HomeMy WebLinkAbout20060784.tiff RESOLUTION
RE: APPROVE VALE GRANT APPLICATION FOR LONG TERM CARE OMBUDSMAN
ADVOCATE/FRIENDLY VISITOR PROGRAM AND AUTHORIZE CHAIR TO SIGN
WHEREAS,the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS,the Board has been presented with a VALE Grant Application for the Long Term
Care Ombudsman Advocate/Friendly Visitor Program between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Human Services, Area Agency on Aging, and the Victims Assistance and Law
Enforcement Board, commencing July 1, 2006, and ending June 30, 2007,with further terms and
conditions being as stated in said application, and
WHEREAS,after review,the Board deems it advisable to approve said application, a copy
of which is attached hereto and incorporated herein by reference.
NOW,THEREFORE,BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the VALE Grant Application for the Long Term Care Ombudsman
Advocate/Friendly Visitor Program between the County of Weld, State of Colorado,by and through
the Board of County Commissioners of Weld County, on behalf of the Department of Human
Services,Area Agency on Aging,and the Colorado Department of Human Services, be,and hereby
is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application.
The above and foregoing Resolution was,on motion duly made and seconded,adopted by
the following vote on the 13th day of March, A.D., 2006.
�� BOARD OF COUNTY COMMISSIONERS
' "" 4 \, ELD •6UNTY, COLORADO
ATTEST: I ;� .x\ /�r�dl J
_ �. • -4fhir ,
Weld County Clerk to the Bf 1 'I
/ ¢`.'�� ..
�1,vi i ti l l ut ,t ' ,,,,,„7„,,,
i -` David E. Long, Pro-Tem
BY: _
DS uty Cle'fk to the Boald r `mot .."
U 'a H. Jerke
APPROVED AS TO FORM: ,
Rob D. Masd n
nn tt eY tom
312 _i leco Glenn Vad _
Date of signature:
) 2006-0784
MEMORANDUM
a .
TO: M.J. Geile, Chair, Weld County Board of
Commissioners
Walter Speckman, Executive Director, W
VC FROM: Department of Human Services
COLORADO DATE: Monday, March 13th, 2006
SUBJECT: Weld County Area Agency on Aging's Long
Term Care Ombudsman Advocate/Friendly
Visitor Program VALE grant approval
Enclosed for Board approval and signature is the grant application for VALE (Victims Assistance
and Law Enforcement Board) assistance. The Ombudsman Program has received this grant for
the past 8 years. The amount being awarded during the next grant cycle will be$8,500. The funding
period will be from July 2006-June 2007. This grant will allow the Ombudsman program to provide
elder abuse prevention programs to long term care staff; continue the long term care friendly visitor
program;and maintain and strengthen the Volunteer Ombudsman program.
If you have additional questions, please contact Eva Jewell at 353-3800, extension 3331.
2006-0784
VALE Grant Application
Signature Page
Applicant Agency: WELD COUNTY AREA AGENCY ON AGING
Street Address: 1551 North 17th Avenue
Mailing Address (if different): Post Office Box 1805
Phone: (970) 353-3800 ext 3324 Fax: (970) 304-6442 Email: rmaldonado@co.weld.co.us
Project Title: Weld County Long Term Care Ombudsman Advocate/Friendly Visitor
Grant Period: July 1, 2006 to June 30, 2007
The following signatories,understand and agree that any grant received as a result of this application shall
incorporate and be subject to the statements made within the above described VALE Grant Application(The
Application). Furthermore, the signatories certify that they have each read The Application and are fully cognizant of
their duties and responsibilities for this project.
(Original signatures of each party to this application(i.e.,Project Director,Financial Officer and Authorized Official)
are required. Please use BLUE INK to distinguish the original documents from copies).
Project Director:
Name: Eva Jewell Position/Title: Weld County Area Agency on Aging Director
Agency(including Division or Unit): Weld County Area Agency on Aging, Division of Human Services
Mailing Address: 1551 North 17th Avenue,Post Office Box 1805 Greeley, CO 80632
Phone: (970) 353-3800 ext 3331 Fax: (970) 304-6442 E-Mail: ejewell@co.weld.co.us
:/Signature �7 ' .2v-/-41- Date: 3- q-OCy
Financial Officer:
Name: Dennis Bogott Position/Title: Financial Officer
Agency(including Division or Unit): Division of Human Services
Mailing Address: 1551 North 17th Avenue, Post Office Box 1805 Greeley, CO 80632
Phone: (970) 353-3800 Fax: (970) 304-6442 E-Mail: dbogott(rico.weld.co.us
Signature: �eSert
Date: — 6
thorized Official
np • . Geile Position/Title: Chair
It*��
' ,4i sc g Division or Unit): Weld County Board of Commissioners
no (�� � . 915 10th Street, Greeley, CO 80631 Post Office Box 758, Greeley, CO 80632
-e-
n j 1t 6-4000 Fax: (970) 352-0242 E-Mail: mgeile@co.weld.co.us
r te: :// aiet: Date: 03/13/2006
TO BOAR of teOr ATTEST: rifLevl�a
pZtESj1N0 S,g1ypTURES ONLY up p
COMM.SS10NEA In accordance with the ea 1CGr�14✓ a ARKgQ6Tihfb AWA plied in this application is considered a public record.
BY: GLtt I tacit"kW(
DE¢i TY CLERK TO THE RD
SECTION A-AGENCY INFORMATION
1. Applicant Agency (including Division or Unit):
Weld County Area Agency on Aging
Division of Human Services
2&3. Street/Mailing Address: 1551 North 17`h Avenue
Post Office Box 1805
Greeley, Colorado 80632
4. Phone: (970) 353-3800 extension 3324 Fax: (970) 304-6442
E-Mail: rmaldonado@co.weld.co.us
5. Project Director: Eva Jewell Title: Weld Area Agency on Aging Director
6. Project Title: Weld County Long Term Care Ombudsman Advocate/Friendly
Visitor
7. Agency Status: Governmental
8. Grant Amount Requested: $8,500
Section B: Summary
The Weld County Long Term Care Ombudsman Program has been a consumer voice for
the elderly residing in nursing homes and assisted living facilities for more than twenty(20) years.
