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Long-Term Care Ombudsman: A Program Snapshot

Written by Legal Aid WV


The West Virginia Regional Long-Term Care Ombudsman Program is made up of nine regional Ombudsmen, a director (who is currently serving in the role of a regional ombudsman too), and a communications and training specialist.

The state is divided into 9 regions where our Ombudsmen serve our residents living in:

  • 124 nursing homes (houses 10,713 beds)
  • 87 assisted living facilities (houses 3,581 beds)
  • 49 legally unlicensed homes (houses 147 beds)

If the beds in all 260 facilities are occupied, we could potentially be serving 14,441 residents in the State of West Virginia.

From January 1, 2023 – August 31, 2023, our Ombudsmen spent:

  • 796.25 hours traveling to and from facilities
  • 2,172 hours working on complaints
  • 580 hours providing information and assistance for 1,312 occurrences
  • 967.90 hours doing facility visits
  • 683 official complaints were addressed

Some Examples of Our Casework

Ombudsman Submission #1

To demonstrate how timing can be vitally important in our work, a call was received from a client’s family member that a resident was being discharged home that day. This resident was pending Medicaid approval while he was receiving rehabilitation services to return home.

Knowing that home was not safety-appropriate without needed assistance available and that resident did not wish this at this time, I immediately changed my schedule to go to that facility. I met with the resident who confirmed I was right about the move, but he signed the discharge because he thought there was no other choice.

I went right to the social worker who was trying to arrange transportation (thankfully, available transport services were currently a challenge which delayed the process). I was able to get the discharge stopped and a meeting with management was held to include plans for the representative (who allegedly was not doing so) to get the needed documents to DHHR for Medicaid approval. The facility agreed, although stressed they were taking a big risk if resident was not Medicaid approved and owed a large debt he could not easily pay. The resident did get Medicaid approval and then he chose to transfer to another facility of preference.

Ombudsman Submission #2

A young (30-something) resident with ALS (also known as Lou Gehrig’s Disease) has been declining in the ability to swallow, increasing the risk of choking which has been quite concerning to staff at their facility. I as Ombudsman have been working with resident and management to find foods resident likes that can be tolerated in a safe form.

The resident does have a feeding tube to supplement eating by mouth. I facilitated a virtual meeting with the resident (who uses an eye movement operated communicator) that included family and key management representatives, including a physician. Management proposed palliative care as this resident now does not wish to take food by mouth nor by feeding tube.

Management and physician are in full support of resident wishes and acknowledge that the resident can receive fluids and food in proper form at any time they wish. While this was personally difficult to hear, as Ombudsman, I have to honor the wishes of my residents and am pleased to find the facility care providers supported resident’s wishes as well.

Ombudsman Submission #3

I received a call from an assisted living resident that she has not received her state supplement pay in the amount of $220 for 3 months.

I met with the facility owner and discussed the issue and realized that this affected more than one resident. It affected several residents at the facility not receiving their supplements. Several residents were issued paper checks and no local bank would cash the checks because the residents did not have identification.

I contacted the DMV about the issue and what help the DMV could provide. Thankfully, the DMV customer service representative helped us by verifying if the person ever had a WV Driver’s License. If the person had a license at any point previously, the DMV has copies of their social security card and birth certificate on file. They reached out to the facility owner to complete the authorized DMV form and take the residents to the local DMV to get ID.

Three residents were transported to the DMV and received their state ID cards. I was so happy for the residents, as many had not had ID for years.

Unfortunately, after this success, the DMV changed their regulations and are now requiring more information/verification so this has stopped the process right now.

Ombudsman Submission #4

I met with a resident who had a disability with her hands. She had to use her mouth to open her closet drawers and kept most of her clothes in the bottom of her closet because she could not reach the top bar hanger. I contacted the facility’s administrator and maintenance manager about this issue.

Maintenance changed the knobs on her closet door to another long accessible (knob) that resident could use to open the closet instead of using her mouth. They aslso lowered the clothes hanging bar and now she reach in to hang up and retrieve her clothes without all of the clothes being stuffed in the bottom drawer.

Ombudsman Submission #5

A resident’s separated wife contacted our program and complained her husband was being held against his will at one of my facilities and was put there by his brother. She said that the Power of Attorney (POA) the brother had was incorrect or invalid. She said that the resident was taken to the ER by his brother and his brother was given POA at that time, then the resident was placed in the nursing home over an hour and a half away from home. 

