KEN IGE / KIGE@STARBULLETIN.COM
John McDermott, long-term care ombudsman with the Executive Office on Aging, shows a board with the sites of state facilities.
Volunteers are needed to monitor and investigate complaints by the thousands of frail, ill and aged Hawaii residents in long-term care facilities around the state. Care-home scrutiny expands
By Helen Altonn
haltonn@starbulletin.comThey would be trained in the program run by Hawaii Long Term Care Ombudsman John McDermott.
"We have so many people who don't have anybody visiting, who can't defend themselves, who have no access to a phone. Who are they going to complain to?" said McDermott.
His program was established in the Executive Office on Aging under the Older Americans Act of 1965 and mandated in all states in 1987.
McDermott and others worked three years to set up Hawaii's program. The 2001 Legislature provided $90,000 for two years of operation.
Staff members are Bobbie Kucera, volunteer ombudsman coordinator who developed policies, procedures and a training program, and Mika Arikawa, clerical assistant. An ombudsman specialist is being recruited.
The ombudsman is required to visit each facility at least once a year -- so volunteers are crucial, McDermott said.
The long-term statewide goal is to have 700 volunteers visiting the 8,060 residents in all 46 nursing homes, five assisted-living facilities and 560 adult residential care homes, he said.
Since January last year, 23 Oahu volunteers have been trained, and Kucera hopes to expand training to evenings and weekends to encourage more working people to participate.
McDermott said he hopes to have volunteers on the neighbor islands by the end of this year.
He said complaints are low here -- averaging about 135 for each of the past two years -- compared with other small states. But this is possibly because "it's not the culture in Hawaii to complain," he said.
He said his office has received some "really horrible calls," but most involve some kind of misunderstanding. "A lot of it is general information on payments, rights residents have regarding transferring from one room to another and informed consent regarding medications."
The daughter of an incontinent resident recently complained that the facility limited her mother to five diapers a day and forced her to use a bed pad when they ran out, McDermott said.
Facilities try to hold costs down because Medicaid pays a low rate, he said. "We don't want facilities closing their doors because there is not enough money, but they need to cut in other ways. Diapers shouldn't be limited.
"The good news is the administrator heard the complaint and won't limit diapers for her mom. But what about the others (who don't complain)?"
The state Department of Health can replace an administrator, revoke a license or fine a facility $10,000 a day for violations, he said.
"But our role is not adversarial. ... We're trying to finesse a solution the resident will be happy with and, for the most part, the facility is happy with. There is no need to bump it up to the DOH licensing branch, but we definitely will do it if the resident wants us to do it."
Volunteers are trained to look for certain things amiss, including whether facilities are posting staffing ratios, the ombudsman's phone number, grievance procedures and residents' rights. State surveys citing deficiencies also must be accessible to the public.
McDermott said Hawaii is one of few states with inter- generational volunteers, ranging in age from 20s to 70s. Participants include retired professionals and students concerned about the quality of life for senior citizens.
"The reward is, they appreciate our services," said retired nurse Helen Hu, one of the first volunteers with Mae Fujii and William Wiley.
The volunteers meet the last Monday of each month in the ombudsman's office, 260 S. Hotel St. This week, they shared stories and concerns about burnout, grief when residents die, angry residents and those who won't or can't talk to them.
Sidney Nakamura said he was close to burnout because of the death of residents with whom he developed a personal relationship.
Kucera suggested taking a break from the program when burnout begins to occur and "stopping to ask, Why am I here?"
"You do become attached to certain people, and you grieve when they die, almost like a family," said William Posenecker, noting he asked to be at the bedside of some residents who had no one else when they died.
Grace Kobata, who recently earned a master's degree in gerontology at the University of Hawaii-Manoa, said it is difficult for her to talk to middle-age people who have had strokes because sometimes they cry at a memory.
"Crying can be cleansing," Kucera said, explaining it's OK to let them cry. "Anger works the same way," she said.
Verna Eddy said a former pharmacist at her facility is frustrated and mad because he is in a wheelchair and feels helpless. "He doesn't see any point in being alive. I just listen. He's happy to talk."
Lily Toyama, volunteering for a practicum in psychology at the University of Hawaii-West Oahu, said many residents grab her to discuss their problems.
"They think I'm with the hospital and ask, 'Can you get me out of here?'"
Fujii, retired McKinley High School teacher, suggested reaching nonverbal people by touching their shoulder or hand. "There is a response, a flicker of an eyelid."
McDermott said families may stop visiting unresponsive loved ones, which puts them at greater risk for neglect. "Your job as advocates is to make sure they're not ignored."
"I can't tell you how important you all are," Kucera added. "You're only one person, but just the fact that you're in a facility is a big plus."
Care program seeking volunteers The Hawaii Long Term Care Ombudsman Program is seeking volunteers to help promote quality of life and care for residents of long-term care facilities.
They must be at least 21 years old; complete an application, criminal background and tuberculosis test; and commit to one year with the program.
They are asked to spend two to four hours once a week at a facility near their home. Training involves 20 hours in a classroom and two four-hour visits at a facility.
Call 586-0100 for more information.
