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Long-Term Care (LTC)
Ombudsman Program The ombudsman program serves residents in Oklahoma who are living in nursing homes, assisted living, and residential care homes. An ombudsman helps improve the quality of life and the quality of care available to the residents. The long-term care ombudsman is a person who receives complaints from residents of long-term care facilities, their friends, relatives or agencies. The LTC Ombudsman attempts to resolve those complaints within the facility. The ombudsman has the authority to explore problems and recommend corrective action. Nature of the Program If you want to check complaint experience on a facility or if you think you need an ombudsman’s help, contact the LTC Ombudsman Supervisor for the area in which the facility is located. Checklist of Needs
After placing a person in a facility, an Ombudsman may be needed to:
Nursing Home Care The nursing facility provides 24-hour skilled care and related services for residents who require medical or nursing care. These facilities are licensed under the Nursing Home Care Act, 63 O.S. Supp. 1998, Section 1-1901 et seq., and the Regulations for Licensure of Nursing and Specialized Facilities, OAC 310:675. Nursing facilities are designed to provide long-term nursing care, or for persons convalescing from illness which are not appropriate for a hospital or available through home care programs or other alternatives. Besides providing 24-hour care, a room, meals, help with daily living, and daily activities are included. Residents have health problems which keep them from living on their own and may require daily medical attention. Nursing facilities are expected to provide a high quality of life and care for all residents. For more information, check the following Web sites: Nursing Home Compare and State Health Department Survey Information at www.medicare.gov, The National Consumer Voice for Quality Long Term Care (formerly NCCNHR) www.theconsumervoice.org, AARP Nursing Home Resource at www.aarp.org, and the Oklahoma Nursing Home Long-Term Care Provider survey/Inspection Search: https://surveys.health.ok.gov/ What is a Skilled Nursing Facility?OBRA 87 amends the Medicare provisions of the Social Security Act, found at section 1819 of the Act. OBRA's Medicare requirements are also contained in the United States Code, at volume 42, section 1395i-3. As found in the OMNIBUS Budget Reconciliation Act of 1987 as amended through 1991 Medicare requirements: 13951-3. Requirements for, and assuring quality of care in, skilled nursing facilities: Skilled nursing facility defined In this subchapter the term "skilled nursing facility" means an institution (or a distinct part of and institution) which - (1) is primarily engaged in providing to residents - (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, and is not primarily for the care and treatment of mental diseases; (2) has, in effect, a transfer agreement (meeting the requirements of section 1395x (1) of this title) with one or more hospitals having agreements in effect under section 1395cc of this title and (3) meets the requirements for a skilled nursing facility described in subsections (b), (c), and (d) of this section. For more information, check the following Web sites: Nursing Home Compare and State Health Department Survey Information at www.medicare.gov, The National Consumer Voice for Quality Long Term Care (formerly NCCNHR) www.theconsumervoice.org, AARP Nursing Home Resource at www.aarp.org, and the Oklahoma Nursing Home Long-Term Care Provider survey/Inspection Search: https://surveys.health.ok.gov/ Assisted Living Assisted living means any home or establishment offering, coordinating or providing services to two or more persons who: are domiciled therein; are unrelated to the operator; by choice or functional impairments, need assistance with personal care or nursing supervision; may need intermittent or unscheduled nursing care; may need medication assistance; and may need assistance with the transfer and/ambulation as defined in Section 310:663-1-2 of the Oklahoma statutes. {63:1-890.1.1} Costs vary with the residence, unit size, and the types of services needed by the residents. Medicaid does not cover costs of assisted living facilities. Also, pay close attention to contracts or agreements as they differ from facility to facility. What Types of Services are Offered in Assisted Living Facilities?
For more information on Assisted Living in Oklahoma, contact the Oklahoma Assisted Living Association at www.OKALA.org or call: 405.235.5000 or contact Argentum (formerly the Assisted Living Federation of America) at: www.argentum.org Residential Care Facility "Residential care home" means any home, establishment, or institution licenses pursuant to the provisions of the Residential Care Act other than a hotel, motel, fraternity or sorority house, or college or university dormitory, which offers or provides residential accommodations, food service, and supportive assistance to any of its residents or houses any resident requiring supportive assistance. The residents shall be persons who are ambulatory and essentially capable of managing their own affairs, but who do not routinely require nursing care; provided, the term "residential care home" shall not mean a hotel, motel, fraternity or sorority house, or college or university dormitory, if the facility operates in a manner customary to its description and does not house any person who requires supportive assistance from the facility in order to meet an adequate level of daily living; A residential care home may provide assistance with meals, dressing, bathing, and other personal needs, and it may assist in the administration of medications. However, it cannot provide medical care. Residents need to be ambulatory. Some residential care homes are located in large facilities while others are in small homes. Medicaid does not pay for a people to live in residential care facilities. For more information, check the following Web sites: Nursing Home Compare and State Health Department Survey Information at www.medicare.gov, The National Consumer Voice for Quality Long Term Care (formerly NCCNHR) www.theconsumervoice.org, AARP Nursing Home Resource at www.aarp.org, and the Oklahoma Nursing Home Long-Term Care Provider survey/Inspection Search: https://surveys.health.ok.gov/ Continuum of Care Facility "Continuum of care facility" means a home, establishment or institution providing nursing facility services as defined in Section 1-1902 of Title 63 of the Oklahoma Statutes and one or both of the following: (A) assisted living center services as defined in the Continuum of Care and Assisted Living Act; and (B) adult day care center services as defined in Section1-872 of Title 63 of the Oklahoma Statutes {63: I-890.2.4}. Continuum of care facilities gives the consumer a choice of settings that can be adjusted to meet their needs and capabilities. When living in a continuum of care residents might not have to be discharged based on short-term variations in their health status or ability to ambulate. This type of facility combines the services of a nursing home with an assisted living center or an adult day care center. For more information, check the following Web sites: Nursing Home Compare and State Health Department Survey Information at www.medicare.gov, The National Consumer Voice for Quality Long Term Care (formerly NCCNHR) www.theconsumervoice.org, AARP Nursing Home Resource at www.aarp.org, and the Oklahoma Nursing Home Long-Term Care Provider survey/Inspection Search: https://surveys.health.ok.gov/ Intermediate Care Facility SUBCHAPER 11. INTERMEDIATE CARE FACILITIES FOR THE MENTALLY RETARDED (16 BEDS AND LESS (ICF/MR-16)310:675-11-1. Scope This subchapter is applicable to small facilities serving the mentally retarded which provide residential accommodations and transitional living training to aid residents in adapting to live in the general society. Resident accommodations are limited to not more than 16 residents, plus any required "live-in" staff. Facilities qualifying under this subsection shall be exempt from other subsections of this Chapter, except as may be specifically referenced in this subsection. In addition to these requirements, all facilities must meet the provisions of the Nursing Home Care Act. ICFMR is a specialized facility providing health care or habilitation services to individuals with mental retardation or developmental disabilities. "A specialized facility is any home, establishment or institution that offers or provides inpatient long-term care services on a 24-hour basis to a limited category of persons requiring such services, including but not limited to a facility providing health or habilitation services for persons who have mental retardation or developmental disabilities." You can find the definition of specialized facility in the Nursing Home Care Act and also in Ombudsman policy. ICFMR is not defined within those acts but the purpose of the directory the specialized facility is applicable. Some homes have more than 16 beds. Directory of Licensed Facilities Resources
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