Nursing Homes: Ensuring That Critical Needs Are Met

>> WHEN WE OR A LOVED ONE IS TRAPPED IN A MEDICAL QUANDARY, IT IS GOOD TO KNOW AN OMBUDSMAN IS ON OUR SIDE.

STAY WITH US AS WE TALK WITH MISS NATALIE BROWN-RATKE ABOUT THE LONG-TERM CARE OMBUDSMAN PROGRAM NEXT ON KENTUCKY HEALTH.

AFTER SEVERAL YEARS OF GENTLE PRODDING, MY MOTHER CONCLUDED THAT SHE WAS EITHER NO LONGER WILLING OR ABLE TO DO THOSE THINGS REQUIRED TO LIVE ALONE IN OUR FAMILY HOME.

SHE CHOSE TO MOVE INTO A LONG-TERM CARE FACILITY WHICH OFFERED VARIOUS LEVELS OF CARE FROM NEAR COMPLETE INDEPENDENT LIVING TO FULL ON ROUND THE CLOCK NURSING CARE.

HER DECISION, WHILE WELCOMED BY ALL CONCERNED, MEANT THAT SHE WAS TRADING COMPLETE INDEPENDENCE FOR A MEASURE OF CARE AND SUPERVISION AND SELFISHLY, PEACE OF MIND FOR THE REST OF THE FAMILY: UNLIKE MY MOTHER, TOO OFTEN THE DECISION FOR A LONG-TERM FACILITY IS MAP DATED BY A NEED OF LEVELS OF CARE BEYOND WHAT EITHER THE PATIENT OR FAMILY CAN DO FOR THEMSELVES.

THE TREATMENT FOR LONG-TERM CARE FACILITY IS IS OVERWHELMINGLY GOOD, THERE ARE OCCASIONS WHERE EXPECTATIONS ARE NOT MET AND A CONFLICT MAY ARISE.

WHEN THESE DISPUTES DO OCCUR, THERE ARE ADVOCATES.

OMBUDSMAN WHO ACT ON BEHALF OF THE PAWSH TO RESOLVE THE COMPLAINT AND MONITOR THE CARE.

TO TELL US MORE ABOUT LONG-TERM CARE FACILITY OMBUDSMAN, WE HAVE MISS NATALIE BROWN-RADTKE, THE DIRECTOR OF THE LONG-TERM CARE OMBUDSMAN PROGRAM AT CATHOLIC CHARITIES IN DISTRICT OMBUDSMAN FOR THE KENTUCKIANA REGIONAL PLANNING AND DEVELOPMENT AGENCY.

NATALIE, Ms. BROWN-RADTKE, THANK YOU VERY MUCH FOR BEING WITH US TODAY.

>> THANK YOU FOR HAVING ME.

>> THIS IS AN UNUSUAL KIND OF A THING FOR US, BUT TELL ME FIRST, THOUGH, LET'S JUST START WHAT IS A LONG-TERM CARE FACILITY?

>> SO WITH LONG-TERM CARE FACILITIES, WE HAVE DIFFERENT TYPES OF FACILITIES, JUST BASED ON THE LEVEL OF CARE THAT AN INDIVIDUAL NEEDS.

SO WE HAVE FAMILY CARE HOMES, SO SAY AN INDIVIDUAL SUCH AS YOURSELF IS LICENSED THROUGH THE OFFICE OF INSPECTOR GENERAL, TO CARE FOR UP TO THREE PEOPLE IN THEIR HOME.

THEN YOU HAVE PERSONAL CARE HOMES, ASSISTED LIVING FACILITIES, AS OF OCTOBER.

AND THEN YOU HAVE THE NURSING FACILITIES.

AND ALL OF THOSE REALLY ARE JUST BASED ON THE LEVEL OF ASSISTANCE NEEDED.

WHEN YOU THINK ABOUT ACTIVITIES OF DAILY LIVE.

SOMEBODY BEING ABLE TO MEET THEIR OWN NEEDS, WHETHER OR NOT THEY'RE ABLE TO TAKE MEDICATION INDEPENDENTLY, WHETHER OR NOT THEY CAN COOK THEIR OWN MEALS, WHETHER OR NOT THEY'RE MOBILE OR MAYBE EVEN ABLE TO JUST MAINTAIN IN THE HOME.

SO MAYBE THEIR MEDICAL NEEDS EXCEED THEIR ABILITY TO BE ABLE TO MAINTAIN IN A HOME.

SO-- >> THAT'S INTERESTING.

I DIDN'T REALIZE THAT SOMEONE COULD HAVE UP TO THREE PEOPLE IN THEIR HOME-- SO ARE THERE CERTAIN STATE REQUIREMENTS THAT ONE MUST HAVE TO DO THAT?

