CONSUMERS : A Referee in the Corner of L. A.’s Elderly

Doris Lindsey of Woodland Hills recalled the time she was summoned by an octogenarian woman in a nursing home. The problem was a hearing aid.

“She had been having trouble adjusting hers. And for some reason, her conservator, who was her cousin, would take the hearing aid home with him after every time he visited.

“She complained to me, and when I had verified that the story was true . . . I sought out the cousin, and now that woman has her hearing aid with her in the nursing home all the time.” Lindsey is a Los Angeles city volunteer in a nationwide program that provides residents in nursing, retirement and day-care homes--and their relatives or friends--with someone to turn to if problems crop up: the Long-Term Care Ombudsman.

The federally funded program has been in effect about 10 years, according to the city’s program coordinator, Charisse Anderson-Rollins, but it has only been with the recent, continuing increase in the number of older people in the population that its caseload has grown tremendously.

The city has about 480 licensed skilled nursing homes, residential care facilities for the elderly and adult day health centers, with about 35,000 residents, according to Natalie Miles-Thompson, associate executive director of WISE Senior Services in Santa Monica, which administers both the city and county ombudsman program. And the other incorporated cities and unincorporated areas of the county have an additional 500 homes and care facilities, Miles-Thompson said, with about 40,000 residents.

(The toll-free phone number for general program information and to learn the location of a specific local office is (800) 334-9473.)

According to state law, each facility must conspicuously post a notice regarding the availability of a public ombudsman, who is empowered to serve as an advocate and to assist with complaints.

The problem, for example, might involve a person with diabetes who feels he or she is getting foods containing sugar. The individual will be interviewed, medical records may be checked. Sometimes the complaints have a basis in fact, sometimes not, Anderson-Rollins said.

This is the way the city program works, according to Anderson-Rollins (the county setup is similar):

“When we get a complaint, either by phone or in the mail, we assign a staff ombudsman or a volunteer to investigate. It is a state law violation per se if a facility denies access (to the ombudsman) or interferes with the investigation.”

The problem is a shortage of people to investigate complaints. The city, for instance, has five part-timers on the staff. It has 25 active volunteers--at least 90 are being sought. The office receives about 375 complaints a month. The county averages 480 a month, has 120 volunteers and needs 200.

Volunteers must complete a 36-hour training class and are asked to donate four hours a week. “The attrition rate of ombudsmen is high,” Anderson-Rollins said. “It’s the stress and burnout.”

In the state of California, she added, the number of volunteer ombudsmen has dropped from about 1,000 to 700 last year.

Lindsey, a volunteer for three years, said she usually winds up putting in eight to 10 hours a week. Although, eventually, everything is investigated, a facility isn’t always found to be at fault:

“One lady in her 70s had bumped her head on the bedrail and had blackened her eye. A couple of days later, a worker was feeding her, and she bit one of his fingers. Her daughter called, thinking the black eye had resulted from the biting,” Lindsey said, meaning abuse was involved.

Allegations of elder abuse get top priority, Miles-Thompson said, but in this instance the ombudsman determined the black eye had occurred two days before the biting.

Eleanor Countee, one of the city staff members, commented: “We are the foot soldiers. We go out and do the fighting. Sometimes I have a nursing home representative, and the patient, and a family member together--and I act as the referee.”

She added that she currently has 40 cases at different stages of resolution. “I do only 20 hours a week--on purpose. After about 16 hours of it, I start feeling the depression and stress.”

Anderson-Rollins said there are occasional cases where some patients “will decide to gang up on the administration, out of frustration and loneliness. That is why it is important to have resident council meetings where gripes can be aired and to have a good social activity calendar.”

Julia Biderman, a staff ombudsman whose area encompasses the East San Fernando Valley, said one of her cases involves a 76-year-old widow who claims that when she left one retirement facility for another, the former one refused to refund her $280 deposit.

Biderman said she has gotten in touch with the administrators at the home and that they have promised to refund the money.

Eileen Greene is a former volunteer who now teaches volunteers during their required training.

“We need them, but I have to know their motivations. I want to see if they truly care about older people, if they have compassion, and an average amount of intelligence.”

Years ago, she said, “if there was a problem at a facility, there was nobody for a resident to turn to. So you didn’t rock the boat.”

Anderson-Rollins said there has been an increase in complaints regarding over-medication and the administering of improper medication.

“The residents themselves often don’t know, that’s the sad part,” she said. “We get complaints from people visiting them and noticing physical or personality changes. Also, we get anonymous tips from people inside a facility, who are afraid of retaliation.”

Richard L. Thorpe, executive vice president of the Alexandria, Va.-based American College of Health Care Administrators, noted that good facilities welcome the presence of an ombudsman.

Thorpe, whose society of long-term care administrators has 6,500 members nationwide, added that the highest level of care “can be done only with the collective action of staff, patients, families, and their representatives--the ombudsmen. We also view the ombudsman as a mediator, not only representing the patient, but the facility.”