Nursing home ombudsmen provide company, help residents get what they need

When Alice Barr, 91, a resident of CareOne in Northampton, sees Cathy Robinson, it makes her day.
“I sigh — like a feeling of relief. Someone’s here who has time to talk to me today.”

Robinson, of Florence, is a long term care ombudsman. The term may sound a touch mysterious. The word “ombudsman” comes from Swedish, and means “representative.” The volunteer position is a federal bureaucratic creation, but its purpose is simple: to protect the quality of care and the rights of nursing home residents.

For many residents, their advocacy provides a lift. “When someone like Cathy comes in, my headache’s gone, my back doesn’t hurt,” Barr said.

Each ombudsman is assigned to one or more facilities, and regularly makes the rounds to see all the residents, offering them the opportunity to simply chat, or to make concerns or complaints known.

For Robinson, rounds might happen any day of the week between 10 a.m. and 8 p.m. “We’re not supposed to be expected,” Robinson said. Each resident — she sees around 110 each week at two facilities — gets a visit that usually lasts three to eight minutes.

“We show up without agenda or family baggage,” said J. Mary “JM” Sorrell, local ombudsman program director. “A lot of people just want to talk, to tell us their complaint over and over again, until they’re ready to go forward.

“It might be as easy as laundry not getting returned — ‘could you please help me find my laundry?’ or making sure meals are hot,” said Robinson.

Barr recently needed help dealing with a change in her insurance that affected her arthritis medication. The patch she had been using to administer the drug became unavailable to her due to changes in Medicare.

“I brought it to her attention,” said Barr, “and she got it re-ordered. I had an extra few months (of the patch) because of Cathy.”

A lot of problems are quickly and easily resolved, but if a problem is severe enough — and the resident gives permission — an ombudsman addresses the issue with the facility’s staff.

According to Robinson, “We make sure each resident is treated properly, that they’re treated with respect and dignity. And we’re a go-between if things don’t go the way they should.”

For example, says Sorrell, “It is painful when a resident wants to go ‘home,’ and there is no home to go to or the family is unable to care for someone at home.”

In every circumstance, says Robinson, an ombudsman advocates for the resident, not the family or the facility. “I may help to facilitiate,” said Robinson, “be a mediator between the resident and family that wants mom or dad or sister home but doesn’t have the means. (Residents) have to be discharged to a safe environment. They have to have no throw rugs, for instance, or maybe the stove burners locked off.”

Whether there’s a larger issue or not, an ombudsman’s emphasis on simply listening to residents is something, according to Robinson and Sorrell, that a lot of geriatric care professionals can’t always take time for. That’s part of the reason the program exists.

Barr gets that. “I was a nurse manager,” she said. “I was on the other side of things. I never knew (what it’s like for residents). I’m very surprised what it’s like — I wish that there was more time to speak to us.”

The history of the program stretches all the way back to the Nixon administration. In 1971, President Richard Nixon appointed Arthur Flemming to the position of Commissioner on Aging. Flemming developed the idea and guidelines for the ombudsman program, and in 1972, several contracts were awarded for demonstration programs. In 1973, Massachusetts joined the roster.

Sorrell points out another catalyst for the program: In 1970, Ralph Nader published the study group report “Old Age: The Last Segregation,” which pointed out the shortcomings of the nursing home industry via allegations of neglect in cases like a fire and a salmonella outbreak, both of which resulted in residents deaths.

“It wasn’t being monitored the way hospitals were,” Sorrell said.

The program appears to have been a success — “Today, it’s federally mandated,” said Sorrell. “Every state has an ombudsman program.”

In Massachusetts, there are 24 program directors statewide, each of whom oversees a group of ombudsmen.

Though the ombudsmen are volunteers, they must undergo training Sorrell describes as “rigorous,” which includes three days of extensive study of regulations and federal laws plus on-the-job training. Her area, which includes most of Hampshire County and part of Westfield, has 15 ombudsmen who visit 11 facilities, says Sorrell. The next training happens in June.

To do the job well, Robinson said, it’s important to be non-judgmental. That’s in part because situations can be thorny, and involve family disputes.

“We don’t want to micromanage,” said Sorrell. “Our job is to diffuse drama, not add to it.”

At times those disputes might center on financial or personal difficulties, but they can be subtler, too, Robinson added. “Sometimes the family has nothing left in them to say, ‘My loved one needs this.’ But I’ve been listening (to what the resident says),” and can find help.

The sensitive nature of conflicts and complaints calls for discretion, and Robinson explains that everything residents tell her is in confidence unless a resident explicitly asks for an ombudsman to advocate in a more open way.

Robinson, a widow for 18 years, moved to western Massachusetts from New York in 2004. She retired from working as a medical office administrator.

She’d had enough of city life, particularly after the terrorist attacks on 9/11, when she saw one of the planes hit the World Trade Center.

She’s plenty busy, she says — two of her six kids and four of her 10 grandchildren live here, too. But Robinson became an ombudsman because she saw one in action. “I was wearing another hat as a volunteer (at a nursing home),” said Robinson. “An ombudsman came into the room. He just presented himself in such a dignified, professional manner, and he said, ‘I’m here to make sure things are going well.’”

She quickly made contact with Sorrell to see how she might volunteer in the same way. The process, Sorrell explains, involves interviewing, then going to facilities to see what they’re really like. That’s followed by a criminal history check, then the three days’ worth of training.

Sorrell says that most of the volunteers she oversees are themselves around retirement age, in their 60s or 70s. Robinson, for her part, is reluctant to say her exact age — in her mid-70s, she is, she says, older than some residents she works with.

For Barr, that’s a plus. “I seem to like the older-aged people around me. I love young people to an extent, but the older people have more they can do for you. They’re seasoned.”

Sorrell agrees. “It makes a huge difference. People under about 55 seem more self-concerned, always on their cell phones. There’s something that’s lost, with just being present.”

More importantly, she adds, “We understand aging issues because we’re aging, too. I think we can relate to older adults more. They don’t feel they have to explain themselves (to us).”

Regardless of bureaucratic trappings, ombudsmen develop strong relationships with residents. Still, says Robinson, it’s important that an ombudsman not get too close, in order to avoid favoritism. “I’m not a friendly visitor — I’m a friendly advocate.”

Clearly, though, the work ombudsmen do is deeply important to residents. Robinson ended up a little teary-eyed when Barr, who has two daughters, pointed out that she has no siblings: “(Robinson’s) like working with a young sister.”

To get more information about the program or becoming an ombudsman, contact JM Sorrell at Highland Valley Elder Services via: jmsorrell@highlandvalley.org or 413-588-5755.