AND IS IT THE SAME AS IF YOU HAVE 100 PEOPLE IN A FACILITY?

>> DEFINITELY NOT THE SAME.

AND GENERALLY, WHEN YOU HAVE SOMEONE IN YOUR HOME, THEY STILL HAVE SOME OF THEIR OWN ABILITIES TO BE ABLE TO MAINTAIN.

THEY JUST NEED LIGHT MONITORING, IF YOU WILL.

THEY'RE STILL MOBILE, ABLE TO MANEUVER INDEPENDENTLY WHETHER THAT'S WALK OR, YOU KNOW, BE IN A WHEELCHAIR BUT THEY WOULD HAVE TO BE ABLE TO SELF PROPEL BUT MAYBE THEY NEED ASSISTANCE WITH MEALS AND MEDICATIONS.

>> YOU ALLUDED TO IT, BUT, AGAIN FOR ME, IN ONE'S-- I SEE NOW THESE FACILITIES, WHICH SEEM TO BE ALL INCLUSIVE AND I'LL GO BACK TO THE EXAMPLE OF MY MOTHER.

SHE IS BASICALLY LIVING IN AN APARTMENT, BUT THERE ARE PEOPLE THERE.

BUT THEN THEY HAVE SERVICES.

SO HOW DO YOU CLASSIFY THOSE THINGS NOW?

IS THAT A NEW CONCEPT OR JUST SOMETHING THAT HAS ALWAYS BEEN AROUND?

>> IT'S NOT A NEW CONCEPT.

WE'VE ALWAYS HAD LONG-TERM CARE FACILITIES FOR QUITE SOMETIME AND IT REALLY JUST DEPENDS A LOT OF TIMES, A PHYSICIAN WILL DETERMINE WHETHER OR NOT TO SAFELY MAINTAIN IN THEIR HOME.

SOMETIMES PEOPLE WILL FOR WHATEVER CIRCUMSTANCE MEDICALLY THAT TAKES PLACE, THAT THEY GO INTO A HOSPITAL AND MAYBE THEY NEED TO GO INTO A SHORT-TERM FACILITY AND EVEN THROUGH THE REHABILITATATION PROCESS, THEY'RE NOT ABLE TO TRANSITION BACK INTO THE HOME SO THEY MAY STAY IN A FACILITY LONG-TERM.

>> SO WHAT IS THE DIFFERENCE BETWEEN A REHAB FACILITIES AND LONG-TERM CARE FACILITY OR IS THERE A DIFFERENCE BETWEEN THEM?

>> OFTEN TIMES THEY'RE WITHIN THE SAME BUILDING A LOT OF TIMES A FACILITY WILL DESIGNATE A PARTICULAR UNIT TO ASSIST SOMEONE WITH REHAB SERVICES SO THEY WILL RECEIVE THE THEERP AND A LOT OF THE OTHER SAME SERVICES THAT OTHER RESIDENTS RECEIVE YOU KNOW, ASSIST WITH MEALS AND MEDICATION ACTIVITIES SO YOU MENTION THEY MAY BE REFERRED FOR REHAB BUT WHAT ARE SOME OF THE OTHER CRITERIA FOR ADMISSION TO A LONG-TERM FACILITY.

HOW DOES THAT WORK?

DO I GO UP TO THE DOOR AND KNOCK AND SAY I WANT TO GO IN?

>> UNFORTUNATELY, YOU CAN'T DO THAT.

IF IT WAS A PERSONAL CARE HOME OR ASSISTED LIVING FACILITY, HOW YOU MENTION WITH YOUR MOM, YOU KNOW, PEOPLE CHOOSING TO GO INTO A COMMUNAL SETTING SUCH AS LONG-TERM CARE FACILITY BUT WHEN IT COMES TO NURSING HOME LEVEL OF CARE, USUALLY THERE HAS TO BE A THREE-DAY HOSPITAL ADMISSION.

NOT ONLY ARE YOU BEING EVALUATED AND ASSESSED AND TREATED MEDICALLY, BUT THEN ALSO AS I SATE STATED, BEING ADMITTED TO THE HOSPITAL, RECEIVING SERVICES AND IT IS DETERMINED THAT PERSON IS NOT ABLE TO SAFELY GO HOME SO SAY AN INDIVIDUAL HAS A FALL AT HOME AND MAYBE BREAKS A HIP.

SO THEY'LL STAY IN A HOSPITAL FOR A PERIOD OF TIME TO RECEIVE TREATMENT, BUT THEN THEY MAY GO INTO A LONG-TERM CARE FACILITY FOR REHAB SERVICES TO ASSIST THEM WITH WALKING TO BE ABLE TO FUNCTION AGAIN, TO BE ABLE TO REGAIN SOME OF THEIR INDEPENDENCE.

