Comptroller Stringer Investigation Reveals Chronic Underfunding of Long Term Care Ombudsman Program Amid COVID-19 Pandemic

(New York, NY) – Today, New York City Comptroller Scott M. Stringer released the findings of an alarming new investigation amid the COVID-19 pandemic revealing massive underfunding of the Long Term Care Ombudsman Program (LTCOP). Long-term care ombudsmen serve as essential eyes and ears to protect older adults and people with disabilities within long-term care facilities; they identify cases of abuse and neglect, advocate for resident needs and raise quality of life concerns. New York State ranks fourth in the nation in the number of people institutionalized in long-term care facilities; yet in 2017, the City did not contribute any funding to the program and the State spends less than $600,000 annually on the City’s LTCOP. The COVID-19 crisis highlights the need for the City and State to sufficiently fund the City’s LTCOP. The Comptroller’s analysis, supported by federal and state reporting, suggests that in addition to the disproportionate impact of the virus, residents of nursing homes are plagued by improper administration of drugs, pressure ulcers, inappropriate discharge to homeless shelters, and mistreatment by other residents.

To ensure there is a sufficient number of ombudsmen available to protect the City’s more than 50,000 older adults and people with disabilities in long-term care facilities, Comptroller Stringer issued a set of recommendations to address the substantial lack of State and City funding for this critical program, including calling on the State to equalize funding for the LTCOP in the City with that of upstate funding; providing City funding for New York City’s LTCOP to assist with long-term care; and ensuring that funding levels allow for at least one full-time ombudsman for every 2,000 residents and one for every long-term care facility citywide. Comptroller Stringer also urged greater oversight and accountability measures, including regular public reporting and annual hearings, to review the program’s findings and efficacy.

“This investigation is heartbreaking, especially as New York City continues to battle the global COVID-19 pandemic that has devastated our parents and grandparents in long-term care facilities. As New Yorkers, we’re defined by how we treat our most vulnerable. Tragically, our failure to support long-term care can be measured in human suffering amid the pandemic,” said New York City Comptroller Scott M. Stringer. “The disproportionately high number of COVID-19 deaths among our long-term care facility residents must be a wake-up call. We must step up, implement stronger oversight and accountability measures, and provide adequate funding for the ombudsmen program to guarantee that beloved friends and family are appropriately protected and that long-term care facilities are safe and secure environments for older adults and New Yorkers with disabilities. It is unacceptable that any of our most vulnerable residents experience neglect, abuse or misconduct in the City’s long-term care facilities. The City should not shirk its responsibility to the New Yorkers who built up our neighborhoods, stayed through the tough times, and remain the bedrock of our communities.”

The Ombudsman Program

The role of an ombudsman was created and shaped by the 1978 amendments to the federal Older Americans Act (OAA) of 1965 mandating each state establish a Nursing Home Ombudsman Program to advocate for older adults and those who reside in nursing homes. In 1981, the program was renamed the Long Term Care Ombudsman Program and expanded to cover long-term care facilities such as adult and assisted living homes. The program’s mission is to investigate and resolve complaints made by and on behalf of residents, and to promote the development of resident and family councils. They are also tasked with fostering dialogue with government agencies, providers and the public on issues impacting residents of long term care facilities, and monitoring laws and policies impacting this vulnerable population.

Subsequent amendments to the OAA further empowered and protected ombudsmen including mandating access to long-term care facilities; access to residents’ medical records upon completion of a record access training program; protection for the confidentiality of residents’ records, complainants’ identities, and ombudsmen files; immunity for the good faith performance of their official duties; and protection from willful interference with their duties.

Ombudsmen Are Necessary Eyes and Ears for Long Term Care Facilities

The COVID-19 crisis has exacerbated issues faced by long-term care facilities, which are often understaffed, frequently pay low salaries to aides resulting in high staff turnover, and rely on temporary aides from staffing agencies. With the recent prohibition on visitors, residents can feel isolated by the lack of continuity of care and human contact.

Ombudsmen notice changes in residents’ conditions overlooked by overworked staff, identify abusive or neglectful behavior, and advocate for residents. They review discharge notices, including examining involuntary discharges to ensure that due process and legitimate reasons for discharge have been provided to residents. Ombudsmen also help residents cope with everything from day-to-day quality of life issues to critical problems affecting health and safety.

Ombudsmen in New York City

New York City falls so far below the Institute of Medicine (IOM)’s recommendations and the national average of full-time ombudsmen per resident bed that, if ranked as a state, it would be last. The IOM recommends that one full-time ombudsman be assigned for every 2,000 beds. Nationally, there is one for every 2,355 beds. However, coverage in New York State and City is far worse. In 2018, New York State was ranked 40th nationally in full-time ombudsmen per bed.

