NALLTCO Code of Ethics for Local Long-Term Care Ombudsmen
Preamble
| preamble_to_nalltco_code_of_ethics1.pdf |
| nalltco_code_of_ethics_for_ombudsmen.pdf |
Regardless of an ombudsman’s level of responsibility or the complexity of the issue or problem that is being addressed, there is a basic set of principles that guide an ombudsman’s decisions.
In addition to the Older Americans Act, the 53 State Ombudsman programs have differing laws and rules governing them. For each of the following, please be sure to check with your state laws and rules and State Ombudsman. You may want consider legislative work if your state laws and rules conflict with the Older Americans Act. Protection and Advocacy Services are in the Older Americans Act as the advocacy resource for resident/client with Mental Health issues and/or Developmental Disabilities. Your State Ombudsman may have a working relationship with Protection and Advocacy Service staff and have guidelines available on working with this resource.
A state may also be limited by its funding sources. Some funding limitations may include:
The Older Americans Act dictates that we are resident/client directed. In some cases, the resident/client’s ability to communicate or think or know may be in question. As Ombudsmen, we usually visit often enough to determine when and how a resident/client communicates his/her wants/needs to another person. We visit with the resident at that time and are able to follow through on his/her direction.
A guardian could be involved. In some states, the guardian is directed to make decisions as the resident/client would make those decisions. How this is determined is through history and advance directives if there are any. Sometimes guardians do not meet the wants and/or needs of the resident/clients. The Ombudsman can carry those concerns about the guardian forward to the appropriate agency or program according to the laws and rules of their State and the State Ombudsman program’s policy.
In some instances an agent authorized by the Power of Attorney (POA) form may be present and acting on behalf of the resident/client . The POA agent only assists or helps a resident/client when the resident/client needs that assistance. POA agents are not guardians and may not make decisions for the resident/client when the resident/client is able to make those decisions. In some states the exception is for Durable POA agent when the situation is present that has triggered the Power of Attorney. This situation is usually when the Physician (or two) declares that the resident/client is not able to make decisions. We may get involved with situations where the Durable POA agent is not acting as the resident/client would act nor in their best interest. We are still resident/client directed and we may need to follow up on the decisions the Durable POA agent is making. Check with your State Ombudsman for further guidance.
There may be some confusion about Mandatory Reporting as an Ombudsman. The Older Americans Act is clear that Ombudsmen are resident/client directed. The 2011 NASUAD Primer for State Aging Directors and Executive Staff, states on page 7, “In practice according to the OAA, LTC Ombudsman may not be mandated reporters. Because federal law trumps state laws, all staff need to be aware of this.” Some states still require Ombudsman to be mandatory reporters. Local Ombudsman should review their state policy on this issue.
In cases where there is no policy or procedure available from the State Ombudsman, there may be some suggestions on how to create such policy or procedures in the Self- Evaluation and Continuous Quality Improvement Tool for Local Long-Term Care Ombudsman Programs developed by Robyn Grant and available through the National Ombudsman Resource Center.
NALLTCO Board members reviewed and revised 7-19-12
In addition to the Older Americans Act, the 53 State Ombudsman programs have differing laws and rules governing them. For each of the following, please be sure to check with your state laws and rules and State Ombudsman. You may want consider legislative work if your state laws and rules conflict with the Older Americans Act. Protection and Advocacy Services are in the Older Americans Act as the advocacy resource for resident/client with Mental Health issues and/or Developmental Disabilities. Your State Ombudsman may have a working relationship with Protection and Advocacy Service staff and have guidelines available on working with this resource.
A state may also be limited by its funding sources. Some funding limitations may include:
- Working with resident/clients under the age of 60,
- Working with resident/clients in community facilities (Board and Care),
- Working with resident/clients in their own home.
The Older Americans Act dictates that we are resident/client directed. In some cases, the resident/client’s ability to communicate or think or know may be in question. As Ombudsmen, we usually visit often enough to determine when and how a resident/client communicates his/her wants/needs to another person. We visit with the resident at that time and are able to follow through on his/her direction.
A guardian could be involved. In some states, the guardian is directed to make decisions as the resident/client would make those decisions. How this is determined is through history and advance directives if there are any. Sometimes guardians do not meet the wants and/or needs of the resident/clients. The Ombudsman can carry those concerns about the guardian forward to the appropriate agency or program according to the laws and rules of their State and the State Ombudsman program’s policy.
In some instances an agent authorized by the Power of Attorney (POA) form may be present and acting on behalf of the resident/client . The POA agent only assists or helps a resident/client when the resident/client needs that assistance. POA agents are not guardians and may not make decisions for the resident/client when the resident/client is able to make those decisions. In some states the exception is for Durable POA agent when the situation is present that has triggered the Power of Attorney. This situation is usually when the Physician (or two) declares that the resident/client is not able to make decisions. We may get involved with situations where the Durable POA agent is not acting as the resident/client would act nor in their best interest. We are still resident/client directed and we may need to follow up on the decisions the Durable POA agent is making. Check with your State Ombudsman for further guidance.
There may be some confusion about Mandatory Reporting as an Ombudsman. The Older Americans Act is clear that Ombudsmen are resident/client directed. The 2011 NASUAD Primer for State Aging Directors and Executive Staff, states on page 7, “In practice according to the OAA, LTC Ombudsman may not be mandated reporters. Because federal law trumps state laws, all staff need to be aware of this.” Some states still require Ombudsman to be mandatory reporters. Local Ombudsman should review their state policy on this issue.
In cases where there is no policy or procedure available from the State Ombudsman, there may be some suggestions on how to create such policy or procedures in the Self- Evaluation and Continuous Quality Improvement Tool for Local Long-Term Care Ombudsman Programs developed by Robyn Grant and available through the National Ombudsman Resource Center.
NALLTCO Board members reviewed and revised 7-19-12