The authority of the local Ombudsman Program comes from the Older American's Act, Colorado
Revised Statutes 25-11.5 and the Nursing Home Reform Law of 1987. The Weld County
Ombudsman acts as a consumer voice for the concerns of the elderly living in institutions, who
may have no one else to speak for them. The Ombudsman also receives and resolves questions,
issues, problems and complaints made by, for, or on behalf of residents of long term care facilities.
Weld County facilities have grown to include seven nursing homes and twenty four
assisted living facilities to respond to the increasing number of frail elders affected with chronic
conditions which interfere with their ability to live independently in the community. This number
does not include the additional seniors moving into the Weld community already requiring long
term care, nor the people who will experience unanticipated changes in their general health status
which will require long term care placement. In fact, the number of nursing home and assisted
living homes are on the rise. Development plans have been submitted to build an additional
nursing home in the Windsor area, and construction is anticipated. Construction has begun for an
assisted living facility in the Greeley area, located by 47th Avenue and Highway 34. "Home
Instead" opened four small Personal Care Boarding Homes in Windsor during 2005. In addition,
"The Bonell Good Samaritan Community," is adding two assisted living facilities in Windsor.
The V.A.L.E. grant has allowed the Ombudsman Program to increase staff time to keep
up with the increasing demand for advocacy on behalf of this very vulnerable population. The
assistant position is currently working 16-20 hours per week in the field, visiting nursing homes
and assisted living facilities. By maintaining a constant presence in these facilities, the Assistant
Ombudsman has built trusting relationships with residents and staff. The funds have also enabled
the program to maintain an abuse prevention and awareness program aimed at educating Certified
Nurse Assistants (C.N.A.'s) and other long term care staff. This has allowed the Assistant
Ombudsman to educate residents and staff about the Ombudsman Program, abuse issues and
resident rights, as well as investigation of complaints of abuse and neglect. The success and
popularity for the abuse prevention program has escalated. As the market continues to grow, the
demand for education for frontline staff also increases. Without the V.A.L.E. resource, the
program will not be able to continue these imperative services. In addition, it would be
impossible to continue and expand our Volunteer Ombudsman Program without the V.A.L.E.
grant dollars.
Long term care residents face both physical and psychological barriers when it comes to
expressing and advocating for their needs. This makes residents more likely to be victimized by
caregivers. The Ombudsman's role through observation and a frequent presence in the facilities;
is to insure that resident rights are being respected, that quality care is administered, and that
abuses do not occur. Continued funding of the Assistant Ombudsman will make it possible for the
Weld County Area Agency on Aging Ombudsman Program to serve the increasing number of
vulnerable long term care residents and their families.
We are requesting a modest amount of VA.L.E. Board Funds ($8,500) to continue to fund
the Assistant Ombudsman position and to increase the expansion of elder abuse education to
additional target populations. In 2006, the funds will allow the Assistant Ombudsman to continue
her presence of 16-20 hours per week. This will continue the necessary involvement with the
"Ensuring an Abuse Free Environment Program, "and aid in the recruitment and training of
volunteers. We believe that our request for a continuation of funding relates to the mandate of
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early crisis intervention and to provide assistance and support to victims and their families.
Section C: Project Concept/Design
Overall Issues Being Addressed:
The purpose of the Weld County Long Term Care Ombudsman Program is to assist and
empower consumers of long term care services by providing information about those services and
furnish support in complaint resolution. These issues or complaints may include, but are not
limited to access to long term care services, redress of neglectful or abusive care, and information
and assistance with civil and human rights. The Long Term Care Ombudsman program is a
resident/patient/consumer-centered advocacy program.
Long Term Care Ombudsmen have statutory status under the Older Americans Act of
1965 as amended and are required by federal and state law to visit every nursing home monthly
and every assisted living facility quarterly. They also receive, investigate and resolve complaints,
identify needs of long term care residents and help establish programs to meet those needs. The
Ombudsmen also document and report problems of long term care and help to stimulate and
promote improvement of the system.
Currently, Weld County has the capacity to occupy 889 nursing home residents and 470
assisted living residents, and the numbers are expected to continuously grow. The recent growth
has resulted in an expansion of assisted living facilities. To meet the demand, the assisted living
industry is expanding into the rural areas as well as continued expansions in the Greeley area.
This additional growth will increase the Ombudsman responsibilities, including all education and
technical assistance components, all required visitations, all complaint investigations, and all
documentation and reporting. We hope to meet the need by continuing the Assistant Ombudsman
position of.25 FTE, funded by this proposal.
Due to the increased number of long term care residents Weld County has experienced in
the last few years, the demand for Ombudsman services has also increased. Federal funds,
through the Older Americans Act, are not keeping up with the growing need for long term care
advocates. With limited current resources available to the Area Agency on Aging, it will be
impossible to meet the minimum requirements for a visible presence in all of Weld's long term
care facilities. hi an effort to keep up with the visitations, the training and technical assistance to
the facilities will be negatively influenced. Such training is the key to the prevention of practices
that diminish the quality of life of residents and in many cases may border on abuse.
There is continuing evidence from statements made by regulatory agencies that an informed,
educated and empowered community presence in long term care facilities can help to maintain or
improve the quality of the facility and thus the quality of the residents' lives. In short, the
problem we are trying to resolve is the lack of Ombudsman resources to cover exceptional
increases in the growth of long term care services in Weld County.