SOMETIMES, YOU KNOW, THEY ARE NOT ABLE TO GET BACK TO SORT OF BASELINE OF WHERE THEY WERE PRIOR TO THE HIP FRACTURE.

MAYBE THEY HAVE OTHER COMORBIDITIES SO MAYBE THEY HAVE HIGH BLOOD PRESSURE, DIABETES, A NUMBER OF OTHER FACTORS THAT CONTRIBUTE TO THEIR ABILITY TO MAINTAIN IN THE HOME SO THEN MAE THINK GO AHEAD AND TRANSITION FROM REHAB INTO THE LONG-TERM CARE UNIT.

>> WHICH WAY DO YOU SEE THE TREND SWINGING.

ARE WE DOING MORE IN HOME REHAB OR CARE OR GOING TO A NURSING HOME?

>> I DON'T KNOW IF I SEE WHICH DIRECTION IN TERMS OF MORE OR LESS.

SOMETIMES IT JUST DEPENDS ON MAYBE THE INSURANCE AND ABILITY TO PAY OR A PERSON'S PREFERENCE, YOU KNOW.

OFTEN TIMES PEOPLE WANT TO TRY TO REMAIN IN THE HOME AS LONG AS POSSIBLE AND SO THEY'LL SEEK OUT SOME OF THOSE OTHER SUPPORTIVE SERVICES TO BE ABLE TO MAINTAIN IN THE HOME.

SOMETIMES IT COULD BE THAT THEY GO INTO A FACILITY TO REHAB FOR A PERIOD OF TIME AND THEN ONCE THEY'RE DONE THERE, THEY'LL TRANSITION INTO THE HOME AND STILL BE ABLE TO OBTAIN SOME OF THOSE THERAPEUTIC SERVICES.

TO ENSURE THAT THEY ADAPT APPROPRIATELY IN THE HOME.

>> IT SEEMS LIKE THERE ARE SOME PROGRAMS WHERE THERE ARE IS SOME SENIOR CARE THAT IS PROVIDED BUT YOU ARE NOT IN A NURSING FACILITY.

IT'S ALMOST LIKE YOU ARE BROUGHT THERE, FOR LACK OF A BETTER TERM, A DAYCARE KIND OF A THING.

TELL ME THE RIGHT WAY TO PUT IT.

>> DEFINITELY NOT A DAYCARE.

NOTHING CAN EVER TAKE THE PLACE OF SOMEONE'S HOME, YOU KNOW.

PEOPLE GIVE UP SO MUCH THINGS THAT WE TEND TO TAKE FOR GRANTED AND, YOU KNOW, I HEARD YOU TALK ABOUT YOU KNOW, GIVING UP INDEPENDENCE, YOU KNOW, THAT'S SOMETHING THAT WE ARE TAUGHT OUR ENTIRE LIVES TO STRIVE FOR AND TO ACHIEVE.

SO GENERALLY WHENEVER THAT HAPPENS IT'S A BIT TRAUMATIC.

PEOPLE DON'T CHOOSE TO GO INTO A FACILITY.

IT'S USUALLY SOMETHING, YOU KNOW, SIGNIFICANT THAT TAKES PLACE THAT FORCES SOMEONE TO BE IN A FACILITY.

SO TO CALL IT A DAYCARE.

[LAUGHTER] BUT I GET WHAT YOU ARE SAYING.

>> AND I DON'T MEAN IT IN THE PEJORATIVE SENSE EITHER.

>> I KNOW.

BUT HONESTLY, IT'S A COMMUNAL SETTING.

IT'S A NUMBER OF THINGS.

IT'S BEING ABLE TO ENSURE THAT PEOPLE HAVE THE SERVICES THAT THEY NEED, BUT STILL HAVE A SENSE OF COMMUNITY, LIKE I SAID, THEY PROVIDE ACTIVITY ACTIVITIES THROUGHOUT THE DAY, HOPEFULLY ONES THAT RESIDENTS ARE INTERESTED IN.

THEY ASSIST WITH MEALS.

I REMEMBER GOING, WHETHER I USED TO VISIT A FACILITY IN PARTICULAR, THEY CREATED SORT OF THIS CRUISE EXPEDITION KIND OF THING OVER THE PROCESS OF A WEEK WHICH GRANTED ON AVERAGE RESIDENTS CAN'T ACTUALLY TRAVEL SOMETIMES, YOU KNOW, NOT ALWAYS THE CASE.

SOMETIMES THEY CAN.

