Long Term Care Ombudsman Program - Frequently Asked Questions

 

Frequently Asked Questions:

Is there a fee for ombudsman services?

There is no charge for services provided through the ombudsman program.

What is the process to file a complaint with the ombudsman program?

Complaints are taken from, or on behalf of, long term care residents. Anyone can contact the program and provide information for investigation through a telephone contact, an email, through a letter or other written communication, a conversation during a visit by the ombudsman at the facility, or by appointment in the office.

Is there a way to maintain confidentiality and still file a complaint?

Yes, the identity of a complainant or resident cannot be released without permission

Are the ombudsman program activities public information?

The specific activities or cases are confidential and not considered public information due to strict confidentiality guidelines. Only,summary data is included in reports compiled through agencies at the county, state, and federal levels.

Does every long term care facility have an ombudsman  visit regularly?

All long term care residents are entitled to access ombudsman services. Regular visits are limited by staffing resources; many volunteers work in the program and provide a regular presence in many of the facilities.

What resources are available to help someone choose a long term care facility?

There are lists of licensed long term care facilities on this website. The best indicator for your choice is a personal visit with comparison notes based on things that are important to you. CMS has developed a 5-star rating system for nursing homes based on a variety of factors, including licensing surveys. In addition, the Maryland Office of Healthcare Quality provides a link OHCQ for the assisted living surveys which provide areas of deficiencies that have been cited.    

What role do volunteers have within the ombudsman program?

Volunteers are a vital component to the timely and successful advocacy efforts. They are citizens who receive specialized training in the skills of complaint resolution, care issues, and resource referrals for long term care residents. They visit residents in the long term care facilities and work on resident-directed concerns. They support resident council and family council activities in long term care facilities in their surrounding communities.

What is the difference between assisted living and group home?

 Assisted living facilities offer housing with qualified staff for senior citizens who need some help with everyday tasks from cooking and cleaning to bathing, dressing or taking medicine. Assisted living homes are usually large facilities that include amenities such as private units, physical therapy services, recreation rooms, barber shop and beauty parlors, pharmacies and fitness centers. Assisted living facilities range in sizes form large communities of 100 or more residents to smaller communities with 15 or less residents.

Group homes are typically smaller units with three to 16 residents. Group homes offer housing to residents in need of social assistance, and who are usually deemed incapable of living alone or without proper supervision. People who live in group homes may be senior citizens, abused or neglected youths, youths with behavioral or emotional problems or persons that are developmentally challenged.

How do I decide which assisted living facility would be best for my loved one?
  1. Ask to look at most recent state surveys (done yearly and when there are complaints). Owners/administrators are required to have them available. Note: Virtually all surveys have deficiencies (state looks for problems), but look for issues and ask how the facility resolved them.
  2. Trust your gut - ask yourself some questions and try to answer them such as: How does the facility look, smell and sound like? Do people look well taken care of? What is your feeling when you first walk into a facility?
  3. Talk to staff - as there are no state regulations on staffing ratios,  make sure you feel comfortable with the ratio during…times like morning/evenings. When people are getting ready for day or bed. Ask staff about their longevity.
  4. Group Homes -ask about owner involvement. In small group homes, we find that successful group homes have significant owner involvement and visits.
  5. IF YOU SELECT an ASSISTED LIVING FACILITY, LOOK OVER THE CONTRACT CAREFULLY! A lot of our complaints stem from contract issues. You can amend contracts.
  6. Go to our website and review: Nursing Home Checklist
What is the difference between Medicare and Medicaid?

Medicaid, also called Medical Assistance, is a program that pays the medical bills of certain needy and low income individuals. It is administered by the Sate and pays medical bills with Federal and State funds.

Medicare is an insurance program that pays medical bills for persons with money from the Social Security Trust Fund. Medicare is for almost everybody who is age 65 or older, whether they are rich or poor. Medicare also helps disabled persons who are under age 65 who have been receiving Social Security Disability Insurance payments for 2 years and certain persons with kidney failure. Medicare pays for nursing home services only under very limited circumstance. Medicare does not pay for assisted living.

Where do I apply for Medicaid?

Call the Montgomery County MA (Medicaid) Long Term Care Program at 240-777-3005 or click here for more information.

What will I need to do when I apply?

When you apply, you will need to complete and sign an application form. The application form will request complete and detailed information on your financial situation. You will have to show that this information is true before a decision on your eligibility can be made. A person knowledgeable about your circumstances may represent you during the application process.

What determines if Medicaid will pay for my nursing home care?

 If you are a U.S. citizen, Maryland resident, and at least 65 years old or disabled, eligibility for Medicaid is based on your income and resources (assets). Income includes but is not limited to: wages, Social Security benefits, pension, and Veteran’s benefits. Resources include but are not limited to: bank accounts, stocks, bonds, trusts, annuities, property, and life insurance. The way income and resources are evaluated and the amounts that you may have and still be eligible for Medicaid are established by law.

 Also, in order for Medicaid to pay for your nursing home care, it must determine that you need the health care services provided by a nursing home. For further information, please refer to the Medicaid and/or Medicare website.