Page 106 - Ombudsman Participant Manual Optimized_Neat

DHS field office and, often, the local ombudsman assists with securing a meeting place, etc. Always notify your regional
specialist if a risk management meeting is being planned in your county. Depending on the situation with the residents
and the facility, the Risk Management Team may meet more than once regarding a facility.

Sanctions:
Nursing homes, personal care homes and assisted living facilities are required to be licensed in order to operate. The
purpose of the annual surveys and the complaint surveys are to measure the facility’s compliance with licensing
standards. Very few facilities receive no “deficiencies” during the survey process. Deficient practices are cited for
correction and are assessed for scope (isolated incident or widespread problem) and severity (no harm to actual harm).
Depending upon the number, type, scope and severity of the deficient practices, facilities sometimes receive licensing
action or sanctions as an incentive to come into compliance and as a method of protecting consumers. License can go
from a full, normal license to a provisional license. Provisional licenses mean the facility can operate but it will not
possess a full license until the deficient practices are corrected to the satisfaction of the licensing agency. Nursing homes
and personal care homes can progress from a full license to a provisional I, II, II or IV. When a facility is progressing
through the provisional licenses, the situation is becoming more concerning- meaning, the facility compliance issues are
getting worse – not better. There is a potential for closure when this type of licensing action occurs. When a facility gets
to a provisional II or IV there may also be fines and admission bans in effect that put a further financial strain on the
facility – increasing its risk of closure. Visible presence by the ombudsman is expected to progressively increase and,
typically, the ombudsman will request a risk management meeting if the facility in question is a personal care home. It is
important to notify your specialist and the state office when a facility is progressing through the provisional levels of
licensing.

Ombudsman follow-up when a facility closes:
• Alert the ombudsman in “receiving” counties when residents move out of county to their new facility.
• When residents relocate within your county, visit them in their new home and ensure that residents have:
o Received their belongings
o Received their money/funds
o Understand their new home and who to see if there are questions or issues
o Received assistance with finding a new physician (if needed)/received their medications, etc.
o
It is important to note that you may receive referrals from other local ombudsmen who have had a facility close and
residents are moving into your county. In that case, you should visit with those residents; introduce yourself; provide
contact information and interview them on the above-listed concerns and any other issues related to their relocation.

Challenges to resident relocation:
• Resident’s payor source
• Resident’s preferences regarding location
• Resident’s ancillary services/needs
• Resident’s functional level

Finding a new residence for displaced personal care home residents can be a challenge. Some residents use SSI to help
them afford care. Not all facilities accept SSI – limiting the resident’s options. Often, these residents have no other
choice but to move to another county. Residents also may have medical assistance or medical insurance that limits the
medical providers they can use. For instance, a resident was displaced from Philadelphia to a facility in Northampton
County. Their MA was a managed care program in the Philadelphia area and there were no providers in their new locale
- requiring intervention that providers are not always familiar with. Sometimes, residents rely on support services from
MH or D & A and those providers need to be aware and assist with referrals to similar care services. Some residents are
unable to do stairs, etc. and they are limited in terms of facilities that can accommodate them. The ombudsman serves as
a “conduit” – making sure that other systems tasked with responding to the needs of the residents are responsive.
Sometimes, the ombudsman needs to make someone aware of the needs of the resident so assistance can be obtained.
But our preference is always that residents be empowered to self-resolve first.

Office of the LTC Ombudsman
Version 1.0 September 2020
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