The Age Guide: Perspectives on the Aging Journey

Through the Looking Glass: An Ombudsman's View of the Long Term Care Lockdown Part 3

• Age Guide • Season 1 • Episode 6

Share episode

Welcome to the third of our 3-episode mini-series, where we’ll bring you the first-hand stories and experiences of a special type of advocate, an Ombudsman.  An Ombudsman advocates for older adults living in assisted living and skilled nursing facilities.  You will hear from 3 different Ombudsmen in this series, all of whom were on the front lines during the COVID outbreak. Our goal in this series is to hear their stories, spread awareness about the work of an Ombudsman, and learn how we can all help protect residents’ rights in the future. In this third episode in the series, we will hear from Kelly Richards, a State LTC Ombudsman at the Illinois Department on Aging. Let’s listen in as Kelly tells us about what she saw and heard from residents in long-term care during the COVID-19 lockdown. #theageguidepodcast #COVID-19 #Pandemic #LongTermCare #Advocacy #ILOlderAdults #OlderAdultAdvocacy #OmbudsmanAdvocacy 

Facebook: facebook.com/AgeGuide
Twitter: twitter.com/AgeGuide
Instagram: instagram.com/theageguidepodcast
Podcast: ageguide.org/the-age-guide-podcast
Website: ageguide.org

SPEAKER_00:

Hello, and welcome to The Age Guide, perspectives on the aging journey. We are here to be your personal age guide and enhance your quality of life on the road ahead. At Age Guide, it's our mission to be a vital resource and advocate for people as we age by providing thoughtful guidance, supportive services, and meaningful connections. Welcome to the third of our three-episode miniseries, where we will bring you first-hand stories and experiences of a special type of advocate, an ombudsman. An ombudsman advocates for older adults living in assisted and skilled nursing facilities. You will hear from three different ombudsmen in the series, all of whom were on the front lines during the COVID-19 outbreak. Our goal in the series is to hear their stories, spread awareness about the work of an ombudsman, and learn how we can all help protect residents' rights in the future. In this third episode in the series, we will hear from Kelly Richards, the State Long-Term Care Ombudsman at the Illinois Department on Aging. Let's listen in as Kelly tells us about what she saw and heard from residents in long-term care during the COVID-19 lockdown.

SPEAKER_01:

Thank you so much. about your role at the state level and what your job is and what a state ombudsman does.

SPEAKER_02:

Sure, absolutely. Perhaps I can start just by giving the listeners a little overview of the Ombudsman Program. That'd be great. And what my role is. So the Ombudsman Program is a advocacy program specifically for residents that live in long-term care facilities. It's a free program. The funding for this program comes from the federal government and also the state of Illinois. And so what we do is we work... to ensure that residents are aware that they have rights in addition to working to solve complaints that they may have or their family members may have alerted us to. Another thing that we're charged to do is to provide community education and services for the community at large and then also for people that work in the long-term care facilities. we are charged with ensuring that we have a regular presence in the visit, I mean, in the facility. So regular presence visits. where we go in to walk around to see if there are any obstructions in the hallway, to look and smell for any smells that are out of order or just very overpowering. And we meet with the administrators. We meet with the director of nursing. We meet with the activity directors, depending on what the residents' wishes are Our problem is resident directed, which means that we are not best interest. We work for the pleasure, if you will, of the resident. We are the voice. of the resident so anything that the resident wants us to do is what we will do confidentiality is the cornerstone of our program so we cannot have any discussions we can't go meet with anyone in reference to what is going on with this particular resident without the permission and consent of that resident

SPEAKER_01:

it's very helpful thanks for that background so i heard you say lots of things that sound like they would have been very challenging during COVID. I heard you talk about regular presence. I heard you talk about doing community education and education for nursing home staff. I heard you talk about in-person visitation and being able to go into the facility to be the voice for residents. And I heard you talk about confidentiality being so important. So can you tell us What happened when COVID hit in March of 2020? What was going on at the state level?

