OMBUDSMAN: A FANCY WORD FOR ADVOCATE
While the tone of this blog is generally light-hearted, it’s also a place to share and possibly help others.
I was just thinking about something that happened in November several years ago where government worked quickly and smoothly – so quickly and smoothly, in fact, that I still shake my head in awe.
A loved one was in a nursing home. One evening, while Brian and I drove home in driving rain from an outing, Brian's cellphone rang. A nursing home official was calling to inform us that there was a problem with our loved one’s medications. Oh, the meds were working fine, that wasn’t the issue.
The problem was that the pills, which were provided to the nursing home via a mail-order drug provider required by our loved one’s insurance company, came in an assortment of mega bottles. The person at the nursing home who dispensed the meds had to unscrew each bottle and it was, well, a hassle.
We were advised by the official – let’s call her, I don’t know –how about Nurse Ratched, that we needed to provide the pills in individual packaging so that said pills could be dispensed in a more efficient manner. Further, she alluded, if we failed to do that, they could no longer accept the meds as provided. And, by the way, perhaps we could simply have the nursing home use its preferred medication provider.
As we drove home in the rain, our moods were gloomy as well. We considered how to proceed. What should we do? Well, we would begin by calling the loved one’s insurance provider the next day and see if they would send the pills in the single-serving packages that the nursing home could “pop out” for convenience. We called and the answer was no. They could not do that.
More phone calls were made to local pharmacies. Unusual question, we began, but if we brought in meds from our loved one’s insurance-approved provider, could a secondary pharmacy repackage them the way the nursing home wanted?
One pharmacist might be able to help, for a sturdy fee, of course.
We were in the midst of a mess. What could we do? At this point, I had not even considered that it was a matter of consumer rights.
Because I work for a newspaper, due to press releases, I have long known about LifeStream Services, a government-funded, non-profit agency that provides services and programs for seniors and people with disabilities. It’s a resource center that serves east-central Indiana. People living in other areas of the state or nation have other similar agencies under various names.
I called LifeStream, reaching out for guidance. I told the receptionist our dilemma and that if we had to drop our loved one’s insurance carrier, the meds would not be covered and would go from excellent coverage to none–all to suit the whim of a nursing home with its “policy” that meds be provided in single-serve packaging for the convenience of employees.
“You need to speak with our ombudsman,” said the receptionist.
Ombudsman? The only other time I had heard this term was in an article I read about a large newspaper with a staff ombudsman whose job was that of a “go-between” for the public and the paper to work out problems. I looked up the definition for the unusual term and it said: public advocate.
Naturally, the ombudsman was not in when I called the agency. However, I didn’t know how much time I had to spare before the nursing home pulled the plug on the meds we had already provided. So, I left as succinct a message as possible, complete with names of people involved and of the nursing home as well as phone numbers for all.
I figured I might or might not hear back from this mysterious ombudsman.
We weren’t home when the message was returned, but it was the next day or at the most, two. I could not believe my ears. The phone message from the ombudsman was this: I have checked into your problem, and there is nothing wrong with the way you are providing the medications for your loved one. I have informed the nursing home that you will continue providing the meds as you have been, and they will be using them as provided. In fact, the nursing home said there was surely a misunderstanding and that of course, they would be happy to keep using those meds, and there was no problem.
Very. Interesting. We were elated.
We never heard another peep about this issue.
It took some nighttime tossing and turning, concerned that we were about to see our loved one go from good coverage to thousands of dollars out of pocket a month if we had no other choice. It took frantic calls to the insurance providers and other possible parties that could help with this situation. It took some digging. Fortunately, we hit upon an agency with a state-provided ombudsman that could help us.
Here is the broader issue that infuriates me:
What about the elderly spouse of a similar loved one in a similar situation who doesn’t know his or her rights – we didn’t – but more, doesn’t know where to turn to figure them out, and even more than that, doesn’t want to make anyone mad or rock any boat. I could very well see such a spouse forking over the extra cash just to keep the peace. I could see such a spouse doing without things she needs such as food or her own meds to keep her loved one in the good graces, so to speak, of the institution.
Many folks in my age bracket have loved ones of their own who are in nursing homes. They need to know that the state of Indiana provides ombudsmen, free to the individuals needing them, to help them figure out just this kind of situation. If you or your loved ones have an issue, consider contacting an ombudsman. It’s a big name for what we found was simply a helpful person who knows your rights even when you don’t. He or she is undaunted in getting to the bottom of a problem that can seem overwhelming – but just might not be, after all.
If you need such help, Google LifeStream Services, Council on Aging or state ombudsman for service providers in your area.
And yes, I did make direct contact with the ombudsman after this incident to thank her. I let her know how very much she was appreciated.
I had heard of the word "ombudsman" before only because our local paper carries a column with issues that the local ombudsman resolved. You described their role perfectly! It seems that the ombudsman carries more clout with the other party than the consumer or the family.
12/9/2015 07:07:17 am
That column in your newspaper sounds very interesting. I'm curious about what kinds of issues the ombudsman tackles. It's such a curious title -- Ombudsman.
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