The Advocate vol. 2, 2015

This communication tool comes from the Office of the State Long-Term Care Ombudsman to long-term care facilities administrators and directors. The Office's objective is to share information regarding various topics of long term care.

Considering a Living Will

A living will is a written declaration informing medical personnel whether certain life-sustaining procedures should be withheld or withdrawn if (1) you are in a terminal condition; and (2) you are unable to decide for yourself. You (the declarant) may execute a living will declaration as a stand-alone document or you may include a living will within a health care power of attorney document. A living will can be revoked at any time and in any way by communicating the revocation to anyone who was aware that the living will existed.

Involuntary Discharge from a Long-Term Facility

An involuntary discharge from a long-term care (LTC) facility occurs when the facility provides a 30-day written notice to a resident informing him/her of the need to move out of the facility. The notice must set out the reasons for the transfer or discharge as well as state the effective date, location of transfer or discharge, statement of appeal rights and the contact information (name, address and telephone number) for the Office of the State Long-Term Care Ombudsman.

Resident & Family Councils in Nursing Facilities

Resident and family councils are vital to the operation of a nursing home, providing a voice for residents and their families. Resident and family councils provide an organized method of creating change, providing support and improving the quality of life for nursing home residents. A resident council is an independent, organized group of residents who live in a nursing home and meet on a regular basis to promote and enhance the quality of life for all residents. A family council is a group of family members and friends of nursing home residents who work to maintain or improve the quality of life for nursing home residents.

Medicaid Home and Community Based Services Elderly Waiver Program

The Medicaid Home and Community Based Services (HCBS) Elderly Waiver program provides assistance to qualified individuals who are 65 or older and prefer to stay in their own home or another community setting when needing long-term health care services. The Elderly Waiver program provides services and support to older Iowans who are medically qualified for the level of care provided at a nursing facility but do not wish to live in a nursing home. The program allows older Iowans to age in environments that are familiar and comfortable, while saving money from expensive nursing home costs.

Volunteer Ombudsman Program

The Volunteer Ombudsman Program places volunteers in long-term care facilities across Iowa to assist the state’s team of Local Long- Term Care Ombudsmen carry out the duties of the Older Americans Act of 1965. The Office of the State Long-Term Care Ombudsman coordinates the Volunteer Ombudsman Program (VOP) to train and certify individuals who are interested in listening, empowering and serving as a voice for long-term care residents. Unlike facility volunteers, VOP volunteers do not assist residents with daily activities. Rather, they are responsible for making several unannounced visits to a specific facility each month to talk to residents and family members and identify concerns.

Long-Term Care Choices

Consumers today have many choices when it comes to considering long-term care – whether they wish to remain in their home or community or move into an assisted living program or nursing home. Choosing a long-term care option that best fits your individual situation can depend on the level of care you need, your location preferences, your lifestyle needs and your ability to pay. The best time to begin exploring your options is long before the need arises. That way, you can communicate your preferences to your loved ones and create a plan that meets your needs as well as your wishes.

Long-term Care Payment Options

As the population ages, many of us will be faced with the prospect of moving either ourselves or a loved one into a long-term care setting (nursing home, assisted living facility or elder group home). Whether the decision comes up suddenly following a hospitalization or gradually as care needs evolve, the question of how to pay for long-term care is certain to arise. Some people mistakenly believe that Medicare will pay for their long-term care stay, but while Medicare will pay for hospital costs and skilled nursing facility stays, it does not pay for long-term care. Rather, possible payment options for long-term care include private pay, Medicaid or long-term care insurance or veterans benefits.

Managed Care Ombudsman Program

In Iowa, the Managed Care Ombudsman Program was established to advocate for the rights and wishes of IA Health Link members who live or receive care in a health care facility, assisted living program or elder group home, as well as members enrolled in one of the seven home and community-based services (HCBS) waiver programs: AIDS/HIV, Brain Injury, Children’s Mental Health, Elderly, Health and Disability, Intellectual &/or Physical Disability. All services provided by the Managed Care Ombudsman Program are confidential and free of charge.

Sexuality & Aging: Debunking the Myths

As the American population continues to grow older, aging and sexuality has become a frequent topic of discussion. Specifically, questions have been raised about if and how older adults experience sexual desire; how dementia and other age-related health issues impact an individual’s ability to express desire for and consent to sexual acts; and whether older adults forfeit their right to intimacy once they move into a long-term care facility. By federal law, individuals residing in long-term care are afforded multiple rights, many of which are relevant to sexuality. These rights include but are not limited to: the rights to privacy, confidentiality, dignity and respect; the right to make independent choices; and the right to choose visitors and meet in a private location. The OSLTCO strives to preserve these rights by promoting attitudes of awareness, acceptance, and respect of sexual diversity.

Capacity vs Competency

“Capacity” and “competency” are terms that are often used interchangeably. However, under Iowa law and specifically within the context of an individual’s rights to make his/ her own decisions, there is a very important difference between the two words. An understanding of the difference between “capacity” and “competency” (as explained on this fact sheet) is essential to determine whether an individual’s consent is valid.

Health Care Power of Attorney FAQs

A health care power of attorney (HC-POA) is a document authorizing an attorney-in-fact (your designated agent) to make health care decisions on your behalf if you (the principal) are unable, in the judgment of your attending physician, to make health care decisions. Health care is defined as any care, treatment, service or procedure required to maintain, diagnose or treat a physical or mental condition. Through your HC-POA, you may authorize someone else to consent, refuse or withdraw consent to health care on your behalf.

Sexuality Expression in Long-Term Care

By federal law, individuals residing in long-term care are afforded multiple rights, many of which are relevant to sexuality. These rights include but are not limited to: the rights to privacy, confidentiality, dignity and respect, the right to make independent choices, and the right to choose visitors and meet in a private location. The Office of the State Long-Term Care Ombudsman strives to preserve these rights by promoting attitudes of awareness, acceptance, and respect of sexual diversity. Though outcomes to sexually-related situations vary innumerably, as each is different and must be considered independently, the OSLTCO believes a multidisciplinary effort is necessary to develop a thoughtful process from which to draw and support conclusions. It is not the responsibility of the long-term care facility or assisted living program (or a single staff member) to solely determine whether a resident/tenant should or should not be sexually expressive.

Visitation and Powers of Attorney

Resident’s rights are guaranteed by the federal 1987 Nursing Home Reform Law. This law requires nursing facilities to promote and protect the rights of each resident and places a strong emphasis on individual dignity and self-determination. Iowa has incorporated these rights into state law for nursing facility residents, assisted living and elder group home tenants. The attorney-in-fact’s authority is over health care decisions and visitation and access to a resident is not a health care decision. The law does not specifically set out restrictions on visitation as a right that the attorney-in-fact can exercise. Therefore, it is the position of the Office of State Long-Term Care Ombudsman that the attorney-in-fact does not have authority to determine visitation. As such, that right remains with the resident.

The Voice Vol. 4, 2014

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