(Solved): Conflict of Interest or Not?Bestcare Nursing and Rehabilitation Center is a 290-bed dually-certified ...

Overarching ACL Goals re: LTCO Rule - High quality ombudsman services for residents - Credible, person-centered problem-solvers with and for residents, - Effective, astute advocates for resident-centered systems change in long-term services and supports. - Provide clarity to provisions of the Older Americans Act, - With regards to both organizational and individual conflicts of interest - Requires Ombudsman programs to: - avoid, - identify, - remedy or remove Related provisions regarding Conflicts of Interest 1324.1 Definitions: "Immediate family" - "Immediate family, pertaining to conflicts of interest as used in section 712 of the Act, means a member of the household or a relative with whom there is a close personal or significant financial relationship." "Representatives of the Office" - "Representatives of the Office of the State Long-Term Care Ombudsman, as used in sections 711 and 712 of the Act, means the employees or volunteers designated by the Ombudsman to fulfill the duties set forth in \( \$ 1324.19(a) \), whether personnel supervision is provided by the Ombudsman or his or her designees or by an agency hosting a local Ombudsman entity designated by the Ombudsman pursuant to section 712(a)(5) of the Act." "State Long-Term Care Ombudsman, or Ombudsman, as used in sections 711 and 712 of the Act, means the individual who heads the Office and is responsible to personally, or through representatives of the Office, fulfill the functions, responsibilities and duties set forth in \( \S \S 1324.13 \) and \( 1324.19 \) of this rule." Why it matters: - For consistency with the OAA, Rule uses the term "Ombudsman" to specifically refer to one individual: the State LTC Ombudsman. - Rule does not use following terms: "local ombudsman" or "volunteer ombudsman" but rather the Rule uses the term "Representative of the Office" - Many States and other stakeholders commonly use the word "ombudsman" to describe staff and volunteers at every level of the program. This Rule does not require a change in the usage of those terms. "State Long-Term Care Ombudsman, or Ombudsman, as used in sections 711 and 712 of the Act, means the individual who heads the Office and is responsible to personally, or through representatives of the Office, fulfill the functions, responsibilities and duties set forth in \( \S \S 1324.13 \) and \( 1324.19 \) of this rule." Why it matters: - For consistency with the OAA, Rule uses the term "Ombudsman" to specifically refer to one individual: the State LTC Ombudsman. - Rule does not use following terms: "local ombudsman" or "volunteer ombudsman" but rather the Rule uses the term "Representative of the Office" - Many States and other stakeholders commonly use the word "ombudsman" to describe staff and volunteers at every level of the program. This Rule does not require a change in the usage of those terms. olicy \& Procedure Requirements \( \$ 1324.11 \) (e) Program policies and procedures are to be established by the Ombudsman if he/she has appropriate legal authority and must include provisions related to: (4) Conflicts of interest. Policies and procedures regarding conflicts of interest must establish mechanisms to identify and remove or remedy conflicts of interest as provided in \( \$ 1324.21 \), including: - (i) Ensuring that no individual, or member of the immediate family of an individual, involved in the employment or appointment of the Ombudsman is subject to a conflict of interest; - (ii) Requiring that other agencies in which the Office or local Ombudsman entities are organizationally located have policies in place to prohibit the employment or appointment of an Ombudsman or representatives of the Office with a conflict that cannot be adequately removed or remedied; - (iii) Requiring that the Ombudsman take reasonable steps to refuse, suspend or remove designation of an individual who has a conflict of interest, or who has a member of the immediate family with a conflict of interest, which cannot be adequately removed or remedied; - (iv) Establishing the methods by which the Office and/or State agency will periodically review and identify conflicts of the Ombudsman and representatives of the Office; and - (v) Establishing the actions the Office and/or State agency will require the Ombudsman or representatives of the Office to take in order to remedy or remove such conflicts. 1324.21 Conflicts of interest -Individual - State agency and Ombudsman must consider COI: can impact effectiveness and credibility. - Examples (for an Ombudsman, representatives of the Office, and members of their immediate family) include: - Direct involvement in the licensing or certification of a LTC facility; - Ownership, operational, or investment interest in an existing or proposed LTC facility; - Employment by or management of a LTC facility in the service area; - Receipt of, or right to receive remuneration from a LTC facility or its management; - Accepting gifts or gratuities of significant value from a LTC facility or its management, a resident or a resident representative of a LTC facility; - Accepting money or any other consideration from anyone other than an entity approved by the Ombudsman for performing program duties; - Serving as guardian or other surrogate decision-maker for a resident of a LTC facility in the service area; and - Serving residents of a facility in which an immediate family member resides. Rule: Second step: remove or remedy the COI - Prohibited COI (i.e. cannot be remedied); individual: - Has direct involvement in licensing, surveying, or certifying LTC facilities; - Has any ownership, operational, or investment interest in a LTC facility; - Has been employed by or participating in the management of a LTC facility - For Ombudsman: within the previous twelve months - For representatives of the Office: current employment; - Receipt of, or right to receive remuneration from a LTC facility or its management. Additional information: - Some states will need to change Ombudsman hiring requirements to comply (others already prohibit prior employment in LTCO facility). - Rule does not require this "cooling off" period for hiring/appointing representatives of the Office, but still a COI that requires development of an adequate remedy. 1324.21 Conflicts of interest -- individual (continued) Rule: Policies and procedures - summary - When considering the employment/appointment of the Ombudsman or representative of the Office, the employing/appointing entity shall: - Avoid unremedied COIs, - Establish a process for periodic review, identification, and removal/remedy of COI. - Ombudsman or SUA must ensure that no Ombudsman or representatives of the Office are required or permitted to hold positions or perform duties that would constitute a COI. Additional information: - Programs need to consider additional COIs that may impact the effectiveness and credibility of the work of the Ombudsman program - Screening is critical (both paper and interviews) when evaluating conflicts of interest, i.e. a prospective volunteer has a profession that may require additional attention and potential remedies. Common examples of individual conflicts - Employees of long-term care facilities are neighbors, friends and family of representatives of the Office - this is especially a challenge in rural areas. - Wearing many "hats," - i.e. individual works as Representative of the Office 15 hours a week, Adult Protective Services investigator 15 hours a week; and supports the guardianship program 10 hours a week. - Previous employment in a long-term care facility and retirement plan is primarily comprised of company stock. - Steps to remedy/remove may include: - Assignment of duties relating to specific facilities to other representatives of the Office without COI; - Removing conflicting duties; - Divestment of financial interests within reasonable time. - At application for a job or to volunteer - The person believes they may have a conflict - job change, moonlighting - family job or circumstances change - The program believes the person may have a conflict - Every year for current staff and volunteers