Quarterly Update from the Ombudsman

Dear Friends!
 

We are proud to showcase our the new and exciting outreach activities undertaken by OOIE staff during the last several months. While the main work of the Office continues to be direct advocacy for people living in long-term care settings, we have also dramatically increased our presence in the community over the last three years.

Specifically, we continue to promote our Volunteer Advocate Program in order to reach our goal of having at least one advocate assigned to every Skilled Nursing Facility (SNF) in the state. In addition, our I Choose Home NJ/Money Follows the Person program is now fully staffed. The sole focus of this federally-funded program is to inform SNF staff, residents and their families about the availability of home- and community-based services that may make it possible for some SNF residents to return home.

As a result of these outreach activities, the ICHNJ team has identified about 130 individuals who have expressed a desire to transition back into the community. Many of these people have either already moved or are awaiting a community placement. If they are not eligible for ICHNJ, every effort is made to link them to an appropriate program to meet their needs.

Also as a result of our expanded outreach activities, we have seen an increase in the number of people participating in the OOIE Volunteer Advocate program. In mid-2011, the Volunteer Advocate Program had about 150 active volunteers. Today, the program has 210 volunteers with an additional 40 in the pipeline currently being trained and readied for placement in early 2014.

Finally, I am proud of the work my staff has done to broaden our outreach to include hands-on assistance to citizens in need in the City of Trenton, where the OOIE is headquartered. Taking our lead from Governor Chris Christie’s highly successful “Season of Service” campaign, OOIE staff recently lent a hand at the Trenton Area Soup Kitchen and Crisis Ministry food pantry. These activities, coupled with the important work we do every day, make me proud to head an agency that has such a direct and significant impact on the lives of our fellow citizens.

Wishing you all a healthy and happy holiday season.

- James McCracken

OOIE Outreach focuses on Community Service

Ombudsman James McCracken and staff at the Trenton Area Soup Kitchen.

Anticipating Governor Chris Christie’s annual “Season of Service,” the Office of the Ombudsman for the Institutionalized Elderly lent a hand to two major social service
organizations in the Trenton area.

OOIE staff are pictured with Crisis Ministry
Directors Carolyn Biondi and Mark Smith.

On November 12th, Ombudsman James McCracken and staff served New Jersey residents at the Trenton Area Soup Kitchen. Also, on November 22nd Ombudsman staff assisted the
Crisis Ministry food pantry by preparing food packages for distribution to local needy families.

The OOIE Outreach Office schedules these volunteer activities not only to give back to the local community but also to increase awareness about OOIE services among the state's most vulnerable and at-risk populations.

A Baby for Gram

Union County Volunteer Advocate Linda Mainker has developed a highly effective and innovative way to improve the lives of nursing home residents living in memory care units: giving them lifelike dolls.

“The idea to provide the residents with dolls in aiding them to remember their early days (came) after seeing a resident holding a great grandchild, ” said Mainker, who has been a volunteer advocate for 15 years. "The residents have responded positively.”

A Baby for Gram is a baby doll therapy program for memory care residents developed by Mainker,
one of OOIE’s most seasoned volunteers. Mainker also serves as a mentor to new advocates and
helped to edit the revised OOIE Volunteer Advocate training manual.

Residents who are “caring” for the realistic baby dolls tend to be more focused and less agitated during routine care and their attitude towards other residents and facility staff is improved, said Mainker, adding “Our capacity for love and nurturing is an inherent basic need.”

To date, the Volunteer Advocate Program has given away over 300 baby dolls in Union, Hudson, Essex and Morris Counties!

Focus on I Choose Home- NJ

Nikiah King, Outreach and Advocacy Coordinator

The I Choose Home NJ (ICHNJ) program, a federal program that moves willing and eligible seniors and disabled individuals out of institutions and back into home-based settings, is in full swing at the Ombudsman's Office. We have been tasked with promoting the program throughout the state, visiting every nursing home to identify possible participants, and spreading the message far and wide that "A Nursing Home (or Developmental Center) May Not Be the Only Option."