SO IT WAS A WAY TO BRING THAT EXPERIENCE INTO THE FACILITY AND , YOU KNOW, WHERE EVER IT WAS THEY WERE SAILING TO ON ANY GIVEN DAY, THEY WOULD HAVE MEALS AND ACTIVITIES DEVOTED AROUND THAT SO I THOUGHT IT WAS A NEAT WAY TO BE CREATIVE, YOU KNOW?

>> IT TAKES A LOT OF EFFORT TO DO THESE THINGS.

>> IT CAN.

CREATIVITY, DEFINITELY.

>> YOU TOUCHED ON IT, BUT SO WHO PAYS FOR THIS STUFF?

>> SO IF IT'S REHAB, OFTEN TIMES MEDICARE WILL PAY A PORTION.

MEDICAID TENDS TO PAY A HUGE PORTION.

SOME PEOPLE ARE PRIVATE PAY.

LIKE IF YOU ARE IN A PERSONAL CARE HOME OR IN A ASSISTED LIVING, IT'S STRICTLY PRIVATE PAY.

SOMETIMES PRIVATE INSURANCE MAY PAY AS WELL OR AT LEAST FOR CERTAIN THINGS.

SO IT JUST DEPENDS ON THE INDIVIDUAL.

OFTEN TIMES PEOPLE ARE, WITHIN THESE FACILITIES FOR SO LONG THAT EVEN IF THEY'RE PRIVATE PAY, EVENTUALLY THAT MONEY RUNS OUT AND SO THEY HAVE TO TRANSITION TO MEDICAID.

>> DOES THAT OFTEN TIMES MEAN THEY MAY HAVE TO TRANSITION OUT OF THE FACILITY IN WHICH THEY MAY BE IN TO GO SOMEWHERE ELSE?

>> NO, NOT ALWAYS.

MOST FACILITIES ARE LICENSED, IF IT'S A SKILLED NURSING FACILITY, MOST OF THEM ARE LICENSED DUALLY SO THEY CAN TAKE MEDICAID AND/OR MEDICARE.

THEY MAY BE ABLE TO REMAIN IN THE SAME BED IN THE SAME ROOM.

BUT IT REALLY JUST DEPENDS ON THEIR BED AVAILABILITY.

SO IF THEY DON'T HAVE ANY MEDICAID BEDS, IT'S POSSIBLE.

>> NOW YOU ARE AN OMBUDSMAN.

>> YES.

>> WHAT EXACTLY DOES AN OMBUDSMAN DO?

IN THIS CASE?

>> SO WE ARE ADVOCATES FOR RESIDENTS.

I LOVE WHAT WE DO IN A SENSE THAT OVER 60% OF PEOPLE IN FACILITIES DON'T HAVE ANYBODY VISITING WITH THEM.

>> 60%?

>> YEAH AND JUST WITHIN THE TWO DISTRICTS THAT WE COVER, WE HAVE OVER 12,000 RESIDENTS.

SO WE ARE ABLE TO PROVIDE SOME OF THAT COMPANIONSHIP, IF YOU WILL WHEN WE GO IN, WE DO UNANNOUNCED VISITS REGULARLY TO FACILITIES TO CHECK ON RESIDENTS.

YOU KNOW, WE MAY SET OUT TO VISIT, YOU KNOW, MULTIPLE UNITS OR THE WHOLE FACILITY IN ONE DAY, BUT WE MAY FIND OURS OURSELVES ENGAGED WITH ONE OR TWO RESIDENTS IN PARTICULAR FOR AN HOUR.

AND I APPRECIATE THE FLEXIBILITY OF WHAT WE DO BECAUSE WE KNOW THAT STAFF ARE GENERALLY, WITHIN THE FACILITY, SO BOGGED DOWN WITH ALL THEIR OTHER RESPONSIBILITIES AND OBLIGATIONS THAT EVEN IF THEY WANTED TO SPEND THAT KIND OF TIME WITH A RESIDENT, THEY DON'T ALWAYS HAVE THE ABILITY TO.

SO WE ARE ABLE TO ENGAGE WITH RESIDENTS IN THAT WAY, BUT THEN ALSO IF THEY HAVE CONCERNS, WE CAN EITHER ASSIST THEM WITH HOW TO RESOLVE THOSE CONCERNS OR WE CAN STEP IN AND ASSIST WITH THOSE CONCERNS.

AND TO BE HONEST, THE CONCERNS CAN RANGE FROM A MULTITUDE OF ISSUES.

