The Frail Elderly Deserve Advocate in Nursing Homes

In the late 1960s, the Long-Term Care Ombudsman Service for nursing home residents was mandated by the federal government. Ombudsmen Resident Advocates began to visit privately with elderly residents, listen to their complaints and inform them of their rights.

Shortly before the programs’ inauguration, my mother died after spending several months in an Orange County nursing home where she suffered great indignities. I have often wondered what her final days would have been like if she’d had the advantage of a trained advocate to listen to her concerns and take appropriate action to remedy problems whenever possible.

Since enactment of the program, supported by state and federal funding as well as contributions from private foundations and corporations, ombudsmen have succeeded in improving the lives and welfare of nursing home residents by instigating reduced use of physical restraints and psychotropic drugs to sedate patients, by protecting patients from involuntary discharges and in seeing that their personal needs are attended to. They are responsible for the Nursing Home Reform Law of 1987.

But during the period my mother was confined to a nursing home, the frail elderly had no voice. At various times she had tried to tell me something was wrong at her facility, but because it had been recommended by her doctor and boasted neatly kept grounds and a clean, shiny interior, I tended to overlook her complaints. Shamefully, I concluded that her judgment had been affected by the stroke she had suffered.

Gradually, though, as time passed, I began to notice some troubling things--things an experienced ombudsmen today probably would pick up with routine visits. Nursing homes now are required by law to allow ombudsmen to make regular unannounced visits to their facilities and to meet privately with residents. Failure to comply can result in a fine of $1,000 to the facility.

Although I finally realized that at least some of my mother’s complaints were legitimate, I didn’t know what action to take and I had no one to turn to. I believed it would be dangerous to remove my mother from the facility, and I worried that if I complained to the staff there might be retaliation. Although this fear of retaliation remains today, it is alleviated by the ombudsmen themselves becoming the complainants after satisfying themselves that the residents do indeed have legitimate complaints.

In my mother’s case there were many instances of abuse, with staff personnel ignoring her requests or answering her with patronizing comments, refusing to let her have phone privileges when she wanted to phone me, and making her feel like an incorrigible child on occasions when she was incontinent and her sheets needed changing.

Bathing was frequently an ordeal since my mother suffered from severe arthritis and was partially crippled from the stroke. Yet she told me that the aides simply stuck her under the shower and paid no attention to her discomfort when a sponge bath obviously would have been a better choice and a more humane alternative.

As my mother’s condition worsened, she found it increasingly difficult to eat. One evening when she refused dinner, the nurse intimidated her by saying if she didn’t eat she would have to have intravenous feedings, and the procedure would be very painful. In her weakened condition, this admonition greatly upset my mother until an IV was actually started later at the hospital and the nurse’s distortion of the truth became evident.

Pam McGovern, who heads the ombudsmen program for the Orange County Council on Aging, told me, “As a caregiver, we would have given you the tools necessary to advocate more successfully for your mother.” The council, a United Way Agency, is a private, nonprofit, single-purpose corporation.

In Orange County there are currently 12 part-time paid ombudsmen and about 40 volunteers to cover the 87 nursing homes and 581 residential care facilities for the elderly, housing 22,500 long-term care beds. Trainees are always needed, and for this purpose classes are held sponsored by the council which contracts with the state ombudsman office in the Department of Aging in Sacramento to provide this service.

Similar to overall success nationwide, the ombudsman program has worked out well in Orange County by giving a much needed voice to the frail elderly confined to nursing homes. It deserves our support.