Since Spring 2013, our Outreach and Advocacy Team has identified approximately 130 individuals in nursing homes who want to move out, educated dozens of nursing facility social workers about a resident’s right to receive counseling about ALL of their possible living choices, and made appropriate referrals to the Department of Human Services to transition residents home under ICHNJ. So far, more than a dozen of these individuals have moved out under I Choose Home NJ, many others are awaiting transition, and still others who were not eligible have moved to more desirable settings and/or received counseling to explore all of their living choices.

As of December 2013, the ICHNJ Program has moved more than 900 individuals out of developmental centers and nursing homes and has saved the State more than $5 million (since 2008). By 2020, the ICHNJ Team will have transitioned more than 2,200 people and saved New Jersey taxpayers more than $35 million!

Please visit our website at www.IChooseHome.NJ.Gov to learn more about this program. And please reach out to us at 1-855-466-3005 if you know someone living in a nursing home or developmental center who has been living there 90+ days, is/will be eligible for Medicaid, would prefer to return to the community.

ICHNJ Outreach and Advocacy Coordinator for the southern region, Lea Hernandez, appeared on WEMG 1310 am’s “Camden en Marcha/Camden on the Move” radio show on Sunday, September 15. Lea spoke to Spanish speaking listeners in the Camden area about the Ombudsman’s Program, and the benefits of I Choose Home NJ and home- and community-based services.

On the Road with Jennifer Sills, Outreach and Advocacy Coordinator for ICHNJ

“If anyone were to ask me what I want out of life I would say - the opportunity for doing something useful, for in no other way, I am convinced, can true happiness be attained”. –Eleanor Roosevelt

These words are true to my heart.

Jennifer Sills writes about her ICHNJ experience

.

As an Outreach and Advocacy Coordinator for I Choose Home NJ (ICHNJ), I have the great pleasure of doing work that is useful and produces positive results for seniors living in nursing homes. I Choose Home NJ helps to transition people out of institutional settings – nursing homes and developmental centers – back to more independent community living with the supports and services needed to meet their health and social needs. I Choose Home NJ is not only great for individual participants, it is also saving NJ taxpayers millions of dollars in the process.

An average day for me starts by driving to Bergen, Hudson, Essex or Passaic County. In these counties I am visiting every nursing home, Aging and Disability Resource Center (ADRC), hospital, and any and all professional or community groups willing to hear the I Choose Home NJ message that “a nursing home may not be the only option.” I educate staff, residents, families, and health care professionals about the program, and search for individuals who have been living 90+ days in a facility, are Medicaid eligible, and who want to return to the community. Anyone familiar with Northeast Jersey can imagine that my GPS is my new best friend! I have had many opportunities to “re-calculate” my way through side streets and back roads.

Arriving at any skilled nursing facility is the best part of my day. Prior to this job, I worked for 20 years as a recreation therapist in nursing homes, and it is where I am most at home. I make connections easily with residents and we form a lasting rapport. My strong sense of advocacy makes it easy for me to discuss a person’s desire to return home, and to make the necessary connections and referrals to explore all of their possible living options.

A resident in Hudson County recently called me to ask a question to which he already knew the answer. I asked him, “Carl, why did you really call me?” His reply, “I really just wanted to chat.” Carl is in the process of transitioning back to the community with the support of Medicaid’s Global Options program and I Choose Home NJ. His greatest wish was that placement be found for him near water as he is an avid fisherman. It is these unique traits and characteristics in the people I meet that I take to heart and feel so strongly about.

Attending community outreach events has been an eye-opening experience for me. Recently, at the Caregiver Expo at the Bergen County ADRC, I was humbled to talk to many caregivers and learn what their daily lives are like. The caregivers in this state are often the backbone to the people we are helping to move back to the community. Children, spouses and siblings are the support staff that often goes unnoticed and unpaid. One caregiver son, caring for his mother since she returned from a nursing home, held back tears as he explained that his mother “was the best mother in the world - she took care of me, now it is my turn to take care of her.” This level of commitment and emotionality is something that the I Choose Home NJ staff witness often. It is moving and rewarding to help facilitate these types of resource connections and to strengthen bonds between families.