IT CAN BE SOMETHING-- I NEVER LIKE TO BELITTLE ANYTHING AS SMALL BECAUSE AGAIN SOMETIMES IT'S THINGS THAT WE TAKE FOR GRANTED, BUT IF YOU WANT A CUP OF COFFEE, CHANCES ARE, YOU KNOW, YOU ARE ABLE TO EITHER GO OUT AND PURCHASE OR MAKE YOUR OWN COFFEE AND HAVE IT AT THE RIGHT TEMPERATURE SETTING THAT YOU WANT IT AND HAVE, YOU KNOW, WHATEVER SUGAR AND CREAM IN IT.

SOMETIMES FOR RESIDENTS, THAT'S NOT ALWAYS THE CASE WHEN THEY'RE RELYING ON STAFF AND THEY GET THEIR COFFEE AND IT'S COLD OR THEY DON'T HAVE THE CONDIMENTS THEY NEED TO PUT WITH IT OR WITH THEIR MEALS SO SOMETIMES IT'S A MATTER OF ASSISTING WITH THAT.

SOMETIMES IT'S THAT THEY'RE NOT GETTING THEIR SHOWERS, YOU KNOW, ON AVERAGE THE WAY IT'S SET UP IS THAT RESIDENTS GET MAYBE TWO SHOWERS A WEEK.

BUT WE-- >> TWO TAYE WEEK?

>> YES-- TWO A WEEK?

>> YEAH, OTHERWISE THEY MAY DO BED BATHS OR SOMETHING LIKE THAT.

SO SOMETIMES WE'LL GET A CALL THAT THEY HAVEN'T HAD THEIR SHOWER IN A COUPLE OF WEEKS OR MORE.

AND WE KNOW THE NUMBER OF ISSUES THAT CAN HAPPEN FROM NOT BATHING OR NOT HAVING THEIR CALL LIGHTS ANSWERED, YOU KNOW, IN A TIMELY MANNER.

SO WE WILL STEP IN TO ASSIST WITH THAT, TO FIND OUT, YOU KNOW, WHY AREN'T THEY RECEIVING THEIR SHOWERS.

WHERE IS THE BREAKDOWN?

AND THEN TO ENSURE THAT THEY'RE RECEIVING THEIR SHOWERS SO WE WILL FOLLOW UP WITH THE RESIDENT AND WE ARE RESIDENT DIRECTED SO ANYTHING THAT WE DO IS WITH THE GUIDANCE OF THE RESIDENT.

AND TAKING INTO CONSIDERATION WHAT IT IS THEY WANT TO SEE HAPPEN.

SO IT'S NOT ABOUT WHAT I THINK IS BEST FOR THEM OR WHAT, YOU KNOW, I FEEL LIKE SHOULD HAPPEN OR THEIR LOVED ONES.

IT'S ABOUT WHAT THAT RESIDENT WANTS.

GIVING A VOICE BACK TO THAT INDIVIDUAL.

>> BUT THE INSTITUTION OR THE FACILITY, AGAIN, INSTITUTION SOUNDS AS BAD AS MY DAYCARE, DOESN'T IT?

I'M SORRY.

BUT THE FACILITY, THEY HAVE A PLAN ON WHAT THEY FEEL PEOPLE NEED.

IS IT THAT SOMETIMES THE PATIENT DOESN'T LIKE THE PLAN THAT HAS BEEN OUTLINED FOR THEM?

>> SOMETIMES IT'S NOT ALWAYS ALIGNED IS WHAT I'LL SAY.

AN INSTITUTION HAS TO, IN MANY WAYS, CREATE A CERTAIN STRUCTURE FOR THEM TO BE ABLE TO OPERATE AND FUNCTION THE WAY THAT THEY SEE FIT.

UNFORTUNATELY, SOMETIMES WHAT THEY DON'T DO IS TAKE INTO ACCOUNT PERSON-CENTERED CARE, AND THE FACT THAT RESIDENTS HAVE RIGHTS.

>> REALLY?

>> YEAH I MEAN LET'S TAKE BREAKFAST, FOR EXAMPLE.

I LOVE BREAKFAST.

>> ALL RIGHT.

>> BUT IF YOU WAKE ME UP AT 7:00 IN THE MORNING FOR BREAKFAST, WE MAY HAVE A PROBLEM.

LIKE I'M NOT GOING TO WANT TO WAKE UP AT 7:00 IN THE MORNING JUST BECAUSE THE FACILITY SAYS THIS IS WHAT TIME WE SERVE BREAKFAST.

I MAY WANT MINE AT 10 OR 10:30.

AND THAT SHOULD BE OKAY, YOU KNOW, THERE SHOULD BE PROVISIONS TO BE ABLE TO MEET AN INDIVIDUAL'S NEEDS.

IN A PERSONALIZED WAY.

I KNOW SOMETIMES THAT CAN BE DIFFICULT.

