Resident Self-Advocacy

A resident first should talk to an employee on duty at the time the problem occurs -- preferably the person or persons directly involved. If no one is available, or the resident is not comfortable talking directly to the persons involved, the resident should contact the facility administrator. Many times, the issue can be resolved at this level, and residents often find that prompt and direct communication can resolve issues in the simplest and most effective way.

Unfortunately, sometimes problems cannot be resolved by talking to the facility staff or administrator. If a resident is not satisfied with a facility’s response, the resident can turn to certain outside agencies and resources for help. Some of these resources are discussed in the following section, “Help Available to Resolve Problems.”

Help Available to Resolve Problems

Long-Term Care Ombudsman Program

Federal law requires each state to have a Long-Term Care Ombudsman program, although ombudsman programs vary greatly from state to state. In general, Ombudsman programs currently are more active in nursing facilities than in assisted living facilities, although each year Ombudsman programs are increasing their involvement in assisted living.

In some states, Ombudsman programs are part of state or local government. In other states, Ombudsman programs are operated by private non-profit agencies. In all cases, Ombudsman programs operate independently from the long-term care facilities in which they visit and work.

Although Ombudsman representatives are impartial in investigation, they take the resident’s perspective when resolving problems. They seek to resolve situations on terms acceptable to the resident. Ombudsman programs use many different strategies to resolve problems. Ombudsman representatives provide information to facilities and residents, investigate complaints, work with family and resident councils, and train facility staff as well as the local community about various issues in long term care.

A resident can request an Ombudsman representative to speak on the resident’s behalf to facility staff, or an Ombudsman representative can take the initiative to address systemic problems on behalf of all residents. Many times, the Ombudsman program can keep an individual resident’s name in confidence if that is what the resident wants.

Phone numbers for state ombudsman programs are located in Appendix B to this guide. As mentioned above, ombudsman programs in most states are currently much more active in nursing facilities than they are in assisted living facilities. Check with your state’s ombudsman program to find out what assistance the program can provide with assisted living issues.

State Licensing Agency

Residents have the right to report problems or complaints to the state licensing agency. Licensing agencies have the authority to investigate complaints about facilities. When a complaint is made, the licensing agency often must investigate within a certain amount of time.

If violations in state licensing requirements are found, the agency generally requires the facility to present a plan to fix the problem, and on occasion assesses fines or other types of penalties. The strength of state licensing standards, and of the procedures used to address violations, vary greatly from state to state.

Residents should be aware that state licensing requirements may be rather minimal. In many or most states, licensing standards in no way reflect the high quality procedures for which residents and their representatives should advocate.

Phone numbers for state licensing agencies are located in Appendix B to this guide.

Professional Licensing Boards

States also maintain professional licensing boards that set standards for health care personnel including registered nurses, licensed practical nurses, physical therapists, certified nursing aides, social workers, and physicians. The licensing agencies provide examinations and certifications to these groups, and also investigate complaints about individual healthcare workers. Consumers usually can report complaints directly to the state’s department of professional licensing.

It should be noted, however, that most state licensing boards will not take action except in response to gross misconduct. In general, licensing boards only act when a license is threatened, and in most states a licensee revocation becomes a possibility only when the conduct of the licensed person has been particularly egregious.

Attorneys and Legal Advocates

Residents and their family members have the right to contact an attorney who can take action on behalf of a resident or residents. An attorney may represent a resident to prevent an eviction, recover lost or stolen property, recover for a personal injury, or protect the resident in some other way. Attorneys with expertise in long-term care are generally elder law attorneys or (in the case of physical injury suffered by residents) personal injury attorneys. An elder law attorney can be located through the National Academy of Elder Law Attorneys at www.naela.com. For residents with very limited finances, free or low-cost legal assistance may be available from the local non-profit legal services agency.