WISCONSIN’S PROCESSES
FOR MONITORING
NURSING HOME CLOSURES
MITIGATING TRANSFER TRAUMA
RELOCATION OMBUDSMAN
SPECIALIST
Thomas LaDuke; Relocation Ombudsman Specialist
State of Wisconsin
Board on Aging and Long Term Care
Works anywhere five or more residents are being
relocated
• 15 years an Ombudsman
• 10 years the Statewide Relocation Specialist
NUMBERS OF NURSING HOMES
RELOCATING RESIDENTS
Since March, 2006
• Nursing Home Closures
• Nursing Home Down-sizing
• Nursing Home Conversions
21
4
2
• Nursing Home Replacements
45
• All have been voluntary and financially driven.
TRANSFER TRAUMA
OR RELOCATION STRESS
• Relocation Stress Syndrome, also called Transfer
Trauma, is a formal nursing diagnosis and defined
as “physiologic and/or psychosocial disturbances
as a result of transfer from one environment to
another.”
• It is otherwise defined as “the combination of
medical and psychological reactions to abrupt
physical transfer that may increase the risk of grave
illness or death.”
STATE LAW AND FACILITY CLOSURES
wis stats 50.03(5m) RESIDENT REMOVAL.
(a)Departmental authority. The department may
remove any resident from any facility…when…:
5. The facility is closing, intends to close or is
changing its type or level of services or means
of reimbursement accepted and will relocate
at least 5 residents or 5 percent of the residents,
whichever is greater.
DEPARTMENTAL RESPONSIBILITIES IN
RESIDENT REMOVALS
• The department must then
• Offer relocation assistance
• Prepare removal (relocation) and transfer trauma mitigation
plans to assure safe relocations and to protect the health,
safety, welfare and rights of residents
• Provide, direct or arrange for planning, placement and
implementation services to minimize transfer trauma and to
ensure the orderly relocation of residents
• Involve the county
RELOCATION PLAN
REVIEW AND APPROVAL
The facility must…
• Notify the department of its intentions (consult sooner than later)
• Submit a relocation plan (template available)
The department must…
• Approve or have plan modified in 10 days. Can impose a plan if the facility can’t
develop one
• No residents may be relocated until the department approves the plan
• Upon approval, the facility establishes a target date of closing that may not be earlier
than 90 days fewer than 50 residents will be relocated, or 120 days if more than 50.
The Ombudsman reviews and monitors that protections are in place.
RELOCATION TEAMS
IMPLEMENT RELOCATION PLANS
MITIGATE TRANSFER TRAUMA
Department of Health Services
Division of Long Term Care Relocation Specialist
FACILITY
Administrator
Social Worker
Nurse
STATE
Regulators
COUNTY
ADVOCATES
Resource Center
Ombudsmen
Managed Care Organizations
P&A
RELOCATION TEAM
ORIENTATION CALL
• Discusses roles in and processes for residents safe
and orderly relocation
• Discusses Plans an announcement and
informational meeting
• Discusses the rights of the residents and steps to
prepare for relocation
• Discusses Team processes for regular reports and
monitoring of plans
RESIDENT AND FAMILY
INFORMATIONAL MEETING
• Facility sends an Invitation and Letter of Intent. It formally
announces the plan to close. Reassures relocation assistance
to be provided
• Ombudsman sends and posts an introductory letter
• Relocation Team Members introduce programs and offer
assistance and resources
• Residents and Family Members provided with an opportunity
to ask questions and vent concerns
• Links made and follow up meetings arranged.
TEAM PROCESS
State and Advocates
monitor
Facility and Care managers
•
•
•
•
•
Weekly Meetings (person or phone)
Written and verbal reports on a roster
Review each resident’s condition and druthers
Monitoring the process for adequate planning
Problem-solving
Ombudsman represents and promotes resident’s interests
and preferences, and protection of rights
RELOCATION AND DISCHARGE
PLANNING PROCESS
1.) Convening an initial (relocation) planning meeting to develop a
relocation plan to assist the resident in exploring options for alternate
living arrangements (including referrals, tours, exchanges of information
and assessments); and
2.) Implementation of that relocation plan to include multiple tours as
desired/indicated (and subsequent planning sessions as needed);
~.~.~.~.~.~
3.) Convening a second (discharge) planning meeting to develop a
discharge plan that details the final steps to be taken to safely relocate
and support the residents during transfer; and
4.) Implementation of that discharge plan to assist and fully support the
resident in relocating and settling into the new location.
REPORTS ON FOLLOW UP ACTIVITY
Reports on Follow up calls and visits to assure the
success of the relocation and to work out any
problems/issues that may be occurring in the new
setting.
•
•
•
•
The Facility
The Managed Care Organization
The Advocates
The Department
OMBUDSMAN INVOLVEMENT
• Regularly present in the facility. Tours to meet with residents and
visitors and to monitor conditions
• Participates in planning conference upon invitation
• Presents to resident council upon invitation
• Consults with facility staff and team
• Represents residents interest and promotes preferences on
relocation team. Monitors for protection of rights.
• Coordinates visits and follow up activity with regional and
volunteer ombudsmen
BEST PRACTICES
LEGAL PROTECTIONS
•
Relocations must be safe and done in an orderly fashion.
•
Process must be person-directed with a focus on relocation stress mitigation.
•
Process must protect the residents’ health, safety, welfare and rights.
•
Process must allow for the development of relocation and discharge plans that fully prepare the
resident for transfer. Subsequent care providers must be adequately prepared to serve the resident as
well.
•
Residents must be kept informed and involved in the process, and provided with all required notices.
•
Residents must be provided with enough options that take proximity to friends/family into consideration,
and no resident can be forced to relocate to or remain in any placement (without a court order.)
•
Residents must be offered opportunities to tour proposed alternate living arrangements and may require
multiple visits for increasingly longer periods of time.
•
Residents must be provided with adequate assistance and support with moving and shouldn’t have to
bear any cost of relocation.
•
Facility cannot close until each resident has been relocated to suitable and acceptable alternate living
arrangement.
ISSUES
• Poor planning and Hasty Relocations for
Expediency Sake
• Limited Suitable Options for Placement nearby
• Alternate Care Providers pressuring the individual to
move (or lose the bed)
• Resident and Family fatigue
• Closing Homes feeling Need to Close Quickly
WHAT’S NEXT FOR WISCONSIN
Work Group Convened to…
• Revise the Relocation Manual
• Improve Processes for Announcing a Closure
• Improve Tools to Better Monitoring and Facilitate
the Process
RESOURCES
• Wisconsin DHS Relocation Manual
• Wisconsin BOALTC website: longtermcare.wi.gov
• Should Your Facility Close…You Still Have Rights
• Relocation Awareness
• Discharge Planning Guidebook
• Making the Right Choice
CONTACT
Thomas LaDuke; Relocation Ombudsman Specialist
State of Wisconsin-Board on Aging and Long Term Care
1402 - Pankratz Street; Suite 111
Madison, WI 53704
262-654-4952 (telephone)
262-654-6194 (fax)
[email protected]