AGAIN WE ARE TALKING ABOUT FACILITIES THAT ARE BRINGING IN PEOPLE FROM ALL WALKS OF LIFE WITH VARYING INTERESTS OR LIKES AND DISLIKESES AND NEEDS, BUT TO THE GREATEST EXTENT POSSIBLE, THAT'S WHAT WE WANT.

IT'S RESPECTING A PERSON'S DIGNITY AND JUST TO THEY ARE AS PEOPLE.

>> YOU RAISE A COUPLE OF INTERESTING POINTS THERE.

I GOT TO ASK, SO TO WHOM ARE YOU SPEAKING WHEN YOUR CLIENT OR THE PATIENT FOR WHOM YOU ARE AN ADVOCATE IS TELLING YOU THIS AND YOU GO AND TELL WHO TO GET A RES SNRUTION.

>> IT DEPENDS ON-- TO GET A RESOLUTION?

>> IT DEPENDS ON WHAT THE ISSUE IS OR WHICH INDIVIDUAL IS IN FACILITY IS GOOD ABOUT ENSURING THAT THINGS ARE DONE.

SO SOMETIMES THAT'S THE ADMINISTRATORS, SOMETIMES THEY PREFER THAT WE SPEAK WITH THE DIRECTOR OF NURSING.

THE SOCIAL WORKER AND THE ACTIVITIES DIRECTORS A LOT OF TIMES ARE ENGAGED WITH RESIDENTS AND OFTEN TIMES COME FROM A SOCIAL SERVICES BACKGROUND AS WELL.

SO SOMETIMES THAT HELPS AND SO SOMETIMES THEY'RE THE ONES THAT HELP INITIATE CHANGE, IF YOU WILL.

>> I BELIEVE THAT THE CARE IN WHICH 3 IS DELIVERED BY FAR AND AWAY IS GOOD.

>> YEAH.

>> GOOD.

ARE YOU SEEING, AS ANTAGONISTIC BY STAFF WHEN YOU COME UP AND SAY Mr. JONES HERE HAS AN ISSUE.

>> I WOULD SAY IT DEPENDS ON THE PERSON.

IT DEPENDS ON THE ADMINISTRATIVE STAFF.

SOME PEOPLE ARE VERY FAMILIAR WITH OUR PROGRAM AND WHAT WE DO AND ARE VERY RECEPTIVE.

A LOT OF TIMES THEY WILL EVEN CONTACT US AND SEEK OUT GUIDANCE AND SUPPORT, BECAUSE AGAIN, LIKE I SAID, WE ARE IN THE FACILITY, VERY REGULARLY.

WE TRY TO BE IN THERE WEEKLY.

SOMETIMES MULT MULTIPLE TIMES WITHIN A WEEK.

IT JUST DEPENDS.

BUT THEN THERE ARE OTHERS THAT ARE NOT ALWAYS THE HAPPIEST TO SEE US, BUT IT'S OKAY.

I MEAN BECAUSE AT THE END OF THE DAY, IT'S ABOUT THE RESIDENT AND IT'S NEVER ANYTHING PERSONAL.

>> GOTCHA.

>> WE ALL SERVE THE SAME PERSON.

AND OFTEN TIMES OUR INVOLVEMENT HELPS EVERYONE, IN A SENSE, YOU KNOW, WE DON'T TRY TO BE UNREALISTIC IN THE REQUESTS OR THE SOLUTIONS THAT RESIDENTS ARE SEEKING: IT DOES NO GOOD TO SAY THAT I KNOW YOU OFFERED TWO SHOWERS A WEEK BUT YOU KNOW, Mr. JONES WANTS FOUR AND THERE IS ABSOLUTELY NO WAY TO MAKE THAT HAPPEN BECAUSE THE STAFFING, YOU KNOW, WHAT HAVE YOU, SO WE DO TRY TO FIND A BALANCE.

>> IS THIS STRICTLY A KENTUCKY PROGRAM?

AND HOW DID IT GET STARTED?

>> SO THIS IS A FEDERALLY MANDATED PROGRAM THAT IS REQUIRED IN EVERY STATE.

SO EVERY STATE HAS AN OMBUDSMAN PROGRAM.

BACK IN THE 60s, THERE WERE ISSUES COMING OUT OF FACILITIES THAT PROMPTED THE NEED FOR MORE OVERSIGHT AND REGULATION.

I KNOW IN ONE STATE SEVERAL RESIDENTS PASSED AWAY FROM SM NELL SALMONELLA POISONING.

ANOTHER FACILITY, THE CARPET HAD CAUGHT FIRE AND SEVERAL RESIDENTS HAD PASSED AWAY FROM ASPHYXIATION.

