A year ago, when Nancy Cunningham got her first assignment as an ombudsman for elderly patients at a Pasadena convalescent home, she was appalled. The facility was so bleak and depressing that she wasn't sure if she could visit the home once a week to listen to and help resolve patient complaints.
"The odor of urine just knocked me over," said Cunningham, a retired Caltech personnel administrator who is one of an estimated three dozen volunteer ombudsmen in the San Gabriel Valley who regularly visit long-term care facilities under a federally mandated program.
A year later, Cunningham is still visiting the same facility, which she would not identify in the interests of maintaining the good working relationship she has established with both patients and administrators there.
She drops in, unannounced, about once a week, and chats both with patients and administrators about their problems.
But now, rather than dreading the visits, Cunningham looks forward to them.
"When you see a real turnabout in patient care, in the attitude of nursing aides and the people who are taking care of the patients, then it makes it worthwhile," Cunningham said.
"When I got there last Tuesday at 10 a.m., there were about 20 patients out in the sun on the patio, doing arm exercises in their wheelchairs.
"I never saw them doing that before.
"Most of the odors are gone and the air is fresh," she said.
Cunningham says she can't take credit for the dramatic changes that have taken place at the convalescent home she visits. She attributes most of the improvements there to personnel changes, including the hiring of a new administrator who, she says, "really wants to know when there are problems."
But, she says, the repeated visits at irregular intervals keep administrators on their toes, and many of the problems she encountered at first, such as unpleasant odors and inattention to some aspects of cleanliness, have gradually disappeared.
"When I first went there, it was really depressing. But now every room is tidy, the floors are shining. They're fixing up the dining room and working on the landscaping."
The primary job of an ombudsman is to listen to patient complaints, determine if they are valid and attempt to solve them. A discussion with the administrator often resolves the problem, but sometimes authorities ranging from health officials to police agencies are called in.
A part of a federal and state program set up under the Older Americans Act, the ombudsman program did not get started in the San Gabriel Valley until last year. The act as amended in 1978 requires states to establish a coordinated system of state and local advocacy services to respond to the complaints and problems of older people living in long-term care facilities.
Every complaint is investigated, said Maria Arechaederra, executive director of the Westside Independent Services to the Elderly, a Santa Monica agency that was selected by the state in 1983 to administer the ombudsman program in much of Los Angeles County, including the San Gabriel Valley.
"If a person's safety is involved, we investigate immediately," she said. Other complaints are handled as soon as possible.
Under the program, long-term-care facilities are required to set up accessible telephone hot lines on which patients can call a toll-free number to report complaints and problems.
"We get 7 to 10 calls on the hot line each day, but in addition to investigating complaints, we like to have volunteers visit on a regular basis because this is preventive in nature."
The Westside agency gets funds from federal, state and private sources to administer the ombudsman program and last year established regional offices, including five in the San Gabriel Valley staffed by three paid coordinators.
The coordinators each work with 12 to 15 volunteers to cover the estimated 200 long-term-care facilities in the San Gabriel Valley. In the East San Gabriel and Pomona valleys, which have the highest concentration of such facilities, the coordinator is assisted by a part-time paid case investigator.
Arechaederra said the program depends on assertive, self-motivated volunteers who are able to evaluate issues objectively and provide concrete solutions to problems.
Volunteers are required to complete an initial 30-hour course and continuing training on the concepts of aging, nursing home law, patients' rights and the complaint process.
Although some administrators object to the program, others say they have found benefit in the work of the ombudsmen.
Sherman Davidson, administrator of the Monrovia Convalescent Hospital in Duarte, said his experience with the program has been positive.
"Often the patient has a problem, such as not getting his milk on time, but he doesn't tell us. So we get feedback through the ombudsman. The ombudsman gets the patients to open up to them when they won't open up to us.
"Most problems are little problems, but when you are sick and have nothing to look forward to they become big problems.