SPEAKER_02:

Absolutely. Well, in March, we had to pivot, right? We got direction from CMS, which is the Centers for Medicare and Medicaid Services, that said, visitations had to cease because of the pandemic, because they were trying to get a handle of it and stop the spread of COVID. And

SPEAKER_01:

so even you weren't able to go into facilities, even though you're supposed to have 24-7 access to facilities, that was absolutely ended in March. Yes, we

SPEAKER_02:

stopped going in in March, but that wasn't just the Illinois Ombudsman program. That was across the country. Through everywhere. Right. Just in an effort to try to keep the residents safe and keep everyone safe. And so what we had to do is we had to pivot. We started communicating over the phone, calling people. The federal government... in the summer gave additional money to CARES Act funding to help facilitate the ombudsman program and other entities, of course, to continue to do the work that we do. And so with that funding, programs were able to get more technology. So laptops, telephones, iPads, so we can start communicating with residents via technology. And so the work that we were doing just looked a little different whereas we weren't going into the facilities but we were calling on the phone more we were doing and because this was coming up to the summer we pivoted even a little bit more and what we started doing was window visits For those facilities that may have been, you know, like one or two level buildings would go around. And we had whiteboards with dry erasers. Hey, I'm your ombudsman. We're still here. We did postcards. We did flyers, letting people know, one, about COVID, how they should protect themselves. The ombudsman is still here. You still have access to the ombudsman. It just looks a little different So we started with the window visits and then we graduated from the window visits to outdoor visits. And because it was the summertime, we were able to visit with residents outside in the courtyard or wherever it was conducive. And we did that for a number of months. And then just one more thing. And I want to say in August, IDPH issued their initial, it was either August or October, issued their guidance for surveyors and everyone in terms of what visitation looks like. CMS came out with a directive saying that residents should still have access to the ombudsman.

SPEAKER_01:

Okay.

SPEAKER_02:

Because they were shutting us out. IDPH. The Illinois

SPEAKER_01:

Department of Public

SPEAKER_02:

Health.

UNKNOWN:

Yes.

SPEAKER_02:

pardon me, the Illinois Department of Public Health also sent out guidance saying that residents should still have access to the ombudsman. May look a little different, but we were trying. We were doing FaceTime. We were participating in Zoom resident council meetings. We were being invited to resident council meetings and we were using the different platforms, Google Meets, Zoom, yeah. in order to maintain a presence in the facilities.

SPEAKER_01:

What was your role in making sure that was happening and that that was working?

SPEAKER_02:

Well, one of the things that I instituted right away is weekly touch base meetings with the ombudsman to make sure that any information that I had, I could disseminate out to them because things were changing with COVID. I'm sure you knew every single week. And so our role here at the state office was to keep people informed. and give them the most latest and timely information for them to do what they needed to do. Worked on getting PPE to everyone, ensuring that my staff, as well as everyone across the state connected to the ombudsman program had access to PPE so we can start doing the work that we used to do. So in the fall of 2020 is when we actually started slowly going back inside the facilities. But- There was really just a small window of time from like March until I want to say June where we weren't seeing residents. And then we started doing these window visits across the state in the outdoor visits. And then we slowly started going back in. And I want to say that Illinois was one of the first programs to do window visits. And we were one of the first programs to actually start going back in. in to facilities. There's still some states that are still slow to start as it relates to getting, I mean, fully into facilities. So we were, I would have to say we were trendsetters.

SPEAKER_01:

Good, very good. I'm glad to hear that because everything that you do is so dependent on that access. And then when you were doing these virtual calls, and window visits, the confidentiality had to have been difficult because there were roommates around, there had to be a staff holding the telephone or helping set up the Zoom call, right?

SPEAKER_02:

Right. And that's one of the things that my office played a very important role in communicating the importance of maintaining that confidentiality wherever we could. How did you do that? I'm just communicating that to the Illinois Department of Public health as it relates to the guidance, communicating or not communicating, because CMS knows that that should happen, but stressing to CMS that these were challenges.

SPEAKER_01:

You had a major role to play. I'm sure you were very busy and stressed. It sounds like all of the ombudsmen who are really on the front lines of this crisis, they, I mean, in your weekly meetings, did you find that you were doing a lot of kind of processing and, and maybe some even grief processing and

SPEAKER_02:

absolutely it's interesting that you say that our first window visit was done by one of our more senior ombudsman and it was actually it was her suggestion and she reached out to me and asked like Kelly is it okay for this for us to do this you know and we had to talk it through you know we want you to remain safe you know we want you to get sick so how can we do this in the most meaningful, safe way. And she talked about how heartbreaking it was. And so you had that COVID fatigue, the fatigue that we experience because of COVID as it relates to our advocacy. And it brought us to tears to hear her talk about her experience interacting with residents and reminding them like, and she said, she wrote on her whiteboard, we're still here for you. And she told a story of a resident who she had never seen before. And she ended up finding out from the facility that he didn't have anyone, no living relatives to help and come and support him. And she's like, I'm here for you. I'll be that person for you. And she just said it broke her heart communicating with him through the window because he just started crying and saying, you know, and so it was just reaffirming to us how important this work is. You know, there are a lot of people that have family members in long-term care, but there are a lot of people

SPEAKER_01:

that don't. That don't have anybody in the ombudsman is their voice like you said and their connection to the outside world and their community absolutely and an advocate for them absolutely definitely what do you feel like you learned from the pandemic

SPEAKER_02:

um that we can continue our work.