SO THERE IS DEFINITELY A NEED FOR THE SAFETY OF RESIDENTS TO HAVE SOME SORT OF OVERSIGHT.

AND THERE ARE MANY OF US-- I WON'T SAY MANY.

BUT THERE IS OUR OFFICE THAT GOES IN AND VISITS WITH RESIDENTS, BUT ALSO ADVOCATES TO ADDRESS CONCERNS.

BUT THEN YOU HAVE ADULT PROTECTIVE SERVICES AS WELL FOR ANY ABUSE AND NEGLECT SITUATIONS THAT MAY COME ABOUT.

YOU HAVE THE OFFICE OF INSPECTOR GENERAL, SO THEY'RE THE ONES THAT LICENSE FACILITIES.

SO A FACILITY WANTS TO OPEN UP, THEY'VE GOT TO GO THROUGH THE OFFICE OF INSPECTOR GENERAL.

THEY ALSO INVESTIGATE CONCERNS AS WELL, SOME OF THE SAME ONES THAT WE MAY COME ACROSS.

BUT THEY ALSO CONDUCT THEIR ANNUAL SURVEYS TO MAKE SURE THAT THEY'RE IN COMPLIANCE.

THEN YOU HAVE PROTECTION AND ADVOCACY, SO INDIVIDUALS WITH-- >> WHO PAYS FOR YOUR SERVICES?

>> OURS IS GRANT FUNDED.

SO WE HAVE A COMBINATION OF-- >> IS THAT THE WAY IT IS FOR MOST OF THE PEOPLE THAT DO YOUR TYPE OF WORK?

>> CAN I SPEAK TO THE OMBUDSMAN PROGRAM WITHIN THE STATE OF KENTUCKY; THAT THAT'S HOW IT IS.

IT IS PARTIALLY FEDERALLY FUNDED, BUT THEN IT'S ALSO STATE FUNDED AS WELL.

>> SO THE MAIN THING, THE COST DOES NOT FALL TO THE FAMILY AND/OR TO THE PATIENT?

>> ABSOLUTELY NOT.

COMPLETELY FREE TO THEM.

>> WHAT ABOUT THE PATIENT WHO IS DIFFICULT?

FOR WHATEVER REASON.

SOMETIMES ILLNESSES MAKE US DO THINGS IN WHICH WE MAY OR MAY NOT...

BUT WHAT RECOURSE DOES-- HOW DOES THAT WORK, ESPECIALLY IF THE NURSING HOME IS HAVING TO SPEND AN INORDINATE AMOUNT OF RESOURCES TAKING CARE OF THIS PARTICULAR INDIVIDUAL?

>> SO WHAT I'M SAYING, IN TERMS OF FOR US, IF THERE IS SOMEBODY IN A FACILITY, I DON'T CARE WHAT THE SITUATION IS, THEY ARE ENTITLED TO OUR SERVICES.

WE ARE REALLY ABOUT BUILDING RELATIONSHIP.

SO WE WILL WORK THROUGH SOME OF THOSE CHALLENGES TO THE GREATEST EXTENT THAT WE CAN.

JUST BECAUSE SOMEONE IS ILL WILL TOWARDS US, I MEAN AT THE END OF THE DAY, WE LOVE WHAT WE DO AND WE LOVE THE PEOPLE THAT WE SERVE AND WE UNDERSTAND THE MANY FACTORS THAT MAKE AN INDIVIDUAL WHO THEY ARE.

SO WE ARE STILL GOING TO CONTINUE TO PROVIDE SERVICES.

WHEN IT COMES TO THE FACILITY, IT CAN GET INTERESTING BECAUSE I WOULD SAY WHEN FACILITIES INITIALLY OPENED UP, I THINK IT WAS MORE A CERTAIN TYPE OF POPULATION THAT WERE IN FACILITIES, MAYBE RETIRED, MAYBE DIDN'T HAVE A LOT OF MEDICAL NEEDS OR MENTAL ILLNESS.

WHETHER OR NOT FACILITIES ARE ALWAYS EQUIPPED TO HANDLE THE MULTITUDE OF CONCERNS OR ILLNESSES THAT AN INDIVIDUAL HAS, ESPECIALLY WHEN THEY HAVE TO CARE FOR SO MANY INDIVIDUALS THAT ONCE AND THEY DO HAVE A RESPONSIBILITY TO PROTECT RESIDENTS, BUT I WILL SAY, TOO, THAT IN WORKING WITH MENTAL HEALTH FACILITIES, YOU KNOW, OR HAVING THEIR MEDICAL DIRECTORS WITHIN THE FACILITYIES, REALLY ASSESSING WHAT THE BEHAVIOR IS, WHAT PROMPTED-- EVERY TIME THERE IS A BEHAVIOR, THERE IS A REASON FOR THAT BEHAVIOR.