When I left work as a recreational therapist, one of the things I had to say goodbye to was twenty years of calling BINGO. However, in my first month as an ICHNJ Coordinator, I discovered that I could use my recreation skills to advance the I Choose Home NJ message, using Residents Rights Bingo as a platform to talk about choices that residents have, including where they want to live and how/where they want to receive their care. This is a great example of how the I Choose Home NJ Team is using each staff member’s strength to advance our message of deinstitutionalization. In a recent, very spirited game of BINGO, an elderly woman told me, “Well sweetheart, you get to call Bingo until you retire, then you get to play Bingo.” I am not making any predictions, but I have a feeling I may be “BINGO’d” out by that time…

Every day that I get into my car and travel to a new destination I know that I am given the responsibility to make a difference. I take this work and the purpose it serves seriously and with determination. The connections that I have made professionally and personally continue to be avenues of growth for me as an individual, a licensed Recreation Therapist, and most important, as an Advocate.

NJ Governor Signs Resident Bill of Rights

On October 17, 2013, Governor Christie signed into law a bill of rights for independent residents living in Continuing Care Retirement Communities (CCRCs). The bipartisan legislation, bills S2052 / A3132, will ensure that residents of independent living sections of CCRCs have an active role in decisions that impact their daily lives. It clarifies that a resident has the right to express a complaint without fear of interference, discharge or reprisal and has the right to contact the New Jersey Long-Term Care Ombudsman (known in the state as the Office of the Ombudsman for the Institutionalized Elderly). It also enumerates certain legal, medical and financial rights. New residents will receive a written copy of the resident's rights prior to the execution of a continuing care residency agreement and a statement of resident's rights entitled "Bill of Rights for Continuing Care Retirement Community Residents in Independent Living" must be posted in a conspicuous place and distributed to all residents. The Commissioner of the Department of Community Affairs may levy and collect penalties in the amount of not less than $250, and not more than $50,000, for each violation of the act. The act shall take effect May 1, 2014.

"On Air" with OOIE: Informing Radio Listeners About I Choose Home - NJ

 

Amy Brown, Director of Outreach and Advocacy for I Choose Home NJ, appeared on Joel Markel’s ‘Preferred Company’ radio show on WOBM 1310am last Thursday, September 12.  Joel and Amy discussed the I Choose Home-NJ program, the Ombudsman’s involvement in it, and the need for expanded home- and community-based services in NJ. For more information about the show, visit: http://wobmam.com/show/preferred-home-healthcare-today

Meanwhile, Outreach and Advocacy Coordinator for the Southern region, Lea Hernandez, appeared on WEMG 1310am’s ‘Heart of the Latino People’ radio show on Sunday, September 15, where she spoke to Spanish listeners in Camden about the Ombudsman’s Program, benefits of I Choose Home NJ, and home- and community-based service.

Volunteer Jocelyn Havison Partners with Twilight Wish Foundation

The unselfish act of one of our advocates, Jocelyn Havison, epitomizes the way in which both Twilight
Wish and the OOIE Volunteer Advocate program enrich the lives of New Jersey’s senior population.

A resident of The Homestead in Sussex County and an Air Force Veteran, Thomas Conklin, 72, has been
fighting multiple sclerosis for more than 38 years.  After noticing that Conklin was unable to get around with his existing wheelchair, Havison decided that she needed to help Conklin acquire a power chair that would give him the freedom to do the things he had come to enjoy, including venturing outdoors. 

Working with Conklin’s wife, Linda, and facility staff, Havison made contact with Twilight Wish Foundation.  Twilight Wish Foundation identified a donor to underwrite the cost of the power chair, which was delivered to The Homestead on May 1.

A special thanks to our advocate, Jocelyn, for her compassion, leadership, and perseverance making the impossible possible!

More information about Twilight Wish Foundation can be found at http://www.twilightwish.org/ .

OOIE Celebrates World Elder Abuse Awareness Day June 15, 2013

World Elder Abuse Awareness Day (WEAAD) was launched on June 15, 2006 by the International Network for the Prevention of Elder Abuse and the World Health Organization at the United Nations to provide an opportunity for communities around the world to promote a better understanding of abuse and neglect of older persons.

