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Reform sought for state homes' monitor
Hand for most vulnerable

Ventura County Star
Tom Kisken
April 7, 2011

A California watchdog office charged with protecting people in nursing homes too often loses its voice on vital issues ranging from inadequate staffing to the use of antipsychotic drugs, according to a Ventura County seniors advocate who is heading a drive to turn the state-run program into an independent entity.

Sylvia Taylor Stein, who leads the long-term care ombudsman program in Ventura County, is part of a group that contends conflicts of interest involving different arms of government mute California's lead nursing home watchdog, the Office of the State Long-Term Care Ombudsman.

A two-year-plus battle over the state office, and the autonomy of nursing home advocates, could heat up this month when legislators start discussing a bill that would push the program out of the California Health and Human Services Agency, also responsible for licensing nursing homes and other long-term care facilities.

"It's conflict riddled all the way through," Stein said of the current system. She suggested a change would protect seniors and disabled people impacted by state policies and actions that affect Medi-Cal funding of nursing homes, the use of medications as a chemical restraint and regulations aimed at eliminating abusive or inadequate care.

"That office has been silent on all legislation. They've never really spoken out on anything," she said.

The office is designed as the top domino in a network of 35 local ombudsman programs, including the one led by Stein in Ventura County. The programs use volunteers to regularly monitor nursing homes, assisted-living programs and other facilities, also investigating allegations of abusive care.

"We're talking about some of the most defenseless people we have," said Steve Bennett, a Ventura County supervisor who sees creating an independent state office as a way to ensure that advocates focus only on one thing: People living in long-term care. "It's an area where it's easy to get complacent."

Joe Rodrigues, the state ombudsman who leads the Sacramento-based office, said change isn't needed because he's already an active advocate with federal law guaranteeing his independence. Acknowledging some of his work hasn't been as public as he wanted, he said officials from the U.S. Administration on Aging have reinforced the power of state advocates to speak out on nursing home issues without fear of what he called "willful interference."

"Now I can take a more visible place," he said. "I'm not fettered. I'm not restrained. I'm not silenced."

The struggle over the office dates to 2008, when then-Gov. Arnold Schwarzenegger cut funding for ombudsman programs in counties across California without visible opposition from the state office. Stein, who leads the Committee for an Independent State Ombudsman Office, said county-level ombudsmen bonded together first to find new funding and then to push for changes in the state office.

Rodrigues said he has access to state leaders and resources that might disappear if the office were removed from government. He answers conflict-of-interest claims by pointing out his office is part of the California Department of Aging. The Department of Public Health, which licenses nursing homes, is run separately, though both divisions are part of the same broad agency, as are other departments involved in long-term care.

"I don't report to anyone in licensing. I'm not answerable to licensing," he said, also rejecting suggestions that publicly opposing Schwarzenegger's budget after it was released would have made any difference. "The state ombudsman doesn't have the ability to influence that kind of a decision. That decision came as a surprise to me and as a surprise to the department (of aging). It was a done deal."

The fight may be escalating. Sen. Lois Wolk, D-Davis, is finishing wording of a bill to reform the ombudsman's office that is expected to be sent to committee early this month.

Stein and other advocates are pushing for the state to find a nonprofit agency that would be contracted to run the program. Wolk said that's an option but she'll also consider moving the office to another arm of state government that has no connection with Health and Human Services.

"The state ombudsman ought to be an independent actor," she said, pointing at California's coming tidal wave of seniors.

"We need a very strong ombudsman. We need advocates for seniors."

But the only way to assure that an advocate has no agenda other than protecting long-term care residents is to snip the cord to government, Stein said. She cited other states including Washington, Colorado, Oregon and Rhode Island that have adopted independent offices.

Nursing home administrators in Ventura County said they know little about the tug of war. A representative for the group that represents long-term care facilities, the California Association of Health Facilities, said it's avoided becoming involved in the "infighting."

"There are certain areas where we feel the ombudsman office could be improved," said spokeswoman Deborah Pacyna. "We're certainly not calling for wholesale change."

Dr. Gary Proffett, an Oxnard doctor involved with long-term care, worries that Stein and other advocates want to be more than intermediaries in disputes involving nursing home residents. Instead, he said, they seem to be seeking power to influence doctors' decisions involving transfer of patients from hospitals to nursing homes and the process of prescribing medication.

"I'm wondering what's next," he said.

Stein said advocates aren't in a power grab. They want to make sure existing laws regarding medication are enforced and vulnerable people are protected, she said.

"We owe this to them," she said.