Ombudsman Questions and Answers about COVID-19
The Centers for Medicare & Medicaid Services • March 20, 2020
The Centers for Medicare & Medicaid Services released revised and expanded
guidance for nursing homes on responding to COVID-19. This letter provides detailed direction on new visitor restrictions imposed to help nursing homes control and prevent the spread of infection.
- Residents still have the right to access the Ombudsman program.
- Their access should be restricted per the guidance above (except in compassionate care situations), however, facilities may review this on a case by case basis.
- If in-person access is not available due to infection control concerns, facilities need to facilitate resident communication (by phone or other format) with the Ombudsman program or any other entity listed in 42 CFR § 483.10(f)(4)(i
Questions and Answers
- Can an ombudsman visit a nursing facility or assisted living facility (ALF)?
- No. All volunteers and staff are temporarily restricted from making an onsite facility visit. In special circumstances, an MLO may obtain approval from the State Ombudsman to conduct a facility visit to investigate a complaint.
- How long are ombudsman visits restricted?
- The restriction began on Friday, March 13, and will extend until at least April 15, 2020. The State Ombudsman will extend this time frame if necessary for the health and safety of LTC facility residents.
- Should I respond to complaints differently right now?
- Yes, some complaints must be reprioritized. Inform the complainant that your ability to work to resolve a complaint is temporarily limited to telephone and email contact with facility staff. Explain that facilities are instructed to prioritize issues related to infection control and abuse, and therefore, these are the issues you are also prioritizing. See guidance in the Complaint Procedures section of this document.
- How does an ombudsman work to resolve complaints during this time?
- Complaint intake, investigation, and resolution must be conducted by phone, email, and video calls such as FaceTime, Skype, and Duo. Specific procedures for this work are described in the “complaint procedures” section of this document.
- What information should I give to residents, their family members, and other concerned citizens?
- For information about COVID-19 and LTC facility operations, refer to the COVID-19 sections of these site:
Click here more information and to read the full Ombudsman Questions and Answers about COVID-19.
The Area Agency on Aging of East Texas (AAA) opened a new congregate meal site in Marshall on Monday, December 15th. Older adults, aged 60 and up, eligible for the Senior Nutrition Program will be able to enjoy a hot lunch, good conversation, and a friendly place to gather. Location George Washington Carver Community Center 2302 Holland St Marshall, TX 75670 Meal Hours Monday–Thursday 11:00 AM–12:30 PM Phone 903-923-8410 The Senior Nutrition Program supports adults age 60 and older through both congregate meals and home-delivered meals. These meals follow dietary guidelines and help older adults stay connected and healthy. For folks who can’t travel, home-delivered meals bring food, a wellness check, and a bit of company to their door. How to Enroll Adults age 60 and older can join the Senior Nutrition Program by contacting the provider for their county listed at: easttexasaaa.org/nutrition , or by receiving a referral from AAA staff. Caregivers who care for someone receiving home-delivered meals may also be referred for services by calling AAA. The Carver Community Center site will give more Marshall and Harrison County residents a place to eat, visit, and keep a steady routine. If you or someone you know could benefit, contact the AAA for assistance!
Medicare Open Enrollment runs from October 15 until December 7, and people with Medicare will have more coverage options to consider. Plan costs and covered benefits have changed, so our Area Agency on Aging of East Texas (AAA) is offering benefits counseling assistance to encourage Medicare recipients to review their coverage choices and decide on the options that best fit their health needs. The changes Medicare recipients can make during Open Enrollment include: Joining a new Medicare Advantage Plan or Part D prescription drug plan Switching from Original Medicare to a Medicare Advantage Plan Switching from a Medicare Advantage Plan to Original Medicare (with or without a Part D plan) “Medicare Open Enrollment allows you the opportunity to review your healthcare plan and check on your financial well-being, which could also help save costs and coverage,” says AAA Benefits Counselor Nellie Spencer. “Call us and talk to an unbiased, qualified Benefits Counselor. We are also your State Health Insurance Assistance Program (SHIP) and available free of charge to go over your options.” For assistance, please call the Area Agency on Aging at 1-800-442-8845 to speak to a qualified benefits counselor. Appointments can be made over the phone, in a virtual meeting, or in person. Local Open Enrollment presentations: Benefits counselors will also be available for appointments at these community events during the Open Enrollment period. To reserve your spot, call the Area Agency on Aging at 1-800-442-8845. Walk-ins will be accepted. Palestine Resource Center for Independent Living, 421 Avenue A, Palestine, TX Date: Tuesday, November 4th Time: 9:00 am-3:00 pm George Washington Carver Community Center, 2303 Holland St., Marshall, TX Date: Thursday, November 6th Time: 10:00 am-2:00 pm Mt. Zion C.M.E. Church, 104 State Hwy. 64, Ben Wheeler, TX Date: Thursday, November 13th Time: 1:00 pm-3:30 pm First Christian Church, 1920 Beaumont St., Jacksonville, TX Date: Thursday, November 20th Time: 9:00 am-12:00 pm Be on alert for these Medicare Open Enrollment scams: There are no "limited time offers." Medicare or a health plan calls and wants to send you a new health card for $299. You receive a call about a refund from last year's premiums or your drug plan cost. An agent tries to sign you up for a plan that you don't need, isn't right for you, or doesn't even exist. Watch out for fake RX cards offering significant discounts with little or no benefits. You receive a call offering significant discounts on a new health insurance plan. Agents can NOT cold call you. Tips on how to stop fraud during Open Enrollment: If it's "too good to be true," it probably is. Don't trust all the ads you see on TV. Review the plan BEFORE you join. Even if you're not switching, review your current plan to ensure it covers your doctors. Medicare will never call or visit. Medicare will only send information via postal mail service. Guard your Medicare card and number like a credit card. Don't give out your Medicare number except to your doctor or other providers. Don't let someone push you into making a fast decision. If you receive a call, especially from a number you do not recognize or anyone requesting personal information, hang up immediately. Know your health care options. Get help from your family, the Medicare website, or your local State Health Insurance Assistance Program (SHIP), which for East Texas is the AAA. No health care plan is allowed to cold call. Medicare plans can be viewed and compared at www.medicare.gov .