Ombudsman Director Ed Hopple and I spoke to the resident, and he said that he would like to go home to his wife’s care, as he had a degenerative brain disorder that is only going to worsen, and he would like to pass away at home. He said that he didn’t want his brother to be his POA but would want his wife to be if he cannot make his own decisions. We connected the pair to the legal unit, and they drew up a new POA. However, there were some issues getting the new POA in place, so we had to go another route.

This resident was difficult to understand when communicating because of his disease, but he was very cognitively intact. I worked with the activities director at the facility to supply the resident with a printed alphabet board (a printed sheet with letters to point and spell) and to teach him how to use it to communicate with staff. The resident was thrilled to begin using it! Once he was comfortable using the alphabet board, we asked that his decision-making capacity be re-evaluated by a physician outside his facility. Initially, the facility thought that an external organization could do this, but that fell through, and I contacted the physician’s assistant (PA) assigned to the facility to conduct the evaluation instead.

When I first spoke with her, she said that she thought in WV, two physicians were required to return capacity to a resident. With the State Ombudsman’s help, we sent her the requirements of the WV Healthcare Decisions Act (HCDA), which states that only one physician’s determination is needed to return capacity to an individual. After seeing the materials, the physician agreed to evaluate the resident’s capacity with the help of the activities director to ensure the resident can use his communication device appropriately.

After evaluating the resident’s capacity, she returned decision-making capacity to him, and he was able to discharge himself from the nursing home to his wife’s care. The PA remarked to me that his capacity should have never been taken away in the first place; just because he is hard to understand does not mean he is not aware or capable of making his own healthcare decisions. This revelation, paired with their new understanding of the HCDA, sparked the facility to re-evaluate healthcare decision-making capacities of all residents that want to be re-evaluated and for those they felt may have a better chance with a modified and accessible evaluation process.

Fun Facts about Our Staff

Dream Job as a Child

  • Doctor
  • Forest ranger
  • Home Renovator
  • Interior Designer
  • Lawyer
  • Nurse

First Jobs

  • Babysitter
  • Department Store Sales Associate
  • Grocery bagger
  • Job Developer
  • Physical Therapy Aide – High School Tech Program
  • Youth Case Manager
  • Waitress

Educational Backgrounds

  • Gerontology
  • Law
  • Psychology
  • Social Work
  • Special Education

Fields Worked In Prior to Be Joining WVLTC Ombudsman Program

  • Activities Director
  • Autism
  • Dementia Education
  • Dental assistant
  • Disability advocate In-Home Care
  • Intellectual and Development Disabilities
  • Law Clerk
  • Paralegal
  • Pharmacy technician
  • Respite Care Program
  • Social Worker
  • Treatment Court Probation

Favorite Fast Food Restaurants When Travelling for Work

  • Arby’s
  • Burger King
  • Dairy Queen
  • McDonald’s
  • Sheetz
  • Subway
  • A couple pack food and avoid fast food purchases, if at all possible.

Favorite Parts of Our Ombudsman Work

  • Advocating for voices that often go unheard.
  • Getting to chat with residents. They have a breadth of life experience and I’ve certainly learned a few things!
  • Getting to know the residents and making a difference in their lives.
  • Interacting with the residents.
  • When a resident feels comfortable enough to self-advocate after working with me to resolve concerns.
  • Working with people.

Our Favorite Things about Our Ombudsman Team

  • We feel like family.
  • A wealth of knowledge to share.
  • The amount of diversity and experience, and the support and training offered.
  • We’re always willing to help each other and give advice on complex cases.
  • A group of caring and dedicated individuals.
  • Everyone fits together in a true team approach, even with our variety of backgrounds and personalities.

Outside the job, you might find our Ombudsmen enjoying:

Favorite Hobbies

  • Crafting
  • Gaming
  • Fishing
  • Music/Singing
  • Painting
  • Relaxing
  • Thrifting

Favorite Vacation Spots

  • Family Farm
  • Gatlinburg, Tennessee
  • Lake Norman, North Carolina
  • Murrell’s Inlet, South Carolina
  • Myrtle Beach, South Carolina
  • Pipestem State Park in West Virginia

Favorite Foods

  • Brown Beans & Corn Bread
  • Butter Chicken
  • Shrimp & Grits
  • Spaghetti
  • Steak

Favorite Movies

  • Anything fantasy or science fiction
  • Road House
  • The Blues Brothers (1980)
  • The Lord of the Rings Trilogy
  • The Ultimate Gift

Favorite Music

  • 80s
  • Classic Rock
  • Country Acapella (Home Free!)
  • HipHop
  • IDM (Intelligent Dance Music – Style of Electronic Music)
  • Metal
  • Rhythm & Blues

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