGrath said many of the issues they see in nursing homes revolve around the staff. For some homes, the ebb and flow of staff members harms the overall care level. "I don't know if some are ready for the responsibility," McGrath said. "It's not easy." Pay is also a concern, she said, as is training. Often, Gross said, homes are short-staffed.
Sandy Sandlin, administrator of Homestead Skilled Nursing Facility of Denison, said staffing issues are a concern, but the problem is being addressed and is improving. "The ironic thing is with the state of our economy ... it has actually helped us," he said. Sandlin said he feels his staff is well paid and well trained, and the facility designs retention programs aimed at keeping employees content at their job.
"It's a very stressful job," he said. "You're not really in it for yourself, you're not in it for the money, it's because you have a calling to be there." Otherwise, he said, "you're not going to make it."
Many ombudsmen face challenges as well, often relating to travel. When gas is expensive, Gross said, trips to the home must be cut down in order to save money. "It's 44 miles round trip," she said.
Bolin said anyone can volunteer, so long as they are older than 21. "A lot of the time, the residents will speak on their own behalf, but there's training to make it to where you're comfortable," she said. Reed said the training is fairly easy. "We should be able to get more ombudsman, but unfortunately, we can't," she said.
The reason, she said, is lack of awareness. "People aren't aware of the circumstances in nursing facilities," Reed said. "People that don't visit and have someone in the nursing home just don't understand." After putting a family member in a home, she said, the level of awareness changes. "After you've had someone in there, you've had one you had to take care of ... you're so tired," she said. "It's very depressing."
All three ombudsmen say they initially became interested in the program after their parents were in nursing homes. "There's an enormous amount of guilt," Gross said. Her mother was put in a nursing home, she said, and though she couldn't be an ombudsman while her mother was in the home, afterwards she was inspired to do so.
McGrath, who recently moved to the area from California, said she participates in many different activities. She went into the ombudsman program knowing many of the volunteers eventually burn out. "God wants us to do justice," she said. "This is me doing justice." The elderly, she said, are often neglected and helpless, and helping them is her "push," she said.
For Reid, she saw her parents on a daily basis, and saw several residents who had no visitors. "I saw that need for an advocate for the residents, especially people like the little lady who didn't have anybody," she said.
The most common complaint, all four said, relates to food. "It's not that the food is bad, it's just that it's not home cooking," Bolin said. For some of the farmers who go into the nursing homes, she said, the food is a particular issue. "They're used to very fresh fruits and veggies," she said.
Though several nursing homes have gardens, food is an issue that often can't be resolved. "They have their different taste buds," she said. "What one person likes isn't to someone else's liking."
Some complaints, however, are more serious. Reid said she worked with a polio victim who had jewelry stolen from he room. "She knew exactly when it came off her hand, and they (the staff) just passed the buck," she said. "Nothing was getting done. She called me, and I got them to reimburse her."
Reid said if it wasn't for the ombudsman program, nothing would have been done. "The main thing is they just have someone who is on their side, someone who will listen to them and understand where they're coming from," Reid said.
"They come and talk to us, but I have no complaints," said Mary Powell, a resident of a local facility. "I do exercise; I play bingo." The key to successful programs at homes is an activities director who is keyed in to the needs of the residents, Gross said.
Belinda Lawrence, the activities director for Denison Nursing and Rehab, said that keeping the residents active mentally and physically is the key. "There's still a life out there," she said. "That's not the end of your journey, so to speak." Some of the major complaints ombudsman receive, she said, stem from deficiencies in the activities department. "The second biggest complaint was boredom," she said. "If the activities department is keeping them busy and entertained, they're not getting complaints."
Joyce Costilow, another local facility resident, said the ombudsmen were good to talk to, even if there were no complaints. "She didn't make me feel like I was on the witness stand," she said. Though she'd never been in a home where ombudsmen had a lot of complaints, the program was still valid.
On the nursing home's end, Sandlin said he encourages residents to report issues to whoever they need to report it to. The home keeps logs of complaints, resolutions and patient satisfaction with the resolution. If the ombudsman for the home is contacted, the procedure isn't significantly different.
"We resolve it just as if they had come to us," Sandlin said. "You have every right to voice a concern." Another option, he said, is contacting the Department of Aging and Disabilities, who will then contact the nursing home. "They ask for records, documentation; they interview the resident, staff and anyone else involved," he said.
After that process, the complaint is either substantiated or not. If the former, a plan must be set up to decide how to address the issue; if the issue is marked as a deficiency, a plan of correction and prevention must be devised. "They accept or reject it," he said. If the plan is accepted, the deficiency is cleared.
Though ombudsmen focus on patient advocacy, Sandlin said they also work closely with the nursing home staff. "We try to get good communication," he said. "They're good for us to call if we've got a situation where we're not able to resolve the problem."
The ombudsmen can sit in on care meetings between patients and administrators, he said, and serve as another set of eyes for other issues. "Ninety-nine percent of the time we resolve it here," he said. On a personal level, he said, he relates well with the ombudsmen, due to his philosophy regarding his job. "I work for the residents. This is their home, and they are my boss."