Unfortunately, no one is immune to abuse, neglect, and exploitation. It occurs in every demographic, and can happen to anyone—a family member, a neighbor, even you. Yet it is estimated that only about one in five of those crimes is ever discovered.

Raising awareness of mistreatment of older persons is an ongoing effort, not limited to one day. OOIE encourages you to get involved to help protect vulnerable senior citizens living in nursing home by becoming a volunteer advocate.

Becoming a volunteer advocate is one way to combat elder abuse and to make a meaningful difference in the lives of elderly residents living in a nursing home. Volunteer advocates receive 32 hours of training and are asked to spend four hours a week at a local nursing home, listening to residents’ concerns and advocating on their behalf.  To become a volunteer, call the OOIE Volunteer Advocate Program at 609-826-5053.

As Ombudsman McCracken always says, “The need is clearly there — will you answer the call?"

Gina Liberali Cavallo: A 'Champion of Change'

According to the White House “Champions of Change” website: “All across the country, ordinary Americans are doing extraordinary things in their communities to out-innovate, out-educate, and out-build the rest of the world.” 

Gina Liberali Cavallo, OOIE’s Volunteer Advocate in Passaic County, has gone beyond the doors of her assigned facility, Wayneview Care Center, to lend a hand in her community in the aftermath of Superstorm Sandy. Gina stepped in and organized teams of volunteers in the shore towns of Lavallette and Ortley Beach, and matched those who want to help with those affected – restoring the shore while restoring our faith in humanity.

As a result, Gina has been nominated, and is now a semifinalist, to be honored as a White House Champion
of Change and was selected by NJ First Lady Mary Pat Christie as a “New Jersey Hero.”

Our advocates really do make a difference in their community!  Congratulations, Gina!

Federal Money Follows the Person initiative becomes...

Director of Outreach and Advocacy Amy Brown

For those unfamiliar with I Choose Home - NJ (MFP), it is a federal program with two main goals:
to move people out of institutions back into the community, and to reinvest Medicaid dollars saved back
into home- and community-based services so that more people can age in place. Residents who are eligible for Medicaid, and have been living in an institutional setting for more than 90 days, may be able to participate in the program and transition out into an independent setting with Medicaid supports and services in their home. The State of New Jersey receives an enhanced federal Medicaid match for the first year that the individual resides in the community. Those cost savings are then invested to create more possibilities for others to remain in their homes and receive the services they need, rather than going into a nursing home.

OOIE now has a team of six staff members working full time on this project, in addition to help from our Chief of Staff and our graphic design specialist. Our Director of Outreach and Advocacy, Amy Brown, heads this initiative. Our Outreach and Advocacy Coordinators - Lea Hernandez, Jennifer Sills, Nikiah Nixon, and Dina Donnelley - who cover four NJ regions - are in the field every day educating nursing facility staff, residents, and their families about , the basic eligibility requirements, and potential services offered though I Choose Home - NJ. Staff is also attending numerous professional and community events -  conferences, seminars, trainings, senior expos, health fairs, and the like - to spread the I Choose Home - NJ message that "A Nursing Home May Not be the Only Option." In recent weeks we have distributed information at a half-dozen professional conferences, guest lectured a Masters-level social work class, given presentations at senior centers and “Resident Rights Bingo” events in nursing homes, trained other advocacy professionals, and educated our cadre of  about  200 Volunteer Advocates about their involvement in MFP.

We are working closely with the Department of Human Services to identify individuals in nursing homes who are interested in transitioning back to the community and then following up on those referrals. OOIE is also playing a larger role to ensure that Section Q (a section of a resident's assessment indicating that s/he wants to leave the nursing home and wants to explore options) are filled out properly and transmitted to the appropriate agency.

In addition, we are working hard to finish our marketing campaign that will launch later this year. We are building a website, ordering thousands of marketing materials, creating additional educational materials, and starting work on videos that will highlight individuals who have transitioned home successfully.

