For Elderly in Crisis, Ombudsmen Can Be Lifeline : * The county’s advocates and volunteers resolve financial and legal woes, find long-term care and provide moral support.

Some are ready to die and need help making sure they will be allowed to if they reach a point when they can no longer speak for themselves.

Some are being abused or neglected by the people who’ve been hired to take care of them, but they’re too frightened, confused or isolated to ask anyone for help.

Some are caught in bureaucratic quagmires, unable to get the government funds to which they are entitled or to arrange for the care they need.

And some are just plain lonely, desperate for a human gesture--a touch of the hand, a warm smile, a gentle voice--meant especially for them.

Whatever their needs, the more than 18,000 residents of Orange County’s long-term care facilities are not as alone as they may think.

Each of the 500 skilled-nursing homes and board-and-care facilities in the county is required by law to display a poster with a phone number that has proved to be a lifeline for many residents in crisis who had no place else to turn.

The number, (714) 972-2676, connects callers with the Orange County Council on Aging’s ombudsman service, which provides advocates for sick and elderly people who are unable to stand up for themselves--or have forgotten how.

The ombudsmen, including 11 paid advocates and about 40 volunteers, make unannounced visits regularly to all of the county’s long-term care facilities, responding to complaints and looking for signs of distress that might otherwise be ignored.

“People lose a lot of control over their own life when they move into a long-term care facility. We try to empower them by helping them realize they haven’t given up their rights,” says Sallie Russell, the ombudsman program’s field services manager.

Pam McGovern, who oversees the nonprofit, Santa Ana-based program as executive director of the Orange County Council on Aging, says ombudsmen help the elderly maintain their dignity in an institutionalized setting that “lends itself to abuses and degrading scenarios.”

During one of ombudsman Gail Smith’s recent visits to a board- and-care home, she noticed a quiet, melancholy man who looked sorely in need of a clean shave and a new set of clothes. She learned he was a 67-year-old stroke victim with no family and no money--the Social Security check he’d been receiving had stopped coming and he had no idea why.

Smith took him to see the administrator of the facility and insisted that his needs be addressed. When she returned two weeks later, she found that the problem with Social Security had been resolved and the man had come out of his shell. He was well-groomed, well-dressed and talkative.

“He’s a different person,” the administrator told Smith.

“He needed empowering badly,” Smith explains. “As long as he didn’t complain, no one gave him any attention.”

Russell recalls an elderly woman in a nursing home who was terrified because one of the medical aides on the night shift had been too rough with her. The woman, scared but not injured, was not able to identify the aide. As in many cases, no one was able to determine what really happened, but Russell quickly found another nursing home for the woman and helped her make the move.

“I was there as her advocate, and the important thing was to get rid of her fear,” Russell says.

McGovern explained that the role of the ombudsman in any case involving abuse is to make sure the appropriate agencies investigate and take whatever action is needed to protect the residents.

Meanwhile, the ombudsman stands by to offer support. For example, when state authorities shut down the Orange Residential Care Home last week and Laguna Manor on Sept. 4, ombudsmen were there to help the residents relocate.

In both cases, state licensing officials took action after investigating reports of unsafe conditions, and the residents had only one day to find new homes.

Ombudsman Grayne Price helped several of the 31 Laguna Manor residents relocate to a much smaller facility, then followed up to see how they were adjusting to their new surroundings.

She found that June Johnson, a widow in her 90s, was at loose ends because she no longer had anyone with whom to play cards. Price immediately started a search for volunteers to bring this small joy back into Johnson’s life.

Price was still working on that when she said: “This can be the most frustrating job in the world; you can’t spread yourself thin enough to do what you’d like to do. I’m quite fond of the people I’ve met, and I wish I could do more.”

Most of all, she wishes she could relieve the “lonesomeness of the elderly.” But, though she is deeply saddened by their isolation, she says she isn’t able to spend much time visiting because there are “too many things that need fixing.”

When ombudsmen feel the burden of not being able to do enough, it helps to remember the people they have been able to help. Says Gail Smith: “This work is my reason for being. You can visibly see that you make difference.”

She has been notified a number of times that a facility was about to evict a resident whose family had not been paying the bills. When it’s clear that the relatives responsible for an elderly person have been misusing the patient’s money, Smith doesn’t hesitate to let them know they’ll be reported if they don’t stop what she calls “fiduciary abuse.”

Usually, one phone call from her is all it takes.

“We have clout,” Smith says with a satisfied smile.

Sometimes the ombudsmen have to use that clout to make sure that the last wishes of the elderly are honored. Russell says some facilities refuse to cooperate when the patient has signed Durable Power of Attorney for Health Care papers stipulating that no extraordinary life-saving measures should be taken and designating someone to speak for them.

In such cases, Russell explains, the ombudsman does everything possible to make sure the dying patient’s wishes are fulfilled, including reminding the family that they can change doctors or facilities, if necessary.

Often, ombudsmen are called in to witness the signing of legal papers by those who have little time left to make their wishes clear. The ombudsmen are there so that, if there’s ever a dispute, they can testify that the patient was fully aware of what he or she was doing when the papers were signed.

“It saves a lot of anguish for the family,” Smith says.

Smith recently witnessed a last-minute signing of legal papers by a 72-year-old stroke victim who had decided she no longer wanted to continue her kidney dialysis treatments. The woman thought she had signed all the papers necessary to prevent the nursing home from sending her to the hospital, but one document was missing.

Smith says she witnessed the signing of that document just in time to make sure the woman wasn’t taken to the hospital for emergency care. The woman was surrounded by loved ones and hospice workers when she died--her way--in the nursing home two weeks after quitting dialysis.

Smith says she was able to reassure the family that the woman, who had been ill and severely disabled for 19 years, knew what she was doing when she stopped the kidney dialysis treatments.

“It was her choice, and the family felt good about the final decision,” Smith says.

Another service that ombudsmen provide is helping the elderly find a long-term care facility that best meets their needs. Russell says the ombudsman service--which is funded through government grants and private donations and involves no fees--receives about 500 calls a month from people needing this kind of assistance.

Often, the call comes from a relative for whom the decision to place a loved one in a long-term care facility involves great emotional and financial stress. Russell says the ombudsmen try to offer comfort along with practical advice.

On the practical side, ombudsmen can tell callers whether a facility is licensed and whether any complaints have been filed against it. And they can guide those with limited resources through the often complicated process of applying for government aid and finding a facility that will accept patients on Medicare or Medi-Cal.

Lawrence Grimes, a 74-year-old Santa Ana resident, is among those who have turned to the ombudsmen service when the task of finding the right facility became overwhelming.

His 80-year-old wife, Laura, had suffered a stroke that left her paralyzed on her left side, and he had placed her in a facility where she could get the physical therapy she needed.

He scraped together $3,000 to pay for a month of care, figuring Medi-Cal would soon take over. But it didn’t. Grimes was contemplating bankruptcy when he saw the Long-Term Care Ombudsman Service’s poster and called Sallie Russell.

“I was desperate because expenses were building up, and I really needed a shoulder to cry on,” he says.

Russell discovered that the facility Grimes had selected didn’t accept Medi-Cal patients. She found a place nearby that did and then helped him provide the documentation Medi-Cal required.

Today, a year after her stroke, Laura is well enough to live in an apartment with her husband, who says he is “deeply grateful” for the help he received from Russell at a time when he was confused, frustrated and deeply concerned about his wife.

“No matter what I did, it seemed it was always wrong,” he says. “It was such a relief to have somebody stand with me and encourage me. It gave me confidence and restored my dignity and self-respect.”