Doris Ferber stood at the side of the nursing-home bed and put her hand on the head of a frail woman who was lying unconscious with a breathing tube in her nose.
Then, with the same care that she would have devoted had it been her own mother, Ferber gently stroked the woman's long, white hair.
It was more than just an affectionate gesture. The touch reassured Ferber that her hair had been combed and recently shampooed.
"If their hair is clean, it's an indication that they're being bathed," she said. "This is one of the ways we can determine whether or not they're getting proper care."
Ferber, a 61-year-old retired nurse, is one of two dozen trained volunteers in Ventura County's Long-Term Care Ombudsman Program. Ombudsman is a Swedish word that means "citizen representative." The ombudsmen are the watchdogs of the county's 69 nursing homes and residential-care facilities.
Last year, they investigated more than 1,000 complaints from patients and their families, ranging from cold food and financial disputes to physical abuse. Nearly 900 of the complaints were verified, and 785 were at least partially resolved.
Although most problems do not require much more than just a little diplomacy, say the ombudsmen, their routine visits do sometimes lead state health authorities to investigate more serious abuses.
Five Facilities Closed
Since the formation of the group locally seven years ago, ombudsmen have reported incidents that ultimately led to a $10,000 fine for one nursing home and the closing of at least five other board-and-care facilities.
"We don't go in as antagonists, but they are aware that we can make waves if necessary," said ombudsman Betty Merrifield, 67, a retired social worker from Camarillo. "If patients can't speak out for themselves, then somebody's got to do it for them."
To that end, each volunteer visits a long-term care facility in the county at least once a week, often taking several hours to inspect the premises, chat with patients and raise concerns with hospital administrators.
Under state law, they have the right to enter any facility without notice and proceed unfettered as they go through such rituals as touching hair, examining fingernails and checking for soiled sheets.
For the elderly patients, many of whom do not have family or regular visitors, those moments are cherished.
"I'm always upset about one thing or another, and they find out what's going on," said one 67-year-old patient at Pleasant Valley Rehabilitation and Convalescent Hospital in Oxnard. "There are times when I really get paranoid and need somebody on the outside who I can call on."
Generally, the complaints are about minor problems, the result of moving an ailing parent from home to a place that can never be a perfect substitute. Patients gripe about the food or noise. A roommate might be incompatible. A cigar-smoker isn't allowed his nightly smoke in bed.
"Sometimes, it's just the person who says, 'I want butter with my bread and I can't get it,' " Ferber said. "It's such a small little thing, but to the person it's really important. They're so helpless."
Occasionally, however, there are severe problems that require a more hard-nosed approach. One woman complained that a man was trying to bilk her of her Social Security checks. Another reported that she had been physically abused by a male aide in the shower.
In one tragic case last year, an ombudsman told a nursing director that a woman patient seemed to be having trouble breathing, but the administrator refused to make arrangements to take the patient to a doctor. Finally, a friend took her, but on the way the woman suffered a heart attack and later died.
The ombudsmen reported the incident to the state Department of Health Services, and an investigator discovered that the patient's medical records had contained incorrect information. The facility was given a $10,000 fine.
'They Deserved It'
"They really got nailed, and they deserved it," said Shirley Radding, director of the county program, which is one of 35 ombudsman programs statewide. "Now they take the ombudsmen a little more seriously."
Although some hospital administrators might grumble about having one more agency inspecting their facilities, most seem to accept the fact that the result often means better care.
"I don't think any of us who are in the industry probably relish the idea of having one more government-type agency coming in and snooping around," said Gary D. Devoir, administrator of Camarillo Convalescent Hospital. "But it's good at times to have that extra set of eyes around the facility that lets us know when things aren't going the way we want them to go."
Families, many of whom are hesitant to report problems to the hospital administration for fear of retribution, also appreciate having someone on their side.
"The ombudsman program is my help, my support and my source of aid and information," wrote Sylvia Jampol of Ventura in a letter to the group last year, after they helped resolve a problem for her 85-year-old mother.
Getting volunteers for the program, however, is not easy. After a 40-hour training course, ombudsmen spend about 20 hours a month in places that, by their nature, are not very pleasant.
There is little coziness to be found between fluorescent ceiling lights and linoleum floors. Demented screams and foul smells are not unusual. Few patients want to be there. Fewer get better.
But for the veteran ombudsmen, satisfaction comes from helping the helpless, from doing a job that one day might have to be done for them.
"You go in there and think, 'But for the grace of God, is this going to be my future?' " Ferber said. "We're all going to get old, and we're all going to die."