It is an exciting time for I Choose Home - NJ in the Ombudsman's Office. Help us spread the word that A NURSING HOME MAY NOT BE THE ONLY OPTION. If you or someone you know is Medicaid-eligible, has resided in a nursing home for more than 90 days and wants to move out, please call us: 1-800-HOME-005.

Talk to Your Loved Ones and Doctors about Advance Care Planning

Isaac Asimov said, “Life is pleasant. Death is peaceful. It’s the transition that’s troublesome.” 

But what if that troublesome transition could be avoided or lessened just by communicating effectively
with your loved ones?

Whatever your age or physical condition, now is the best time to have “the conversation” with your loved
ones and your doctors about advance care planning.

Advance care planning is a process where you communicate with your loved ones and care providers
to make sure the treatment and care you receive is aligned with what a good life looks like to you,
especially if you are unable to speak for yourself. It isn’t always easy, but it is important to make sure that
you are cared for and treated in a manner consistent with your wishes should you become seriously
incapacitated or nearing the end of your life – or both.

 “The conversation,” is the most critical part of advance care planning (ACP) and can remove some of the
challenges when you are seriously ill, and even when you are dying, and make that time of transition more
about what it should be – living.

Advanced care planning is a process that involves reflecting on your goals, values, and treatment preferences in the context of your current health and possible future situations and communicating those goals to loved ones and doctors; identifying someone to make decisions on your behalf in case you can’t; documenting your decisions; and revisiting these goals, values, and preferences as circumstances and feelings change.

You've likely heard of some of the most common advance care planning documents - living wills, health
care proxy, advance directives – and the recently available POLST (Practitioner Order for LifeSustaining
Treatment). Keep in mind these documents are valuable only to the extent that you've clearly talked to
loved ones and healthcare providers about what is in them.

The types of decisions you might wish to make as part of the advance care planning process
include:

• Determining who will make decisions on your behalf.
• Identifying what a good life looks like to you. For example, what you want to be able to do (gardening, listening to music, communicating with loved ones) or religious beliefs that should be followed when making health care decisions
• Establishing goals of care. For instance, do you wish to receive aggressive treatment so you can hit a particular milestone (graduation, birth of grandchild) or do you wish to receive treatment for only so long as you are living your definition of quality of life?
• Whether you want specific treatments, (for instance, a feeding tube).
• Defining what type of physical space you want. Do you want music or total silence? Do you want lots of family in attendance or very few? 

There are some very good reasons for you to begin this discussion now. Here are a few of them:

• You will be prepared. When a crisis hits or a critical decision has to be made, you will have an advantage. You will have a blueprint, conceived of and created by you, to help you and your loved ones make difficult medical and ethical decisions about your care.
• You will be a pioneer. While it has been reported that 33 percent of Americans currently have an advance directive, only 16 percent of New Jersey residents are similarly prepared. 
• You will strengthen the connection with those closest to you. During “the conversation,” you and your loved ones will be talking about your values, your goals, and the things that make your life worth living - some potentially deep emotional terrain.
• You will protect those you love. If you have not clearly explained the care you want or don’t want, the people you love will be forced to guess. One study showed that 63 percent of surrogates didn’t know what their loved one wanted. Studies also show that surrogates who had to make decisions without any guidance from their loved ones had higher levels of stress and more frequent, prolonged bouts with depression.
• You take control. “The conversation” will lay out your priorities, values, and goals so your proxy can make decisions consistent with them.

The consequences of not having an advance care plan are significant. For instance, despite the fact that 70
percent of Americans surveyed say they want to die at home, the reality is that only 30 percent actually do.The importance of advance care planning has become a frequent topic in the media including recent segments on ABC News, Oprah, NBC’s Rock Center, and Good Morning America. So it’s likely that the people closest to you will have heard about it.

And you don’t have to start from scratch: many “how to” resources exist to assist you in this process. Materials and information are available through The Conversation Project, The American Bar Association, Engage with Grace, and Five Wishes, among others.

Many of these tools are available for free.

So, be a pioneer, be prepared, connect with and protect your loved ones, and take steps to live your life on your terms until the very end.

Go ahead, have that talk –today.