A federal commission concluded that nursing home and assisted living communities were
severely understaffed and have made recommendations to enforce stricter and tougher staffing
requirements and guidelines. As a result, Governor Bill Owens formed a Blue-Ribbon panel in
June of 2000, to review these issues and make recommendations. In November of 2000, this
panel developed a draft for assuring quality health care for Colorado, "A Partnership for Nursing
Excellence."Unfortunately, the work to develop solutions is in the beginning stages and those of
us who have the responsibility to oversee the care of the elderly must respond to this crisis now.
Some of the recommendations suggested have been to increase vocational and educational
training, to expand and encourage people to enter the elder care health industry, empower current
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employees to enhance retention and give the patient-care professionals better tools to get their jobs
done, and to reduce the numerous elder abuse and neglect incidents. To contribute to positive
changes in nursing homes and assisted living facilities, the Assistant Ombudsman has become
active with the Colorado Culture Change Coalition and the Pioneer Network.
Project Goals:
Goal#1 (standard): The Weld County Long Term Care Ombudsman Program will provide direct
services that assist crime victims with emotional and physical needs to stabilize their lives,
provide a measure of safety and security, and/or enhance victims' experience with the criminal
justice system.
To provide elderly victims of crime with literature and guidance on how to report an
abusive situation, and educate long term care facility staff on their responsibilities of
reporting abuse. To assist elderly victims of crime with their rights as a victim, and
referral to the Victim/Witness Program.
To provide elderly victims of crime with information and assistance on how to apply for
any financial assistance that may be available from Crime Victim Compensation.
Inform elderly victims of crime and their families of their responsibilities as a victim.
To continue a "Facility Alert Notice Pilot Project,"to ensure that Weld County Nursing
Homes and Assisted Living Facilities are aware of potential concerns for residents. An
Alert Notice may include information regarding, however, not limited to:
• Unidentified Visitors • Senior Scams • Telephone Solicitors • Robbery
Goal #2: To enhance the ability of the Weld County Long Term Care Ombudsman Program to act
as a consumer voice for the concerns of the elderly living in nursing homes and personal care
boarding homes. By visiting nursing homes and personal care boarding homes, there is an
ongoing process of building trust and rapport with the residents and staff so that instances of
mistreatment and elder abuse can be identified and addressed promptly.
► To enhance the ability of the Weld County Long Term Care Ombudsman Program to
receive and resolve questions, issues, problems and complaints on behalf of residents of
long term care facilities.
► To enhance the ability of the Weld County Long Term Care Ombudsman Program to
provide community education regarding issues of elder abuse and quality of life for
residents in long term care facilities.
► To strengthen the ongoing elder abuse training program. The current training being used
is a program developed by "CARTE," which stands for, "Coalition of Advocates for the
Rights of the Infirm Elderly." This educational program is also known as, "Ensuring an
Abuse Free Environment" training. CARTE consists of eight training modules that focus
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•
on various aspects of elder abuse. The training program will be used to assist with
educating staff, residents, and family members regarding victimization. Training and
education can be accomplished through C.N.A. conferences or in-services at nursing
homes or assisted living facilities.
Currently the CARTE program is being offered to C.N.A.'s (Certified Nursing Assistants)
and PCP's (Personal Care Providers). Also, the Weld County Ombudsman Program has
discovered the benefits of offering the training to administrative and managerial long term
care staff. The additional training for this program has been developed and is being offered
to managerial staff on an ongoing basis. In addition, the Assistant Ombudsman has added
a victims' rights and victims' assistance portion to the CARTE training program. Our goal
is for each trainee to understand how to assist a victim with reporting a crime, and how to
help them apply for victim assistance and compensation.
However, due to the lack of adequate staffing, facilities had faced the challenge of
enrolling their staff for an all-day training. The Weld County Ombudsman program has
implemented an abbreviated version of the training to the students who attend the
"Ensuring an Abuse Free Environment" training. In addition, the Assistant Ombudsman
has been able to address the issues of elder abuse in the earlier stages of C.N.A. training,
through the C.N.A. training center, which has been in existence since 1994. The C.N.A.
training center provides the opportunity for individuals to become trained as Certified
Nursing Assistants (C.N.A.'s). Upon completion of the training, many of the C.N.A.'s
find positions within Weld County long term care facilities.
This has allowed the Abuse Prevention training to be delivered to more students on a bi-
monthly basis. Also, this has given the Ombudsman Program an opportunity to reach a
wide variety of future nursing assistants, which will provide outreach services that are
conducive with the Governor's Blue-Ribbon Committee goals.
Project Objectives:
Objective #1(standard): To provide services to the following estimated unduplicated number
of crime victims during the 12-month grant period. (Note: Count each victim only once based
upon predominant crime type).
TYPE OF CRIME PROJECTED ACTUAL# ACTUAL# ACTUAL# ACTUAL# YEAR-TO-
#VICTIMS VICTIMS VICTIMS VICTIMS VICTIMS DATE TOTAL
(grant year) 1sT QTR 2ND QTR 3R0 QTR 4T"QTR #VICTIMS
(7/1-9/30) (10/1-12/31) (1/1-3/30) (4/1-6/30)
1. Child Physical Abuse
2. Child Sexual Abuse
3. Domestic Violence
4.Adult Sexual Assault 6
5. Adults Molested as
Children
6. Other violent crimes:
hate,bias
7. Survivors of Homicide
Victims
4
TYPE OF CRIME PROJECTED ACTUAL# ACTUAL# ACTUAL# ACTUAL# YEAR-TO-
#VICTIMS VICTIMS VICTIMS VICTIMS VICTIMS DATE TOTAL
(grant year) 1ST QTR 2ND QTR 3RD QTR 4TH QTR #VICTIMS
(7/1-9/30) (10/1-12/31) (1/1-3/30) (4/1-6/30)
8. Elder Abuse(including 54
economic exploitation and
fraud crimes)
9.Assault
10.Robbery/Bank Robbery
11.Vehicular Assault&
Homicide, DUI/DWI
Crashes
12. Other, including Federal
Crimes(specify)
TOTAL 60
According to the statutes listed in the State Long Term Care Ombudsman policies and procedures,
the following definitions will be used for the above types of crime.