• As of 2018, there is only one full-time paid ombudsman for every 8,650 residents in New York City and one full-time paid ombudsman for about every 3,600 beds in the State’s long-term care facilities, far below the recommendation of one full-time ombudsman for every 2,000 long-term care residents.
• In Queens over 17,000 residents in 84 facilities are supported by a single full-time ombudsman aided by nine volunteers.
• There are only six full-time paid ombudsmen assigned to visit the City’s over 50,000 long-term care residents in 244 long-term care facilities.
• There is no assigned ombudsman for more than 20,000 residents in 80 long-term care facilities.
• The City has one-third of New York State’s long-term care residents, yet the LTCOP managed by the Center for the Independence of the Disabled New York (CIDNY) received less than one-seventh of the State’s funding and no funding from the City.
• The last annual report detailing the work of the Office of the State Long Term Care Ombudsman was released in 2017, and the last State or City public hearings held on the program were also in 2017, limiting insight into the most recent data from the program.
• In 2017, New York State spent less than $7.34 per resident bed on its LTCOP, while the remaining 49 states, on average, spent more than twice that amount: $14.70. The State spends less than $600,000 annually on the City’s LTCOP.

Effect of the Shortage of Ombudsmen

Due to the underfunding and shortage of ombudsmen in New York City, over 20,000 residents in 80 nursing homes do not have an assigned ombudsman, whether full-time or volunteer, as of 2017. In addition to better serving residents and families during the current COVID-19 crisis, appropriate funding and staffing of ombudsmen could address:

• The over 45 percent of the intake calls the Center for the Independence of the Disabled New York (CIDNY) received during 2016 and 2017 that came from long-term care facilities where no volunteer ombudsman was available, making a timely and appropriate response and resolution difficult.
• CIDNY’s insufficient capacity to review the over 1,500 monthly notices of discharge it receives, many of which happen without appropriate planning.
• Recruitment of and training for potential City volunteer ombudsmen. As of March 2019, CIDNY had over 65 potential volunteers interested in becoming ombudsmen, yet months-long delays before the required training is available discourages volunteers from continuing with the program.

Conclusions and Recommendations

Comptroller Stringer’s investigation of the City’s long-term ombudsman program found that New York City’s LTCOP is severely lacking in its ability to hire full-time staff or obtain volunteer ombudsmen to assist with advocacy on behalf of older adults and people with disabilities. In addition, the City contributes no funding to this program. New York City’s LTCOP can maintain only one quarter of the full-time staff per resident bed ratio than LTCOPs average elsewhere in the United States, and only half the ratio elsewhere in New York State.

To correct the massive challenges plaguing the LTCOP program and protect long-term care facility residents amid the COVID-19 pandemic and beyond, Comptroller Stringer proposed a series of recommendations, including:

• The State should increase funding for the City’s LTCOP to at least $2.5 million annually to ensure proportional funding for the City and the rest of the State.
• The City should contribute funds for its LTCOP to assist its long-term care residents.
• Total funding should be increased so that:
  • There is at least one full-time ombudsman for every 2,000 residents, which would mean 25 full-time ombudsmen for the city.
  • There is a sufficient number of volunteers for weekly visits to every city facility.
  • Every city long-term care facility has at least one ombudsman.
• The Office of the State Long Term Care Ombudsman release reports detailing the number, nature, and resolution of complaints raised through the ombudsman program as a whole and by region, for 2018, 2019, and all years going forward.
• The State Senate and Assembly should hold annual hearings to review the program and the complaints that are unearthed by ombudsmen during their work, and the New York City Council consider doing the same for the New York City region of the program.
• Long-term care facilities provide ombudsmen with access by phone and/or internet to residents able to employ such methods to the greatest extent feasible.

Comptroller Stringer’s recommendations build on findings laid out in his 2017 report, Aging with Dignity: A Blueprint for Serving New York City’s Growing Senior Population, which found that older New Yorkers required delivery of effective and appropriate services to ensure this vulnerable population can age in place. That report also found that older adults who age in place in their own homes are more socially engaged than those who live in institutional settings like nursing homes, due to better health outcomes including depression, physical function, and muscular strength — demonstrating how nursing home residents are more vulnerable and isolated than the general senior population, and need an external voice to be their advocate in their communities and in the halls of government. Ombudsmen are that voice.

To read Comptroller Stringer’s investigation of the Long Term Care Ombudsman Program, click here.

To read Comptroller Stringer’s Aging with Dignity: A Blueprint for Serving New York City’s Growing Senior Population report, click here.

###