Additional information about Advance Care Planning resources is available at www.nj.gov/ooie/helpful/yourcareyourchoice.html.

This article appeared in several daily newspapers in New Jersey in advance of National Health Care
Decisions Day on April 16.

OOIE Polls Volunteer Advocates in First-Ever Satisfaction Study

Late last year, the OOIE initiated a comprehensive satisfaction study among its approximately 200 volunteer advocates. This survey was critical to OOIE’s continuous improvement process and provided a formal way for volunteers to provide their feedback and suggestions to the Volunteer Advocate Program.  The survey was developed by the OOIE State Coordinator with input from the Regional Volunteer Coordinators.  Communications were put forth in advance of the survey distribution to notify the volunteers  and to encourage their participation.  The survey was anonymous and all results were analyzed by an independent research firm.

Here is what the Office of the Ombudsman learned from our Volunteer Advocates: The volunteers were asked about their employment status and length of time with the program.   Almost 55% of our advocates have been with the program for more than four years, more than 67% are retired and about 24% work full
or part time.

Training and Professional Development
The initial section of the survey gathered feedback on the support given to the Volunteer Advocates in the form of orientation for new volunteers, ongoing training opportunities and preferences for future training and development programs.  The comment section provided great insight into the training needs of the volunteer and, with the exception of the interest in webinar-based trainings, the volunteers largely agree with the quality of trainings.

Communication and Support
 Nine questions were included to evaluate the communication and support between the volunteers and OOIE staff.  On a scale of 1 through 5 (1= strongly disagree; 5= strongly agree), the average ratings range from a low of 3.91 (facility staff understanding the role of the volunteer advocate) to a high of 4.59 for support received from the program’s regional coordinators.  The OOIE was encouraged to see a 4.46 rating in response to the question:  I am clear on my roles and responsibilities as a volunteer advocate.

Overall Satisfaction
The final ratings on the survey gathered feedback on “big picture” items such as the volunteer’s overall
satisfaction, passion toward the work and likelihood of recommending others to serve as an OOIE Volunteer Advocate.

The OOIE has never surveyed our volunteers in this way before.  Based on this survey, it appears that the Volunteer Advocates are highly satisfied with their experience.  They are very passionate about their work and are likely to recommend the volunteer work to others.  We will use these results to improve support for our volunteers and will inform of future trainings as we enhance the quality of life of New Jersey’s nursing home residents.

(For the complete Volunteer Advocate Satisfaction Survey, please visit our website at www.nj.gov/ooie)

OOIE on the road!

NJ Long Term Care Ombudsman James McCracken and Warren
resident Antoinette D’Costa talk during his visit to Warrenbrook Senior Center.
Photo: Gwen Chalker

OOIE Director of Policy and Legislative Affairs,
Elizabeth Speidel, presents on Advance Care Planning
at the NJDONA Conference on April 15,2013.

OOIE staffers Jennifer Sills and Janet Khanlian attended
the Burlington County Senior Expo at the Fellowship Center
in Burlington on May 30, 2013.

I Choose Home-NJ Regional Coordinator,  Lea Hernandez, shared information about
the OOIE programs at the Cumberland County Senior Expo on May 10, 2013

Amy Brown, I Choose Home - NJ Outreach Supervisor, represented OOIE at  the National Association of
 Social Workers NJ Conference in Atlantic City on May 5, 2013.

Health Care Decisions Day event, hosted by Tri-County Regional Ethics Committee at
Fox Rehab HQ in Cherry Hill on April 16, 2013. This event was attended by many senior citizens
and featured  special appearances by Cherry Hill Mayor Chuck Cahn and Ombudsman James W.m McCracken.
Helene Weinstein, Treasurer for TREC and head of the sub-committee that coordinated this event,
presented an appreciation award to Jane Knapp,Helene Weinstein, Treasurer for TREC and
head of the sub-committee that coordinated this event, presented an appreciation award to Jane Knapp,
Chairman of TREC.

The OOIE Outreach team exhibited at the
LeadingAge New Jersey 2013 Annual
Meeting and Exhibition on May 29, 2013.