Ombudsman programs were begun in response to complaints about the quality of care in many nursing homes. In 1986 an expert panel from the Institute of Medicine submitted its report, Improving the Quality of Care in Nursing Homes. The report recommended that the federal government help to regulate the quality of skilled nursing facilities. It also recommended that performance standards be revised and the inspection process be changed to include patients and their families. The panel felt that better training of staff was needed, as well as remedies for nursing homes that did not provide a high standard of care.
As a result of the report, the 1987 Omnibus of Budget Reconciliation Act included the Federal Nursing Home Reform Act. Prior to the Act, state inspectors visiting nursing homes spoke only to the staff. Now ombudsmen include visits to patients and families of patients in their visits. Any dissatisfaction felt by residents or their families is reported and recommendations for improvements are made.
The National Citizens’ Coalition for Nursing Home Reform created the Campaign for Quality Care to make sure federal guidelines were implemented, and changes for the better took place. As a result of the new program, physical restraints and anti-psychotic drugs are used less for restraining patients. To be restrained a resident must actually be a danger to himself or others. To be given an antipsychotic drug a resident must have an actual diagnosis of psychosis rather than just feeling the need to pace the hallways.
Ombudsmen are trained to listen to residents’ and families’ concerns and to investigate and report them. Their training includes learning their role as patient advocates. They are taught about the basic aging process, common illnesses and conditions and commonly prescribed medications. Residents’ rights are an important part of their training. They are taught the underlying principles behind residents’ rights and how to empower residents, supporting them in exercising their rights. Lastly, ombudsmen are taught to resolve problems and help nursing homes to comply with federal and state guidelines in providing the best possible care to residents.
The rights of nursing home residents, which the ombudsmen check, vary from state to state, but essentially they ensure the right to the same care we would all like to see for our elderly or disabled relatives. Residents have the right to treatment that will keep them as healthy and happy as possible, including nutrition, clean environment, hygiene, privacy, ethical treatment and dignity. Residents have the right to participate in decisions concerning their own care, accepting or refusing medical, surgical, or nursing procedures. Nursing homes must document what the patient directs in the way of life support when he or she becomes unable to make that decision.
The state where you live has a written code with expectations of how you are to treat patients, and what the ombudsmen will be looking for when they visit your place of employment. The code is available from the Board of Nursing in your state. Your teachers will also have copies that are available for you to read.