• Sexual Abuse/Assault: Includes, but is not limited to, sexual harassment, sexual coercion, or
sexual assault. Scenarios may include: resident to resident, staff to resident, and family to resident
sexual abuse.
• Elder Abuse: The term abuse means the willful (A) infliction of injury, unreasonable
confinement, intimidation, or cruel punishment with resulting physical harm, pain or mental
anguish; or (B) deprivation by a person, including a caregiver, of goods or services that are
necessary to avoid physical harm, mental anguish or mental illness. (Older Americans Act, Section
102[13]) The term Elder Abuse will include: financial exploitation, physical abuse, verbal abuse,
mental abuse, and involuntary seclusion.
Objective #2 (standard): To provide the following types of services to the following estimated
number of victims during the 12-month grant period.
TYPE OF SERVICES PROJECTED ACTUAL# ACTUAL# ACTUAL# ACTUAL# YEAR-TO-
PROVIDED #VICTIMS VICTIMS VICTIMS VICTIMS VICTIMS DATE
(grant year) 1sT QTR 2ND QTR 3RD QTR 4T"QTR TOTAL#
(7/1-9/30) (10/1-12/31) (1/1-3/30) (4/1-6/30) VICTIMS
1. Crisis Counseling
2.Follow-up 50
3.Therapy
4. Group
Treatment/Support
5. Shelter/Safehouse
6. Info/Referral in 40
Person
7. Crim Just
Support/Advocacy
5
TYPE OF SERVICES PROJECTED ACTUAL# ACTUAL# ACTUAL# ACTUAL# YEAR-TO-
PROVIDED #VICTIMS VICTIMS VICTIMS VICTIMS VICTIMS DATE
(grant year) 1ST QTR 2N°QTR 3R°QTR 4 "QTR TOTAL#
(7/1-9/30) (10/1-12/31) (1/1-3/30) (4/1-6/30) VICTIMS
8. Emergency Financial
Assistance
9. Emergency Legal
Advocacy
10. Victim Comp 30
Assistance(required)
11. Personal Advocacy 50
12. Telephone Contact 40
(Info/Referral)
13. Crisis Hotline
Counseling
14. Other(specify):
TOTAL 210
During this grant period we intend to:
► Continue the Assistant Ombudsman's presence of 16-20 per week in Weld County long
term care facilities, for the purpose of providing a consumer voice for the concerns of
elderly living in institutions and to be able to promptly address any instances of
mistreatment or abuse.
► Continue and expand implementation of the "Ensuring an Abuse Free Environment"
training (CARTE), for C.N.A.'s, managerial staff and volunteer Ombudsmen.
► Maintain and distend the volunteer program to sustain the current 2 volunteers and to
continue to recruit, and train an additional 6 volunteers. Volunteers assist the Ombudsman
program for increased visibility with friendly visits. Volunteers are also involved in the
CARIE training process, as well as the C.N.A. training program. From November 04 -
October 05, volunteers contributed 437 hours to the Long Term Care Ombudsman
Program. Although volunteer recruitment and retention is challenging, we have
successfully retained 4 significant volunteers. Additionally, the temporary volunteers have
gained much insight regarding the Ombudsman Program and other services, such as victim
assistance.
Timetable:
Visit 600 long term care residents and investigate 100 complaints by June 2007.
This is a continuation request to proceed with the future CARTE training.
The ongoing and enhanced Elder Abuse Prevention Program timetable will be as follows:
► Maintain the Alzheimer's disease training for direct care staff who work with
residents inflicted with Alzheimer's disease. The Ombudsman Program will
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continue to combine efforts with the Rocky Mountain Chapter Alzheimer's
Association to educate individuals on older adults and Alzheimer's Disease. The
Assistant Ombudsman and Alzheimer's Association Coordinator will provide
Alzheimer's Disease trainings to 60 direct care staff by June 30`h, 2007.
► Continue offering the Abuse Reporting section of our current Ensuring an Abuse
Free Environment Evaluation.
► Continue to provide the Victims' Rights and Victims' Assistance portion in our
Abuse Free Training.
► Continuous CARTE training to 100 direct line long term care staff along with 30
administrative and management staff by June 30`h, 2007.
► Provide condensed version of Elder Abuse Prevention Training to 230 C.N.A.
students through the AIMS Community College Training Center by June 30`h, 2007.
Heighten volunteer program:
• Recruitment and marketing to continue on a monthly basis from July ls`, 2006-June
30`h, 2007.
• Screening and orientation of new volunteers to proceed on a monthly or as needed
basis from July 15t, 2006-June 30th, 2007.
• Training and support to continue on a monthly basis from July ls`, 2006-June 30`h,
2007.
• Expand role of one volunteer to assist with the instruction of the AIMS C.N.A.
Training Program, and additional Ombudsman presentations as needed by
December 3l51, 2006.
Impact of Crime Program (formerly known as Victim Empathy for Offenders):
The purpose of this program is to have offenders experience empathy for victims.
• Continue a routine presentation schedule through the Probation office of Weld
County. We continue to be the sole advocacy program that speaks to this group
regarding victims of elder abuse.
• Continue to speak on behalf of residents who reside in long term care facilities on a
routine basis.
Sexual assault intervention and reaction program:
• Provide sexual assault education program for long term care facilities.
• Coordinate guest speakers to present on sexual assault prevention and reaction
tactics.
• The Ombudsman Program will serve as a voice for residents in long term care
settings by attending monthly Sexual Assault Resource Team (SART) meetings, as
well as quarterly Coordinating Committee for Victims of Crime (CCVC) meetings.
