Question: You are Hawaii’s ombudsman for long-term health care. What is that?

Answer: Ombudsman is really a Swedish word, and the problem is nobody here speaks Swedish so they don’t know what I do. It’s basically an advocate. I’m supposed to represent residents of long-term care facilities.

Q: What areas of long-term care are you involved with?

A: In our state that includes nursing homes, adult residential care homes, expanded adult residential care homes, community care family foster homes and assisted-living facilities. That total bed capacity is a little over 12,000.

Q: What is your main objective?

A: Our goal is to go to facilities, talk story with the residents confidentially so that they feel free to say whatever they want to and then if there are problems, if there are concerns, if there are things that need tweaking, we do an exit interview with the administrator. We bring to their attention things that we think could be improved upon, and the next time when we go back in, that becomes old business (to revisit).

Q: What are other important parts of your job?

A: We share best practices (with facilities). We help facilities organize family councils. In my mind a sign of a really strong facility is that they have an active family council that meets once a month.

Q: Do families of long-term care residents seek you out?

A: All the time. I spend most of my job on the phone working with families. I’really believe in trying to empower families to do as much as they can on their own. I do a lot of coaching in terms of who they should contact, how they should address their concerns, what they might want to put in a letter, those kinds of things.

Q: Do you have enforcement powers?

A: We’re not state inspectors. When (Department of Health) inspectors come in and find something wrong, you get written up, it’s a public document, it’s your deficiency report. We have no power to give any kind of a deficiency (report). Our power is the power of persuasion. We want to get things fixed. We’re almost like unpaid consultants. We could bring things up to the attorney general’s office, to the Department of Health, to the media, to the (facility’s) corporate headquarters. That actually has never happened.

Q: How was this ombudsman position created?

A: This position actually started out as a pilot project in 1975, and there were several states that did this. Way back when, before we had the Nursing Home Reform Act of 1987, nursing homes were kind of warehouses where people really just went to die. I mean social services were not requirements, activities were not requirements. It was basically feed them, keep them dry and you’ve done your job. Nobody was really focusing on quality-of-life issues. It was more just quality-of-care issues. The pilot project was very successful in finding all kinds of problems and was brought to the attention of Congress. So in 1978 they mandated that every state must have a long-term care ombudsman program.

Q: How long have you been Hawaii’s long-term care ombudsman?

A: I’ve done this since 1998.

Q: What the program’s biggest challenge?

A: Staffing. Ideally the (state) Executive Office on Aging wants us to visit everybody at least once a quarter. But we are a staff of three. That’s not possible. We have 50 nursing homes with 4,300 beds. We have 13 assisted-living facilities with 2,249 beds. We have 502 care homes with 2,748 beds. And the fastest-growing is the community care family foster homes. We have 1,123 community care family foster homes, and they have 2,777 beds. You total that and it comes out to 1,688 facilities and 12,074 beds. Our budget is really pretty pitiful. We really could use some money from the Legislature to do our job. We also use volunteers. We really need more volunteers.

Q: What has been a major improvement in long-term care?

A: We’re very proud last year the governor signed into law House Bill 120, which is now Act 213. Come July of 2015 every long-term care facility  not just nursing homes  will also be required to have their inspections on the (Department of Health) website. So before you put your mom in a care home or an assisted-living facility or a community care foster home, you know a little bit about that facility.

It really benefits the public. And it benefits the industry, because if I now know that everybody can see my report card, I’m going to be very motivated to look good. Because otherwise, I’m going to have an empty house. I’m not going to be generating income because my beds will be empty.

Q: What are good resources for more information?

A: The national ombudsman resource center (ltcombuds’man.org). That has information about ombudsman programs across the country. Another really important resource in terms of checking out the quality of care in our nursing homes is (medicare.gov/nursinghomecompare). You can see the annual inspections of every nursing home in the country.

Interviewed by Andrew Gomes