What Is a Healthcare Ombudsman? Massachusetts Guide for Facilities

When you operate a long-term care facility, making sure your residents live a comfortable life is a top priority. You want them to maintain as much autonomy as possible while providing enough oversight to ensure they’re safe. So, what happens when a resident isn’t able to speak up for themself?

Their voices can be heard with the help of an official advocate called an ombudsman. Massachusetts volunteers assume this advocacy role to ensure elderly residents live with dignity and respect. We’ll explain how an ombudsman program works, describe the services they provide, and offer tips to help you prepare for an ombudsman visit at your facility.

What Is the Massachusetts Ombudsman Program?

The Long-term Care Ombudsman Program (LTCOP) is an advocacy program dedicated to improving the quality of life for seniors receiving long-term care. This national program, administered by the Administration on Aging (AoA)/ Administration for Community Living (ACL), oversees paid and volunteer ombudsmen in each state. Representatives strive to resolve issues and serve as a voice for seniors in need of support.

In Massachusetts, an ombudsman may advocate for elders in various settings. For example, a community care ombudsman represents individuals receiving home care or services through MassHealth (the state Medicaid program). These representatives help MassHealth recipients navigate their benefits and get the care they need. Care recipients can learn more about ombudsman services by visiting my ombudsman MassHealth.

Elders living away from home benefit from the services of a long-term care ombudsman. Massachusetts representatives in that role advocate for residents in:

• Assisted living facilities
• Nursing homes
• Rest homes

An ombudsman may serve as a mediator between staff and residents, representing individuals or groups. Anyone can contact an assisted living ombudsman. In Massachusetts, volunteers always maintain confidentiality unless further reporting is required, such as in cases of abuse or neglect.

What Does a Massachusetts State Ombudsman Do?

An ombudsman’s primary duty is to advocate for residents who express concerns about their care or quality of life — no matter how big or small their issue may be. They serve as a voice for someone who doesn’t have the ability to advocate for themselves. Other aspects of an ombudsman’s role include:

• Addressing concerns, investigating situations, and working to resolve issues.
• Advocating for resident rights.
• Helping elders select long-term care facilities.
• Facilitating family councils.
• Educating residents and healthcare providers about issues in long-term care.
• Advocating for change in long-term care settings.

It’s important to know that they’re nonmedical. Ombudsman (Massachusetts-based and elsewhere) volunteers cannot provide medical or legal services, but they may educate a resident about their rights or provide resources to pursue legal action. There may also be times when a family member isn’t present to witness the signing of legal documents and a resident needs the support of an ombudsman. Representatives may witness the signing of wills and power of attorney forms in these instances.

Who Does a Healthcare Ombudsman Work With?

In addition to residents, an ombudsman may work closely with families and healthcare staff members in long-term care facilities. The Massachusetts Advocates for Nursing Home Reform advises residents to follow a chain of command before escalating concerns to an ombudsman. For less-serious concerns, residents may address matters with:

• Nursing staff
• Nurse managers
• Social workers
• Activities directors
• Dieticians

If concerns aren’t addressed, a resident should reach out to an ombudsman, who may interact with these staff members when investigating a concern. Another way to oversee the process of addressing residents’ concerns is through the support of a family and resident council. Federal regulations state that all nursing home residents are entitled to participate in councils, and that facilities must consider their recommendations.

Family councils are often facilitated by a nursing home ombudsman. Massachusetts was the third state to mandate protections for Federal Resident and Family Council Regulations. The facility must designate a staff member to coordinate with the council who provides assistance and responds to written requests that materialize from such meetings. Residents have a right to participate in council meetings or have a family member present.

How to Contact Your Massachusetts Healthcare Ombudsman

The Massachusetts Assisted Living Ombudsman Program consists of local offices that serve their respective city or town. General contact information for your local ombudsman (Massachusetts phone number details, for example) is listed below.

Tips for Facilities Working With a State Ombudsman

When working with an ombudsman for nursing homes, facilities should remain cooperative and take a patient-centered approach to resolving issues. Here are some suggestions for making the most of your working relationship.

1. Collaborate Proactively for Resident Satisfaction

Collaborating with an ombudsman can prevent issues from escalating to a formal grievance and help maintain resident satisfaction at your facility. This proactive approach to complaints or identified grievances can help boost the morale of not just your residents, but staff as well.

Suggestions:

• Create routine meetings with your local ombudsman representatives for regular updates and to improve ongoing communication flow.
• Ensure ombudsman volunteers have easy access to your facility and that meetings with residents are facilitated to provide maximum value.

2. Enlist Support With Maintaining Compliance

An ombudsman service isn’t a regulating agency for long-term care facilities. However, these experts are informed about CMS regulations to which facilities must adhere. They’re trained to provide education and advice to residents and families navigating situations that need to be reported. To remain compliant with residents’ rights, long-term care facilities should have a grievance policy, educate residents on how to file a grievance, and make every effort to promptly resolve grievances. They should also be able to provide grievance policies upon request.

Suggestions:

• Consider having your local ombudsman host education sessions on compliance topics for your staff.
• Share outgoing information and resident materials (such as a routine newsletter) with your ombudsman representative to review and contribute any required additions.

3. Make Protecting Resident Rights a Combined Effort

Massachusetts ombudsman volunteers can help keep long-term care facility leaders aware of pertinent regulatory information. Examples of this include the two budget items that protect residents covered by MassHealth: The Massachusetts Bed Hold Budget and The Personal Needs Allowance (PNA). The former protects residents from being forcibly removed from their living space while away for personal reasons or hospitalizations. The latter allows residents to make comfort purchases (like haircuts) that aren’t covered by MassHealth.

Suggestions:

• Be transparent with policies, protocols, and actions so that ombudsman are fully armed to help navigate any complaints or issues that may arise.
• Designate a specific point of contact within your organization to facilitate faster, more direct communication with your local ombudsman.

Find More Ways to Support Long-Term Care Residents

One way to improve the experience of patients or residents is to prepare facility leaders and staff to collaborate with your local ombudsman. Massachusetts representatives help resolve issues so your residents can live with dignity and respect. Stay connected with IntelyCare to learn more ways to support residents and families at your facility.