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Objective 3: To provide the following services to positively impact older adults residing in long
term care facilities.
TYPE OF SERVICE PROJECTED# ACTUAL# 181 ACTUAL# ACTUAL# ACTUAL# YEAR-TO-
(grant year) QTR 2N°QTR 3RD QTR 4TH QTR DATE TOTAL
(7/1-9/30) (10/1-12/31) (1/1-3/31) (4/1-6/30) #
1.Friendly/Educational Visits Total: 600 NH= NH= NH= NH= NH=
AL= AL= AL= AL= AL=
Other= Other= Other = Other= Other=
Total =
2. Complaint Investigations Total: 100 NH= NH= NH= NH= NH=
AL= AL= AL= AL= AL=
Total=
3.Abuse Free Training 100 Persons Persons Persons Persons Persons Persons
(C.A.R.I.E.) Summer off
TYPE OF SERVICE PROJECTED# ACTUAL# 1ST ACTUAL# ACTUAL# ACTUAL# YEAR-TO-
(grant year) QTR 2N°QTR 3R°QTR 4TH QTR DATE TOTAL
(7/1-9/30) (10/1-12/31) (1/1-3/31) (4/1-6/30) #
4. Managerial Training 30 Persons
5.Volunteer 6 Persons Persons Persons Persons Persons Persons
Program/Training
6.Certified Nursing Assistant 240 Persons Persons Persons Persons Persons Persons
Training
7. Community Education 350 Persons Persons Person Persons Persons Persons
8a. Resident Council 80 NH= NH= NH= NH= NH=
Meetings Nursing Homes
8b. Resident Council 60 AL= AL= AL= AL= AL=
Meetings Assisted Living
Facilities
9.Attend SART Meetings 10
10.Attend CCVC Meetings 3
TOTAL Visits: 600 Visits: Visits: Visits: Visits: Visits:
Complaints:100 Complaints: Complaints: Complaints: Complaints: Complaints:
#Trained: #Trained: #Trained: #Trained: #Trained: #Trained:
Meetings: Meetings: Meetings: Meetings: Meetings: Meetings:
Total: Total: Total: Total: Total: Total:
How Goals and Objectives will be accomplished:
Under the guidance of the Lead Ombudsman, the Assistant Ombudsman will continue to
be assigned a specified number of long term care facilities to visit on a regular basis. Sixteen to
twenty hours per week will be allotted for visitation and travel time. The average visit per facility
will be one hour, however the visit could take longer if there is a need. During the first 3
quarters of 2005-2006 funding cycle, the Assistant Ombudsman and Ombudsman Volunteers
made visits to 592 residents of long term care facilities and investigated 233 complaints.
The Elder Abuse Prevention Program is based on a training module called the CARIE
program also known as, "Ensuring an Abuse Free Environment"training. CARIE consists of
eight training modules, each focusing on an important aspect of abuse issues including,
identifying and recognizing abuse, the possible causes, understanding the complex issues
surrounding care-giving, cultural and ethnic perspectives, resident/staff dynamics, ethical and
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legal issues, how to report abuse and intervention and prevention strategies.
The Assistant Ombudsman will continue to utilize this curriculum to train staff and
residents at long term care facilities, students attending Aims' Nurse and C.N.A. Training Center,
and others in the community. The Assistant Ombudsman has designed a condensed version of the
CARTE training program, which will continue to be used to meet the changing needs of the long
term care facilities in Weld County. Topics discussed include the following types of elderly
abuse: physical, emotional, sexual, financial, abandonment, and neglect. Training individuals
about elder abuse is very important for several reasons.
First, the older adult population is the most vulnerable and frail. Many older adults rely
on other people to take care of their activities of daily living and finances. Second, abuse of older
adults is under reported. Many states including Colorado do not have mandatory reporting of
elder abuse. However, Weld County has experienced an increase in reported incidences. This
could be due to education, awareness, and empowerment on abuse issues, but also could indicate a
heightened number of abuse occurrences. The Assistant Ombudsman will continue to track the
reported number of abuse cases. Third, older adults (especially those 85+) are the fastest growing
segment of the population.
Anticipated problems in implementing goals and objectives:
Currently, the program has two active volunteers, and the Assistant Ombudsman continues
to progressively recruit potential dedicated volunteers. Unfortunately, the program has an
ongoing challenge of recruiting appropriate and reliable volunteers. The Assistant Ombudsman
will continue to recruit and screen potential volunteers for appropriateness.
Staffing issues continue to be a major crisis in long term care facilities. For this reason,
the Assistant Ombudsman continues to be flexible and open to suggestions from long term care
facilities regarding training programs. If necessary, the developed programs can be modified to
meet the needs and schedules of those working in long term care facilities. We do not anticipate
any problems of reaching the new goals and objectives for July 2006-June 2007. The Assistant
Ombudsman will be able to fulfill the original goals and objectives while enhancing the
Volunteer, C.N.A. training, Sexual Assault training and CAME programs.
Effectiveness Evaluation:
To evaluate the effectiveness of the CARTE program, the Assistant Ombudsman will
continue to collect data from evaluations that are distributed at the end of each training session.
This data continues to be utilized to determine if the goals and objectives of the program are being
met. This information will also be used to enhance and modify the program as needed. The
success of the Ombudsman Volunteer Program will be measured by monitoring the number of
additional visits, educational sessions and volunteer satisfaction surveys will be evaluated. In
addition to previous years, the results of this year's evaluations highlight how valuable the CARIE
training is for staff working in long term care facilities.
Program goals as related to the V.A.L.E. statute:
This program continuation request most relates to 24-4.2-105, Section 2, part a and part b.