SPEAKER_01:

OK, no matter what, you're going to make it through. You're going to push through it. And you're going to continue to be that voice for residents.

SPEAKER_02:

Absolutely. We learned that the effects of social isolation are real. I mean, we've heard some very disheartening stories and some very sad stories about people who have been isolated as a result of COVID. And the lessons learned is if we're ever in this situation, again, there has to be some things that are in place to ensure that people aren't isolated, that there are opportunities for family members to be able to have some connection with the folks that they love.

SPEAKER_01:

Yes, that social isolation. It's really hard to say if it's more dangerous to contract the virus or to be socially isolated for months on end. Both are very significant.

SPEAKER_02:

Yeah, we had just a really quick story of a husband and wife. That'd be great. That wanted to just hold hands, right? Married 60 something years. Husband was in this... One was in skilled, the other one was in assistant on the same campus. Oh, but they weren't in the same room. No. Oh, no. What happened? We wanted to visit with each other and we were called like to help as advocates, you know, to try to convince the facility to allow them to just hold hands. I mean, can you imagine how powerful that would have been? And we received a lot of of resistance resistance from the nursing home because they were trying to keep

SPEAKER_01:

people safe right it was very much against their policy at the time

SPEAKER_02:

right you know and we're not clinicians but my argument was where's the humanity yes you know I mean we are protecting people to death Yeah,

SPEAKER_01:

this was husband and wife who need to see each other.

SPEAKER_02:

Absolutely, absolutely. So we kept pressing and pressing and pressing. Eventually it happened. But it took a long time. I mean, we were like, put up a plexiglass, you know, let them reach their hand around. Right. Yes. You know, just trying to give all kind of different suggestions on what they could do. So

SPEAKER_01:

PPE would have been helpful, too, if they could have worn like the full suit or something. But I don't think there was enough PPE at that time.

SPEAKER_02:

Right. And, you know, the husband and wife were like, we don't even care.

SPEAKER_01:

Right. We'd rather get COVID. than not see each other, right?

SPEAKER_02:

You know, so those were the heartbreaking stories that would keep you up at night to know. Like I could not imagine not being able to hold my husband's hand. I do for my moms, you know, a resident that was blind who had swallow issues. Her daughter would come in and be a caregiver for her prior to COVID. So that would allow the CNAs to do what they needed to do because for those few hours that the daughter was there, mom was being taken care of, you know, washing her hair or what have you, or a husband and wife, she would groom her husband and cut his beard. And so these are the things that I would say are important to residents. Yes. And they want to get their hair. You want to wash your hair, right? Right. You want to groom yourself. And so these were the stories that we carry to share to the powers that be that hey something has to give these people need that human contact and so that's why compassionate care visits were so important and that was a challenge yeah as advocates to get people to see how important compassionate care can

SPEAKER_01:

you

SPEAKER_02:

tell us what those visits are Sure. Well, initially, people thought that they were just for people who were actively dying, who were in hospice and actively dying. But it was much broader than that. For example, the story that I just told you about with the mother who was blind and who had swallow issues. That's a compassionate care visit that he had. because mom needed to continue to thrive. You know, how difficult is it to not be able to see having swallow issues, isolated, beginning dementia? I mean, you know, she needs to get in to see her mom. So she reached out to me and told me her story. And I got right on the phone to the Illinois Department of Public Health and talked to their infection control specialist. folks and said, hey, here's a situation where you all need to get involved and talk to the facility to explain to them how important compassionate care visits are.

SPEAKER_01:

Good. And were they able to do that? Good. Excellent. Wow. Good stories. Appreciate you sharing those. So besides the legislation that did pass and based on what you learned, are there any policies or other procedures that you would recommend changing or other things that are needed? Um,

SPEAKER_02:

Well, the visitation was the biggest thing. And staffing. Can you talk about staffing a little bit and that challenge? Staffing was a significant issue during COVID and still is. It still is. Here's the thing. Staffing was an issue prior to COVID. So... A lot of these things were issues prior to COVID. COVID just illuminated things that we as ombudsmen and activists, I mean, advocates, sorry, and activists... had been seen anyway, right? Right. It just sort of shone a light on these things. Right. And it went to like the 25th degree. Yes. Staffing was a significant problem because the staff were getting sick with COVID, right? And the CNAs are the ones that take care of residents. And so, you know, they make minimum wage and they're taking... COVID from one facility to another facility because they're working at two different facilities trying to make a decent living wage to take care of their families. What we found is COVID was coming into the facilities because the residents weren't going out, right? How did they get sick from COVID? They got sick from the staff and it's because these staff had to live and support their families. It was already short staffs So they're over here, then they're going to this facility. So staffing was a big, big issue and continues to be. And there's legislation that actually just passed House Bill 246 that HFS was a strong proponent of. It was their proposal in terms of rate reform. And in that rate reform, and I don't know all the details, but there is a significant piece that address staffing and the incentives that the facilities can get and the the CNAs can get for longevity. You know, I've been a CNA and these are just arbitrary numbers. I don't know the exact number, but I've been a CNA for a number of years. I may be able to get a bump up in salary just for that longevity. Okay.

SPEAKER_01:

That would be

SPEAKER_02:

nice. Right. How do we keep this population of workers in our pool? And so they're just trying to create different mechanisms through funding to keep the staffing and actually elevate them so residents could have the quality care that they so rightfully deserve. I mean, for residents... for the facilities to approach residents from a person-centered standpoint. And what does that look like? That looks like me having the same CNA every day. This CNA this day, and then another this day, and then you don't know my concerns. You don't know. You want somebody to get to know you. Exactly. And then let's talk about those residents that may have dementia. Right. And they're

SPEAKER_01:

seeing different people

SPEAKER_02:

all

SPEAKER_01:

the time. So confusing.

SPEAKER_02:

Very confusing, you know, and they have their challenges with communication and interacting with the world because we are not in their world, you know.

SPEAKER_01:

It takes a while to get to know an individual and what their preferences are. And maybe you learn something. Oh, this worked really well for me. Well, now I'm not going to be working with this person again for a week and nobody else knows this little bit of information that I just learned. So that's very frustrating too. I think the staffing issue is definitely something that needs to be addressed. And I know you guys are not advocates for the staff, but it sounds like you see advocating for staff to get a living wage as part of residence rights. Am I right?

SPEAKER_02:

Absolutely. Absolutely. Right. You know, and so I, To that end, I've partnered with different entities. I've reached out and weighed in on some things with HFS or lent my voice to help support legislation, talking with AARP and participating in town halls or roundtables just to help deliver the message like, hey, this is important. You need to pay attention. Speaking with legislators and communicating stakeholders to raise the issue and let people know that staffing is an issue and that these people need to get paid a decent wage so we can have a nice pool, a number of CNAs to help take care of these residents who deserve the best care they

SPEAKER_01:

can possibly get. These are our most vulnerable people. members of our society, really. And it's not an easy job to be a CNA. It takes a really special person to want to care for these vulnerable populations. It's not easy. And I feel like we treat it like it's just, you know, some low wage entry level job. You have to be the right kind of personality, have some serious skills in working with people to be able to do this. And we should acknowledge that with what we pay people. I

SPEAKER_02:

agree.

SPEAKER_01:

And

SPEAKER_02:

there ended up being a strike that occurred during the pandemic. In Illinois? In Illinois, right around Thanksgiving in 2020, 11 facilities in the Chicagoland area went on strike. I forgot about that.

SPEAKER_01:

So then they had to bring in temporary workers and I know some of the facilities are still using temp workers, which isn't ideal either.

SPEAKER_02:

Right. And it makes it very hard to keep staff because you have some companies paying a lot of money. Hey, come work for me. We'll pay you 30 bucks an hour. How can you

SPEAKER_01:

compete with that? Right. Yeah, those temp agencies can do that, but then they come and go from one facility to another and they're not consistent.

SPEAKER_02:

You don't have that continuity for the residents. Absolutely.

UNKNOWN:

Right.

SPEAKER_02:

You don't know what makes me tick. You don't know that I like to have ice cream right before I go to bed or like me, I have to eat popcorn every day. You don't know.

SPEAKER_00:

Yeah. Now that we have learned about our guests and who they are, we want them to walk up the steps, grab a microphone and get on our age stage. This segment allows a soapbox like platform to speak to the aging community on any topic they want to shine a light on. In this age stage, we asked Kelly to expand on the problems that already existed before COVID. We discussed what we can do as a community to address the ongoing challenges in long-term care that were so devastating during the pandemic. Let's listen in.

SPEAKER_01:

So how do you think aging advocates can get involved in some of these things that you go around talking about with legislators and at your town halls? It sounds like we really need to change some systems and some bigger picture policies. What can we do?

