"Alameda County elder care watchdogs unresponsive, underfunded"
By Angela Woodall
Oct. 4, 2009
When Angel Carter found her elderly mother in a wheelchair soaked in urine because staff at an Oakland assisted-living home had not changed her in more than 24 hours, she complained to the California Department of Social Services - loudly. And things changed.
But about a year later, when Carter tried to seek help from the Alameda County Long-Term Care Ombudsman Program - the eyes and ears of state watchdogs - she had a different experience.
Carter said she called the Oakland-based ombudsman in early September because she was frustrated after a dispute with Eden Manor over clothing belonging to her 89-year-old, legally blind mother that repeatedly went missing. Carter said she was also concerned that Eden staff did not appear to recognize that her frail mother, Naomi Kees, had suffered a stroke in early September for which she was hospitalized.
Carter wanted an ombudsman to help settle the matter directly with Eden Manor, but after three weeks she still hadn't gotten help from the ombudsman's office.
"I'm surprised it (has taken) so long," she said.
California law requires nursing home neglect and abuse to be reported. Care homes are required to hang posters in common areas showing the information and telephone numbers of advocates who receive those reports. The most prominent contact is the California Long-Term Care Ombudsman Program, which supplements state oversight.
The community-based ombudsman program has offices in 35 counties across California that have discretion over who carries out the local services.
Residents and their caregivers may file complaints about the quality of care in a facility or suspected financial, emotional or physical abuse directly with a local ombudsman or may call a crisis hot line. Coordinators then send out the volunteers to follow up on the reports. They also make surprise visits to facilities in between regular state inspections.
But residents and their caretakers, as well as elder advocates, complain that the Alameda County ombudsman's office at 7700 Edgewater Drive in Oakland is unresponsive.
"They're not in the business of helping people," Carter said.
Johnny Ballelos, who has owned Eden Manor since October 2007 under the licensing name Golden Years Health Services LLC, said he mainly deals with the state Social Services Department, which twice annually inspects the assisted-living facilities it oversees.
The home on Fruitvale Avenue has a generally good record of care in the past two years, according to Social Services Department documents.
"Every breath we take, we have to let them know," Ballelos said, while also disputing Carter's characterization of her mother's care.
The ombudsmen are supposed to help bring the worst problems to the attention of the Social Services Department, Ballelos said. They are there but don't always do what they are trained to do, he added.
The program is overwhelmed and underfunded, said Sylvia Soublet, spokeswoman for the Alameda County Social Services Agency, which took over the ombudsman program about a year ago. Before that, the agency contracted services to a company called Ombudsman Incorporated, which since has gone out of business, Soublet said.
Now the ombudsman program has one staff member to log complaints from any of 400 residential and skilled-nursing facilities, as well as a coordinator, four part-time paid staff and 13 volunteers responsible for addressing those complaints, Soublet said.
"Would we like our response time to be better? Absolutely," Soublet added. "But it is a system that does an extremely competent job based on the resources that are provided," adding that their funding for the year was reduced from $360,000 to $160,000 as part of Gov. Arnold Schwarzenegger's budget cuts.
The entire system is overwhelmed and requires a comprehensive overhaul, she said. "It was not designed to handle this level of demand."
Problems, however, were apparent even before the cuts, said Carole Herman, founder of the Foundation Aiding the Elderly and an outspoken critic of state oversight. Even if the ombudsman office was more responsive, she said, the office lacks the regulatory teeth and training to be effective watchdogs.
In addition, the quality of ombudsmen varies from county to county and depends on the qualifications of volunteers and the training they receive, she said.
Her opinion is shared by Boyd MacDonald, longtime owner of a San Leandro nursing home, who called the office "useless." His family ran the Bancroft Convalescent Hospital until MacDonald took over in 1992.
In one case, a local ombudsman told MacDonald, "We don't deal with financial matters," which is incorrect. MacDonald reported that ombudsman to the state ombudsman supervisor.
They are supposed to advocate for the well-being of residents, MacDonald said, "but they don't do anything."
What to look for
One of the most important steps caregivers can take is thoroughly inspecting a home before making a decision to place family members there, said Deborah Pacyna of the California Association of Health Facilities, a nonprofit that advocates for quality elder care.
She cautioned relying on rating systems such as Medicare's nursing home comparison Web site, which may not reflect the true quality of care available at the facility.
But Pacyna said caregivers can ask if confidential customer and resident satisfaction surveys are done and ask to see the results. They should ask about employee turnover and how long the administrator has been on board. They also should expect to be able to visit the facility anytime.
More detailed information about nursing homes, skilled-nursing facilities and other long-term care providers also is available from the California Department of Public Health Web site: http://hfcis.cdph.ca.gov.
The Web site lists facilities' main source of funding, which for three out of five residents of nursing homes will be Medi-Cal, Pacyna said. But funding for Medi-Cal continues to remain limited, she added.
If a county ombudsman is not helpful, Pacyna recommends contacting the attorney general's Bureau of Medi-Cal Fraud and Elder Abuse and the county Adult Protective Services department. "Follow-up by the family is important," she added.
To report neglect, abuse:
Assisted-living facilities: California Department of Social Services, www.dss.cahwnet.gov
Skilled-nursing facilities: California Department of Public Health, www.cdph.ca.gov
California Long-Term Care Ombudsman Program hot line: 800-231-4024
Alameda County Long-Term Care Ombudsman Program: 510-638-6878
Attorney general's Bureau of Medi-Cal Fraud and Elder Abuse: 800-722-0432
Your local police department or sheriff's office
Legal Assistance for Seniors: www.lashicap.org, 510-832-3040
California Advocates for Nursing Home Reform: www.canhr.org, 415-974-5171
Foundation Aiding the Elderly: www.4fate.org, 877-481-8558