Part a addresses provision of service for early crisis intervention. As mentioned earlier, there
is evidence that when there is constant and continuing community presence in long term care
facilities the potential to improve the quality of life and prevent abuse and exploitation is reduced
for the residents. We intend to continue advocate contacts with long term care residents as a
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preventive move. We know that there may be many bathers to the elderly, particularly those in
long term care facilities, to express their individual needs without assistance from others. Some
of these barriers are physical due to loss of sight, speech, or hearing. Some bathers are
psychological due to a sense of isolation, fear of retaliation, or disorientation. Barriers to self-
advocacy can also be related to the lack of information about rights, alternatives, and legal
remedies.
Part b addresses assistance programs for victims and their families. A key role of the long
term care Ombudsman is complaint investigation and complaint resolution. Long term care
residents must be assured that the Ombudsman will be able to follow up on their complaints in a
timely and professional manner. With the continued increase in long term care beds, the ability of
the present Ombudsman to respond appropriately to complaints will be jeopardized. The
extension of the friendly visitor/advocate under this proposal will continue our Ombudsman hours
insuring that the Lead Ombudsman and the Assistant Ombudsman will be able to respond to
residents and their families in a timely and appropriate manner.
Case Number 1: Sexual Inappropriateness
The Assistant Ombudsman investigated an allegation of a competent male resident taking
advantage of a female at-risk adult. Specifically, the resident had a diagnosis of Advanced
Alzheimer's Disease, however, she was documented as having the ability to make some decisions.
The Director of Nursing at the facility witnessed the male resident fondling the female resident's
breast in the hallway of the nursing home. The Director of Nursing contacted the Assistant
Ombudsman and stated that it was the facility's intent to discharge the male resident. Through
investigation, the Ombudsman found that the male resident had been admitted to the nursing
home ten years ago, despite exhibiting similar behaviors. The male resident also had a long
history of physical disability, resulting in a decreased ability to harm others physically. In
addition, the Assistant Ombudsman found that this resident had a history of inappropriate
behavior around children.
The Assistant Ombudsman met with the female resident and found that she was unable to discuss
the incident, possibly due to memory impairment. The facility staff had also interviewed the
female resident and did not find evidence that she had been harmed emotionally or physically.
The Assistant Ombudsman found that the facility did not have just cause to discharge the male
resident, based on the following: the female resident was not exhibiting any mental or physical
anguish related to the incident; the facility staff chose to admit the male resident knowing he had
such behaviors; and the male resident was easily redirected after the incident. As a result, the
Assistant Ombudsman had the challenging task of advocating for both residents. The facility had
an obligation to protect the female victim, other female residents at the facility, and community
children who enter the building. In addition, the facility staff had the responsibility of keeping the
male resident in the building, although behavioral, and attempting to manage his behaviors. The
Assistant Ombudsman advocated for the female victim and suggested that the social worker meet
with her on a frequent basis to observe for possible signs and symptoms of stress related to her
previous interactions with the male resident. Since the male resident was competent and aware of
his actions, the Assistant Ombudsman proposed that the facility develop a contract for the resident
to prevent further incidents from occurring. The contract could also be used to address any
concerns regarding community children (reportedly, no incidents involving children had taken
place during the male resident's ten year stay).
The Assistant Ombudsman continues to follow this case closely and maintains frequent contact
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with the victim and her husband, the other female residents, the male resident involved and the
facility staff. This would not be possible without the VALE dollars.
Case Number 2: Family Issues Regarding Physical Restraints
This year the Assistant Ombudsman was contacted by a distressed family member, who was
concerned about her father's frequent falls at the facility. She was very upset about the fact that
the nursing home was unwilling to use physical restraints for him while he was in his wheelchair.
The family member felt that this is why the male resident continued to fall and injure himself.
The Assistant Ombudsman obtained permission to discuss the issue with the nursing home
administrator and the director of nursing. Through investigation, the Assistant Ombudsman found
that the facility had in fact attempted to use a lap belt and a lap tray while the resident was in his
wheelchair. Unfortunately, this only agitated the resident and he began trying to remove the lap
device and would also try to stand with his wheelchair. The Assistant Ombudsman coordinated a
meeting with the resident's family and the nursing home staff to discuss safety risks involved with
restraints. All parties agreed to meet.
The Assistant Ombudsman advocated for the resident by educating the family on issues
surrounding restraints. Reportedly, many residents with memory impairment have had accidents
involving restraints that have resulted in serious injury and even death. In fact, nursing home
facilities must make sure that each resident lives as restraint free as possible. In this case, the
facility's Fall Risk Committee found that all restraints would not benefit this individual, and
would actually put him at risk for additional falls.
The Assistant Ombudsman worked closely with the facility to educate the family and develop
other methods of dealing with the resident's fall risk. Although the information was presented
appropriately and thoroughly, the family continued to be adamant about the resident needing
wheelchair restraints. As a result, the Assistant Ombudsman recommended that the family discuss
the issue further with a representative from the Alzheimer's Association, and if necessary, the State
Health Department. The Assistant Ombudsman continues to routinely visit with this resident and
offers additional suggestions for fall prevention as needed.
Case #3 Solicitations of Older Adults in Long Term Care Facilities
A variety of situations have taken place within long term care facilities that have affected or could
potentially affect the safety and welfare of vulnerable at-risk adults. In response to numerous
reports of solicitors targeting residents, the Long Term Care Ombudsman Program has developed
a pilot project to alert long term care facilities when suspicious incidents have taken place. The
following examples are just some of the possible scenarios that have occurred and would trigger
the Alert System.
Situation A: A male in his 30's entered a local nursing home in the middle of the night at
approximately 3 am. Reportedly, the male appeared have an erection and looked very suspicious
while walking quickly up and down the hallways, peering into residents' rooms. One of the
nurses on duty approached him and asked him what he was doing in a nursing home so late at
night. The nurse reported that he became nervous and stated that he wanted to get an application
for employment. The nurse gave him an application and he left immediately. The Assistant
Ombudsman discussed this case with the nursing home administrator and suggested that future
suspicious incidents need to be reported.