SPEAKER_02:

One of the things that I would encourage people to do, we created a statewide resident family support council. And that council meets every other Tuesday. So like we have a call this Tuesday and this is brought to folks by the Ombudsman Program and we have different topics every week to help amplify issues, share information. We encourage anyone to join these calls that we have. We've shared this information with legislators, community stakeholders, residents, family members, to talk about things that are important to residents or important for residents. Reach out to the ombudsman program in your area. We have on the Department of Aging, we have an ombudsman page. If people are interested in finding out more about the ombudsman program or, you know, the ombudsman program in their area, there is a document on our website that shows you by area where the programs are and people we love to have volunteers and people want to get involved and they the volunteers can look like Whatever that volunteer wants to do, somebody may not want to go into the facility. So perhaps they could work behind the scenes with the regional ombudsman program, making telephone calls, sending out postcards, sending out flyers, or doing regular presence visits, or going to do in-services, or doing community education. You know, we were talking about just last week, the church churches are untapped in terms of us going out educating people about the ombudsman program our statewide initiative for this year every year we come up with the statewide initiative around the work that we do and coming out of the pandemic we felt as a team that it would be important to kind of like reintroduce ourselves to folks um because people may have forgotten about the ombudsman program or didn't know about the ombudsman program and i'm amazed when I hear people like, man, I wish I had talked to you a month ago or last week. Our statewide initiative was to make greater awareness about the ombudsman program. So be very intentional about having like this conversation that I'm having with you today. And so from the state office perspective, that's what myself and my deputies have been doing. We've been going to conferences. We're on podcasts. We're on Facebook Lives. meeting with community stakeholders, senior advocacy groups, participating in these discussions, sharing information about regulations and laws with folks to educate them and empower them. I've held a couple of town hall for residents specifically to talk about their issues, living in the pandemic. And I partnered with the Illinois Department of Public Health on the first town hall so they can take questions and speak directly to the residents as it relates to their concerns. Just various different avenues. We're just trying to keep the discussion going about our advocacy and the importance to ensure that residents have quality care and quality life.

SPEAKER_01:

That makes sense. And it's one of those programs where you might not know about it because you maybe haven't really had much exposure to long-term care or maybe never needed the ombudsman program. But then all of a sudden, when you have a loved one in long-term care or if you're in long-term care yourself, you suddenly need to know about this program. So it'd be good for everyone in the community to be informed about this program so they could be advocates

SPEAKER_02:

absolutely I want the ombudsman program to be a household name and to your point you know even younger folks you know those that are in their 30s and 40s that have parents that are they'll have parents right They don't know or themselves. You know, a lot of people have autoimmune diseases, MS and lupus. Right. Or

SPEAKER_01:

all it takes is one accident or something. Right.

SPEAKER_02:

So, you know, when we think of long-term care, we generally think of our seniors, but it's not just our seniors that are in long-term care. So it's important to educate younger folks. I had a friend that was in her 30s that had to go into long-term care because she had MS. She had a reaction or, you know, so. It's important for people to know about it, to know that there are people out there, the ombudsman program, your nearest ombudsman program can advocate for you. Yes.

SPEAKER_01:

Excellent message. The work that you do is so important. Ms. Richards, thank you so much for sharing that. And is all of the information that you shared about the support council and volunteer opportunities, is that all on the Department on Aging's website? We can link to that in the show notes.

SPEAKER_02:

Yes. So anyone could go to the department on aging's website and click on the ombudsman tab and all the information that i talked about is there we have all of our recordings from our previous councils on there we have information about the ombudsman program in particular we have our brochures in different languages okay good and a contact list for ombudsmen

SPEAKER_01:

across the state okay we'll be sure to put that that link up for the show notes then thank Thank you so much for sharing that. I really appreciate it.

SPEAKER_00:

Thank you for listening to The Age Guide, Perspectives on the Aging Journey. We hope you learned something new on this podcast because we all have a stake in promoting a high quality of life for people on their aging journey. Age Guide coordinates and administers many services for older adults in Northeastern Illinois. We serve DuPage, Grundy, Kane, Kankakee, Kendall, Lake, McHenry, and Will Counties. Our specially trained professionals are available to answer questions and connect you with local service providers and resources such as Adult Protective Services Program, which responds to and investigates reports of abuse, neglect, and financial exploitation of people 60 plus and adults with disabilities aged 18 to 59 who live in the community. The Long-Term Care Ombudsman Program, which advocates for residents of nursing homes, board and care home, and assisted living facilities. They are trained to resolve problems and can assist with complaints of residents living in long-term care facilities. If you are interested in these services or want to learn more, go to our website at ageguide.org. Please follow our podcasts so when we post our monthly podcast, you are notified on your streaming account. Thank you, and we will see you next time on The Age Guide. perspectives on the aging journey.