Hawaii’s lone ombudsman asks neighbor islands to speak up for long-term care residents
KAILUA-KONA — John McDermott said if neighbor islands want the best care for their most vulnerable seniors then citizens must do for those people what he’s made a career of doing for the elderly — advocate.
The mission of the long-term care ombudsman program is advocacy for residents living in long-term care facilities. Hawaii is home to 1,702 such facilities serving more than 12,000 long-term care residents.
According to the guidelines set by the Institute of Medicine, that ratio demands six full-time ombudsmen across the state. Instead, Hawaii’s program employs only one — McDermott — rendering it the smallest long-term ombudsman staff in the country.
“The feds, the Administration on Aging, want me to visit every facility at least once a quarter,” McDermott said. “That would be 28 facilities a day. It’s not at all possible.”
Senate Bill 530 — which made its way through the Senate and was subsequently sent to the House of Representatives where it’s already passed one joint hearing and awaits approval from the House Committee on Finance — wouldn’t afford McDermott all the help he says he needs.
But it would be a start.
If passed, the bill would allocate $150,000 to the program and allow McDermott to spend half that money to hire a full-time, paid ombudsman for Oahu. The other half would go toward hiring a part-time employee for each of the neighbor islands, where a system of volunteers tries to patch what gaps it can in advocacy for long-term care patients.
“My feeling is that the neighbor island folks have been waiting way too long, way too patiently,” McDermott said. “It’s supposed to be a statewide program providing regular and timely access to all of the long-term care residents, and instead it really has been providing mostly access to Oahu because that’s where I live and that’s also where the office is.
“We really need the neighbor island folks to put pressure on the legislators that this is something that’s really important.”
McDermott’s current budget is just shy of $31,000 — money he says is spent entirely on airfare and car rentals so he can catch up with as many long-term care residents as possible.
The work of the ombudsman program is crucial, he added, because many seniors have no family nearby to monitor their situations and ensure their rights are maintained, their needs are met and their voices are heard.
He said many such residents are reluctant to complain about anything, fearing retaliation. But when they begin to build a relationship with people like McDermott, understanding they have someone on their side who will listen to them and protect them, that person becomes like a trusted family member.
Executive Director of Life Care Center of Kona Holly Raymer said relationships between ombudsmen and service providers operating above board tend to be positive, as they’re all out to achieve the same goal — the preservation of residents’ rights leading to the best possible care.
Hawaii’s ombudsman program is allowed to train volunteers to fill the gaps left by under staffing. It has trained nearly 180 of them over the last 15 years, according to SB530. However, it currently staffs only eight.
Raymer said there is no regular volunteer who fills that capacity at the Life Care Center of Kona, adding that in her two years there, McDermott is the only resident advocate with whom she’s dealt. That’s the primary reason she supports SB530.
“I absolutely think that one man is not enough for the whole state,” she said.
McDermott’s work load has also recently increased, as Centers for Medicare Services has instated a new rule that long-term care facilities must report every discharged patient to the ombudsman program.
McDermott said this is needed because some facilities try to push patients out once reimbursements decrease, typically after around three weeks, using tactics involving bullying or manipulation and claiming they are only licensed as rapid recovery units so as to cycle more patients in and out and make a greater profit. Such a licensing paradigm doesn’t exist, he said.
This type of behavior isn’t necessarily more common on neighbor islands, but because of a pronounced lack of advocacy on Hawaii Island, Maui and Kauai, it might be easier to get away with in those locations.
“Neighbor Island folks, they really need to speak up, otherwise everything stays in Honolulu and it’s not fair,” McDermott said. “Why should you have to wait for the crumbs to fall off Honolulu’s table?”
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