Situation B: A male salesman from the Denver area was contacting older adults by phone,
stating that they had been entered into a drawing to win a free specialized bed, which was worth
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$3,000. He required that each individual that he had contacted provide him with a$50 service
fee. Unfortunately, the salesman contacted an 86 year old female resident, who had Medicaid as
her pay source. The salesman traveled from Denver to the area nursing home and collected a $50
check from the resident. Luckily, the female resident felt uncomfortable about the transaction and
reported her concern to the social service director. The social service director then contacted the
Ombudsman Program to report. The Ombudsman Program worked closely with the facility to
resolve the problem. The Better Business Bureau was contacted, and the social service director
called the salesman directly, demanding that he return the resident's check to her. In the end, the
money was returned to the resident and she did not suffer any additional financial losses.
Situation C: A male realtor contacted a female resident who resided in a Weld County nursing
home. The resident was on Medicaid and had actually been declared incompetent. The realtor
entered the building on occasion and announced that he was taking the individual to see a show
home that he had available. The nursing home administrator intervened and the Ombudsman
Program was contacted for reporting.
Situation D: An extremely hard of hearing male resident received a flier in the mail, stating a
sale price for a brand new Cadillac. Reportedly, the resident felt that this was a personal
invitation and felt obligated to take advantage of this opportunity. Although the resident had no
funding available to purchase a vehicle, he somehow drove away with a new Cadillac. In addition
to not having funding, the resident also did not have a valid driver's license. The resident's family
and the facility staff contacted the Ombudsman Program to report, prior to taking the car back to
the dealership.
It is our goal that each long term care facility be notified of such incidents when they occur. The
Assistant Ombudsman will coordinate this pilot program, while maintaining confidentiality of
facilities and residents involved.
Section D: Service Information
Population and geographic are targeted:
Populations targeted are 60 plus elderly residing in nursing homes and personal care
boarding homes located in Weld County.
Numbers of persons in need of these services/Presently being served:
Approximately, 1,400 Weld County residents live in long term care facilities. All of these
residents receive services through the Ombudsman program, either directly with visitations and
complaint resolution or indirectly through training and technical assistance provided to staff to
improve the quality of care. By extension, the program also may represent the concerns of
relatives and/or friends of long term care residents as long as the concern reflects the concerns of
the resident.
Continuation of support will make it possible for the Area Agency on Aging Ombudsman
Program to continue to serve all of the long term care residents and their families with the same
type and degree of services that we currently are providing.
Duplication of Services:
There is no other program which provides services equivalent to the Ombudsman Program.
Community Support, Coordination and Networking:
(a) The Weld County Area Agency on Aging's primary goal is to help maintain an
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individual's independence and dignity in their homes and community by identifying and
advocating for their special needs. In order to accomplish this goal our agency works closely with
community providers to facilitate a means to obtain needed services quickly and efficiently to the
seniors in our community. We have formal agreements with agencies that we fund directly to
provide a variety of services to seniors such as: Elder Garden Adult Day Program, Senior Peer
Counseling through North Range Behavior Health and in home personal care through RVNA. We
have established coordination agreements with a number or other agencies such as: Greeley Police
Department, Sheriffs Office, Adult Protective Services, Weld County Victims Assistance, the
Probation Department, Social Services of Weld County, the District Attorney's office, the
Alzheimer's Association, local nursing facilities, and local assisted living facilities (PLEASE SEE
ATTACHED COORDINATION AGREEMENTS).
(b) The Weld County Area Agency on Aging is an active participant in Weld County's
Coordinating Committee for Victims of Crime (CCVC), and also a participant in the CCVC
Coordination Agreement. Currently, the active member is Raegan L. Maldonado, Lead Long
Term Care Ombudsman. The Lead Long Term Care Ombudsman anticipates further involvement
with future subcommittees, as assigned and needed in the CCVC meetings. It is pertinent for
Assistant Ombudsman to be involved in this committee and she has been attending CCVC
meetings. The Assistant Ombudsman will offer to share information from our"Ensuring an
Abuse Free Environment" training with the members of CCVC. In addition, the Lead
Ombudsman routinely presents information to the CCVC committee about other networking
groups available in the community that focus on aging and adult services.
c) The Weld County Area Agency on Aging has been actively involved in TRIAD since its
formation in Weld County. Currently, Marcia Jorgensen, Assistant Long Term Care Ombudsman,
attends the TRIAD meetings and provides pertinent information from TRIAD to the rest of the
Area Agency on Aging staff. In addition, the Lead Ombudsman attends the "SART" Sexual
Assault Resource Team meetings. The Weld County Ombudsman Program is actively involved in
the Weld County Community Resource Network, as well as the Weld County Governor's White
House Conference on Aging.
Crime Victim Compensation Program:
(a) The Weld County Area Agency on Aging regularly informs victims about Victim
Compensation. For example, during a sexual assault case involving an at-risk adult, the
Ombudsman's office assisted the victim's family in applying for services. The victim's family
and the Ombudsman used resources available through Victim Compensation during the time of
the trial. Such resources include the Victim Assistance area set up for victims and families at the
Weld County courthouse.
(b) The Weld County Area Agency on Aging and the Ombudsman program do not foresee
any issues that would prevent informing crime victims of the Victim Compensation eligibility
requirements and information regarding victims' rights. We would also be able to provide
assistance to those individuals who are unable to apply for assistance independently.
(c) Our agency receives Victim Compensation training for direct services staff and
volunteers on a regular basis. The last training was provided by Karol Patch from the District
Attorney's office on April 27th, 2005, which took place at the Weld County Area Agency on
Aging. Tony Tilger also presented to our group on April 27`h, 2005. We are scheduled to attend
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the 2006 training on April 3`'. This training session will be provided by Karol Patch. Also, the
Weld County Ombudsman Program participated in the Greeley Police Department Victim
Assistance and COVA training regarding Victims' Rights and Case Studies on April 151, 2005.
