Many people with loved ones in nursing homes or other facilities have complaints about the quality of care but don't know who to call. Arline Solomon hopes they will call her.
Solomon, 83, is among 42 volunteers who make up the staff of the Ombudsman Program, which investigates complaints for the nonprofit Long Term Care Services of Ventura County Inc. During the past 19 years, the ombudsmen have helped expose problems at local facilities.
The group has helped plug holes in a system that steadily seems to develop new problems. At the same time, volunteers said their work has given them the kind of rewarding experience few jobs can provide: They believe they are making people's lives better.
Solomon has been with the program since its inception in 1981 and has investigated numerous reports, including caregivers slapping patients and inadequate nutrition. She has even gone face to face with nursing home staffers, once plopping cockroaches onto the desk of an administrator to persuade him an insect problem did exist.
At first, said Doris Ferber, one of the group's founders, ombudsmen found some of the worst cases, because there was no control of the facility except by the state.
Many times, ombudsmen learned that nursing home administrators had hired inexperienced caregivers and never trained them. Ferber said one aide had a prison record.
"Years ago, I walked into a nursing home and there was an aide giving medication," Ferber said. "When we approached her, she said, 'I have to do this; there is no nurse.' We took the medication away from her and called the director of nursing, who was on call 24 hours. Then we called licensing and every nursing home heard about it. And it hasn't happened again. Now they know better."
A 1978 amendment to the Older Americans Act created the framework for the program by requiring states to provide ombudsmen to serve elderly residents in long-term care facilities. "Ombudsman" is a Swedish word meaning someone who advocates for the rights of others.
Ombudsmen say their investigations have forced ownership changes and the closing of nursing homes with severe violations. While they may still encounter cases of abuse and other problems requiring law enforcement, now they mostly find communication breakdowns and chronic under-staffing, as some patients may wait 30 minutes for someone to answer their call bells.
Nursing home administrators say they prefer having ombudsmen bring problems to their attention rather than hearing from the Department of Health Services.
"They are an extra pair of eyes and ears to bring to our attention something we need to correct," said Maggie Parreno, administrator of Shoreline Convalescent Care in Oxnard, the county's largest care facility. "They do it in a professional way."
Susan Cottman, Solomon's partner for six years, said home administrators thank them for pointing out problems. Ombudsmen often note problems that state regulators would see during their annual survey.
"They've learned that if they listen to us, it helps them when they have their survey," Cottman said. "Patients learn that we can solve problems on the spot."
Cottman, a retired nurse, volunteers up to 20 hours a week, because she finds it satisfying. "You also develop a huge group of friends," she said.
Ombudsmen must have state certification, which requires 36 hours of training that covers legislation, reform, aging and illness issues. They also perform 15 hours of field service. For yearly recertification, they take 12 hours of continuing education classes.
Cottman said certification may also help weed out those who have a hidden agenda, often involving a family member. Those people may have the "get-even" philosophy toward a certain facility.
To help maintain quality and objectivity, she said, ombudsmen are screened and work in teams.
Volunteers make weekly, unannounced and unscheduled visits to the county's 24 skilled nursing facilities, which have nurses working 24 hours a day. At the county's 131 board-and-care facilities, volunteers visit once a month. Those facilities usually have about six residents and an aide, not a nurse, on staff.
The program receives about 38% of its funding from the federal government, passed through the Area Agency on Aging. An additional $128,000 a year comes from donations from private foundations and corporations.
That money makes it possible for ombudsmen to look out for patients, who often feel powerless in these facilities. "They're afraid of retaliation. Most of the time there won't be retaliation, but they perceive that there will be," Cottman said.
In one case, however, a staff member observed a patient being attacked by another patient and asked the supervisor to relocate the offending patient. But nothing happened. After the staff member reported the incident to the ombudsman, she was fired.
"That's a violation, to retaliate against a resident or staff member who brings a complaint," said Cottman. The nursing home was cited by the state and later sold.