Usually, committee meetings in Sacramento are pretty sparsely attended affairs. You have committee members listening, bill presenters talking and sometimes as many as half a dozen lobbyists stepping up to briefly weigh in.
But at a recent Senate Health Committee hearing, when it came time for people to enter their support into the record, the line of advocates went far past the usual half-dozen — it stretched all the way to the back of the chamber, where a knot of people waited to join the queue.
They were all there to state their support for the Long-Term Care Ombudsman Program.
There are 35 local ombudsman programs in California, with about 1,200 volunteers visiting approximately 9,300 senior housing sites, nursing homes and assisted living facilities across the state. The program is run by the Long-Term Care Ombudsman Program, a state agency within the Department of Aging.
According to Tippi Irwin, executive director of Ombudsman Services of San Mateo County, the volunteers work both tirelessly and efficiently. “At those facilities,” she said, “we handled 43,000 complaints, and we had resolution of 73% of them.”
Irwin said senior Californians — and the wave of seniors expected as baby boomers age — cannot go without this program.
“Abuse and neglect is going unreported even now,” she said. “We monitor both for quality of care and quality of life. The ombudsman program is critical to health and safety of residents.”
The nursing home and senior housing watchdog agency is a popular one, particularly among the powerful bloc of senior voters. So it’s a bit surprising to some experts how difficult it has been to fund it.
At the same time, many questions have been raised about the program’s size, scope and duties. Just how much responsibility should be given to volunteer advocates? How should the state structure this organization? Should it be an independent agency? And from where will funding come?
Money, Money, Money
The governor cut all general fund money for the program in 2008, totaling $3.8 million. Lawmakers later restored almost half of it, $1.6 million, to keep the program afloat.
Now even that temporary funding is gone, and officials have been scrounging to come up with enough money to keep it going.
One bill, AB 2555 by Mike Feuer (D-Los Angeles), plans to cadge $1.6 million from another state program — the State Health Facilities Citation Penalties Account. That program has been used to help with relocation expenses if a facility is closed or maintenance of facilities when the state temporarily takes over a facility.
“We’re concerned that the money is being taken from a program that’s actually pretty important,” Nancy Reagan of the California Association of Health Facilities said. “And it’s important for patient care. We realize it’s temporary, but we feel the ombudsman program should have its own funding source, rather than borrowing from another one.”
That funding source could come from the state budget that’s being debated right now, or it might come from federal dollars, according to Joseph Rodrigues, who heads the state Long-Term Care Ombudsman Program.
“We’ve been working with federal Department of Aging, and we think we’re entitled to Medicaid reimbursements for the ombudsman program,” Rodrigues said. That funding would be similar to the money that eight other states currently receive, he said.
In addition, certain activities that advocates perform — such as conducting the survey and licensing process and helping people transition out of nursing homes — should be reimbursable through Medicaid, he said.
There may be money available through the national Elder Justice Act, as well, Rodrigues said, to train people in the ombudsman program.
Expanding Mission
Funding has recently dribbled away from the program, while the scope of its responsibilities has continued to expand over the years.
No one seems to be questioning the importance of the ombudsman’s office or the work its advocates are doing throughout the state. However, a recent state Senate report questioned the broad scope of those volunteers’ work.
“There are questions about how much the ombudsmen should be doing, and what they’re trained to do,” Reagan said. “The program was intended more for advocacy, not so much as an enforcement agency. There are other agencies for that.”
Less Money, More Duties
Rodrigues has no answer for why the popular program has had such a hard time staying funded.
“People really see the value . . . how we advocate to solve problems for residents,” he said. “When we lost that funding [in 2008], we had to lay off 76 of 180 paid staff, and that really hampered our ability to get out quickly to respond to complaints. And other [more routine] visits were diminished because we had respond to complaints.”
In addition to advocating for patients and fielding complaints, the ombudsman in California also has to witness advance directives, Rodrigues said.
“We’re only one of three states where they need to witness advance directives,” he said.
In addition to the small number of states to require ombudsmen to witness advance directives, only five other states have the ombudsmen investigate mandated reports, he said.
Future of Ombudsman Program
Even if the program can remain funded and the concerns about what volunteers are allowed to do can be resolved, there remains one open question around the ombudsman program.
Many states run their ombudsman program as an independent agency, and the Senate report raised that issue.
“There’s a question about whether or not the agency should be inside or outside state government,” Rodrigues said. “The question is: Is the state ombudsman able to advocate without restriction?”
He said that has never been a problem in the California Long-Term Care Ombudsman Program.
“There is no plan at this point to move us outside of state government,” Rodrigues said. “I can speak publicly and freely. If that’s in place, then that issue doesn’t matter.”