The Ombudsman Program participated in the Victim Awareness Luncheon on April 8`h, 2005, as
well as the Weld County Commissioners declaration of Victims' Rights Week that took place on
April 11`h, 2005.
Staff and Volunteer Training:
The Weld County Area Agency on Aging continues to take the steps necessary to assure
that pertinent staff and volunteers have read and understand the rights afforded to crime victims.
(a) Our agency notifies victims about their rights under VRA.
(b) To assure that pertinent staff and volunteers are trained on VRA, our agency
coordinates training seminars with the Colorado Organization for Victim Assistance (COVA), and
with the District Attorney's Office.
(c) The last COVA VRA training took place on September 16, 2002 at the Weld County
Area Agency on Aging. Other agencies were invited to attend this training. Kerry Johnson
provided the training, and COVA indicated that future training would be possible. In addition, the
Lead Ombudsman attended a COVA training during a quarterly CCVC meeting on September
10`h, 2003. Terri Livermore provided this training. The last VRA training provided by the District
Attorney's office took place on April 27th, 2005 and was conducted by Karol Patch. The Weld
County Ombudsman Program anticipates further VRA training from Karol Patch in the near
future. Other agencies have been invited to participate in this event.
(d) When appropriate, the Area Agency on Aging notifies victims of their rights under
VRA by referring individuals to the District Attorney's Office Victim Assistance Program. As
mentioned above, the Area Agency on Aging referred the victim of the sexual assault case and her
family to the District Attorney's Office. The Ombudsman Program also educates residents,
families, and facility staff on residents' rights and provides them with resources.
(e) Ombudsman brochures, provided in English and Spanish.
Cost Savings:
When an advocate visits a long term care facility and discovers issues that affect the direct
health of a resident, the advocate can facilitate and coordinate care with the facility to enhance the
resident's plan of care to help reduce the problem from escalating. There are considerable
medical savings to the taxpayer(most nursing home residents are on Medicaid) when extreme
medical procedures can be avoided. When long term care patients are restrained, not only is it a
violation of individual rights,but an opportunity is missed to administer therapies, which can help
the patient become more independent. The ombudsman, again, can identify these situations and
work with the staff to develop alternate interventions which will respect individual rights and give
the patient care that may increase his/her potential to be independent. Dependence costs society.
Elder abuse education is invaluable to reduce incidences that occur. When a resident is
exposed to an abusive situation the experience can cause not only physical, but also emotional,
psychological, and social damage. The resources used to investigate and monitor these incidences
are costly and limited, the Ombudsmen become a valuable resource to assist and prevent abuse in
long term care facilities. Repercussions from abuse result in expensive and time consuming
therapies and utilize valuable resources allocated for the community. The abuse education
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provided by the funds from this grant help to raise awareness and allow intervention before abuse
situations occur.
Management Plan:
The Director of the Weld County Area Agency on Aging will be accountable for the
administration of this project. The part time Ombudsman advocate will continue to be trained
and supervised on a daily basis by the Lead Ombudsman under the supervision of the Weld
County Area Agency on Aging Director.
Service Providers:
Lead and Assistant Ombudsmen along with volunteers will provide the proposed services.
Interestingly 19.7 of the current volunteers indicated they would be interested in increasing the
number of hours currently volunteering. The respondents stated one of the primary reasons for
volunteerism is they feel useful when helping others. In order for the Ombudsman program to
continue to meet the needs of the ever-growing long term care population, we must expand the use
of volunteers in the program.
The Assistant Ombudsman has taken the lead in regard to volunteer recruitment, training
and supervising. The increase of Ombudsman presence in all of the long term care facilities may
allow intervention to transpire before abuse situations occur.
Section E: Efficiency
Evaluation of project:
The Ombudsman Program maintains files that generate monthly, quarterly, and annual
reports. Data is kept on numbers of visits, complaints, referrals and technical assistance contacts.
Data is broken down further to reflect types of interventions, types of complaints, types of
facilities, and actions taken. This data is analyzed by the state Ombudsman office to assist in
determining the efficiency of the program.
In addition, the Ombudsman Program has developed and utilizes a client satisfaction survey. It is
anticipated that these questions will assist with measuring the quality of Ombudsman services
provided to residents, families and community individuals. Overall, the 2005-06 survey response
was positive. At the conclusion of the current grant period, the Ombudsman Program will have
provided CARTE training for CNA staff representing all nursing homes and the majority of
Assisted Living Residences in Weld County. This is evidenced by the number of contacts made
by the end of 2005-06 3"' quarter, 592 residents visited and 233 complaints investigated by the
Assistant Ombudsman. This would not have been possible without the funds from the V.A.L.E.
grant.
Cost / benefit ratio:
Due to the complexity and uniqueness of the program, the current cost benefit ratio is
difficult to determine as we provide a combination of training, technical assistance and direct
service to an unlimited number of residents and family members. However, we do know that
early intervention by the Ombudsman can prevent costly medical costs that may have resulted due
to poor quality of care.
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Section F: Budget
Future funding needs:
Future funding needs will correlate with how much growth occurs in long term care beds
in Weld County. The current growth spurt is statewide and is reflective of the rapid increase in
numbers of elderly 75 years of age and older who are frail and in need of some type of long term
care. Assisted living continues to be a fast growing industry in all areas of Colorado and the
nation. Area Agencies on Aging nationwide are working to bring this to the attention of federal
and state governments emphasizing the need for support of the Ombudsman Program.
Budget Narrative:
We are requesting $8,500 dollars for a .25 FTE advocate/friendly visitor for 16-20 hours PER
week and supervisory oversight for a total of$7,700 for salary. Travel reimbursement will be at
.385 cents per mile for approximately 2077 miles equaling $800. Mileage records will be kept
by the Assistant Ombudsman for documentation.
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