What Is a Healthcare Ombudsman? California Guide for Facilities

Life for seniors in residential care facilities can be lonely. Families can’t always visit every day, and short-staffing leads to residents having less time with a direct care provider. While their basic needs are met, residents’ day-to-day preferences may fall by the wayside.

One way for residents’ concerns to be heard is by speaking to an ombudsman. California offers special training for volunteers to advocate for residents in long-term care facilities. They’re neutral parties who investigate concerns or issues on behalf of residents. Find out what a California ombudsman does and what to expect when they visit your facility.

What Is the California Ombudsman Program?

The California Long-term Care Ombudsman Program, directed by the California Department of Aging, provides long-term care residents with healthcare advocates. The purpose of the program is to give elderly Californians a voice to address their personal needs and improve their daily life.

California long-term care ombudsmen are state-certified representatives with extensive training. Volunteers must complete a minimum of 36 hours of training, a supervised internship, and 18 hours of annual continuing education. Representatives must be over the age of 18 and may not have worked in a long-term care facility in the past year to qualify.

The state of California also provides ombudsman services for recipients of government programs like Medi-Cal. The Medi-Cal Managed Care and Mental Health Office of the Ombudsman provides neutral support to resolve problems, such as ensuring members get medically necessary treatments or services covered by the program.

What Does an Ombudsman Do in California?

A California long-term care ombudsman is a resident advocate. They listen to residents’ complaints, investigate problems, and find resolutions. Ombudsmen resolve issues ranging from “I don’t like the food here” to “I think I may be experiencing financial abuse.” Issues are often related to an elderly person’s quality of life, such as:

• Medical care
• Meals
• Safety
• Abuse
• Placement
• Violation of dignity or residents’ rights
• Issues related to Medicare or Medi-Cal benefits

When a problem is identified, an ombudsman takes the proper steps to resolve it while maintaining a neutral and confidential stance. They do not have the authority to cite a facility, but their advocacy efforts may lead to corrective action. One example is a Santa Cruz ombudsman who identified the illegal dumping of a resident from a long-term care facility. When the resident was transferred to the hospital, the facility refused to re-accept them upon discharge. The representative’s investigation led to a citation and fine from the California Public Health Department.

An ombudsman’s training prepares them to identify issues that may occur in the long-term care setting that a typical volunteer may not recognize. The main anchor points of their role are to:

• Advocate. Ombudspeople serve as the voice for people without one. They maintain confidentiality when residents bring up concerns about issues affecting their safety or quality of life. This may include poor quality of care, instances of abuse, or suspected financial exploitation. They may also witness the signing of advance directives.

• Protect. California ombudsmen investigate cases of suspected abuse and neglect in facilities. This can include physical, mental, or financial abuse. They may also investigate violations of resident rights like improper restraint usage. While they can’t deliver citations, they can report facility violations to state licensing agencies. Ombuds may also direct residents to the proper channels to file a grievance.

• Educate. An ombudsman may deliver educational sessions for residents and their families in long-term care settings. They may give group talks covering topics like financial abuse or residents’ rights, or provide informal one-on-one education. They have a duty to maintain transparency, which may include informing individuals or communities about facility issues. Ombudsmen may also provide unbiased help with placement by making referrals to other care facilities.

Who Does a Healthcare Ombudsman Work With?

All California residents in long-term care facilities can receive free and confidential services from their ombudsman. California representatives work with residents in nursing homes, assisted living facilities, and board and care homes. In addition to residents, they may also speak with families and facility administrators or staff.

Ombudsman Office Phone Number and Contact Information

You can contact the California Department of Aging (DOA) to find your local ombudsman. California has 33 Area Agencies on Aging (AAA) that provide services to seniors or adults with disabilities. The programs are separated by region; for example, the Long-Term Care Ombudsman Program in Orange County and Riverside is directed by the Council on Aging in Southern California. The contact information for the DOA is outlined below.

Tips for Facilities Working With a State Ombudsman

All long-term care residents in California, regardless of age, are entitled to ombudsman services. Visits give residents the opportunity to express concerns or complaints to an ombudsman. California representatives make unannounced, regular visits to long-term care facilities. If an ombudsperson visits your facility, it’s important to work with all parties involved by:

• Being transparent. Let your residents and visitors know they have the right to speak with an ombudsman. California long-term care facilities are required to display informational posters with the name, address, and ombudsman office phone number of the nearest program. It must also include the phone number for the statewide 24-hour CRISISline, where residents can make complaints.

• Following through with requests. The primary role of the ombudsman is to investigate complaints from residents. Direct staff to remain compliant by providing information as needed while maintaining privacy and confidentiality.

• Creating a collaborative environment. Ensuring resident satisfaction and well-being is at the center of ombudsman programs. Create a healthy work culture that allows all parties to work together to deliver patient-and-family-centered care at your facility.

Find More Ways to Improve Residents’ Quality of Life

There are many opportunities to improve the quality of care at your facility — without added expenses. It’s free to work with an ombudsman. California long-term care residents get the extra support to live happier, fuller lives thanks to these services. Learn more ways to improve residents’ quality of life when you sign up for IntelyCare’s free newsletter.