AND IT'S REALLY ASSESSING WHAT IS A TRUE NATURE OF THE REASON BEHIND THE BEHAVIOR AND TREATING THAT.

IT IS IMPLEMENTING WHATEVER INTERVENTION, WHETHER THAT'S MEDICATION OR THERAPY OR YOU KNOW, WHATEVER IT IS, TO TRY TO ENSURE THAT WHATEVER THEY'RE IMPLEMENTING, THAT THEY'RE ASSESSING IT AND GAUGING WHETHER OR NOT IT WORKS AND GIVE IT TIME.

I KNOW I WORKED WITH AN INDIVIDUAL THAT WAS ON DIALYSIS, AND THEY COULDN'T UNDERSTAND HE DIDN'T WANT TO GO TO DIALYSIS, YOU KNOW.

BUT LOOKING AT WHY DOES HE NOT WANT TO GO TO DIALYSIS?

WHAT IS GOING ON?

I DECENT KNOW THAT HE IS JUST-- I DON'T KNOW THAT HE IS JUST TOTALLY REFUSING DIALYSIS, BUT WHAT IT IS, LEE HE HAD AN ILLNESS AND WAS LOSING CERTAIN CAPACITY AND HE LOST THE ABILITY TO, YOU KNOW, KNOW WHEN YOU HAD TO URINATE OR ANYTHING LIKE THAT.

SO HE WAS WEARING BRIEFS AND WHAT WOULD HAPPEN IS HE DIDN'T WANT TO BE SITTING IN DIALYSIS FOR HOURS ON END AND HAVE AN ACCIDENT.

SO SOME OF THAT WAS LOOKING AT WELL, IT'S NOT THAT HE DOESN'T WANT TO DO IT.

IT'S HOW DO WE MAINTAIN HIS DIGNITY THROUGHOUT THIS TREATMENT PROCESS.

IT'S, OKAY, WHAT ADDITIONAL THERAPIES MIGHT HE BE RECEIVING TO HELP HIM BECAUSE, YOU KNOW, AGAIN, THIS IS A SIGNIFICANT LIFE EVENT, SOMETHING TRAUMATIC THAT HE IS HAVING TO, YOU KNOW, CONTEND WITH.

>> SO GIVE ME YOUR 30 SECOND ANSWER ON THIS.

WE ARE-- ONE OF THE BIG THINGS THAT YOU GUYS DO, IS TO MAKE SURE THAT WE MAINTAIN OUR DIGNITY AND THAT EVERYONE, BOTH THE PROVIDER AND THE PATIENT IS GETTING THE BEST OUT OF THE EXPERIENCE THAT WE ALL CAN.

FOUR SECOND ANSWER.

THAT'S THE THING THAT GOES WITH THAT.

ARE WE DOING A GOOD JOB?

ARE WE GETTING BETTER AT IT AS FAR AS A CURE YES OR NO?

>> I WOULDN'T SAY THAT WE ARE GETTING BETTER AT IT, CONSIDERING COMING OUT OF A PANDEMIC AND THE STAFFING SHORTAGES.

>> I'M GOING TO LEAVE IT AT THAT.

NATALIE, THANK YOU VERY MUCH FOR BEING WITH US TODAY.

I THINK YOU OPENED OUR EYES ABOUT SOME OF THE PEOPLE THAT CAN HELP US MAKE THAT EXPERIENCE BETTER.

I WOULD LIKE TO THANK YOU FOR BEING WITH US TODAY.

I HOPE THAT YOU HAVE A BETTER UNDERSTANDING OF THE RIGHTS AFFORDED TO PATIENTS IN LONG-TERM CARE FACILITIES AND HOW DO ENGAGE AN OMBUDSMAN TO HELP SETTLE DISPUTES AND BE A PATIENT'S ADVOCATE F. YOU WISH TO WATCH THIS SHOW OR WATCH AN ARCHIVED VERSION OF PAST SHOWS, PLEASE GO TO WWW.ket.org/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KYHEALTH@ket.org.

I LOOK FORWARD TO SEEING YOU ON THE NEXT KENTUCKY HEALTH.

BE CAREFUL.

WHEN YOU GO TO A NURSING HOME, GREAT CARE BEEN PROVIDED BUT BE THERE FOR YOUR INDIVIDUAL AND LOVED ONCE.

IF YOU HAVE INDIVIDUAL CONCERNS, CHECK WITH YOUR OMBUDSMAN, THEY ARE AAIL VABL AND WILL HELP YOU WITH THE PROCESS.

WE ALL NEED HELP.