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Problem Solving
Chapter 8 describes an ombudsman’s approach to resolving complaints on behalf of residents. This chapter includes cases for discussion and practice using ombudsman problem solving steps.
Learning Objectives
Understand how long-term care ombudsmen approach problem-solving
Identify investigation and resolution skills
Learn basic negotiation strategies
Practice the problem-solving process with case examples
Understand how to research statutory support – find the laws and regulations that uphold resolution outcomes.
Contents
Overview
Problem Solving Process Step
1 Identify the problem from the resident’s perspective and research statutory support
2 Consider underlying causes and determine scope of the problem 3 Explore possible ways to resolve and take action
4 Check on progress and outcomes
5 Determine resident’s or complainant’s satisfaction with the outcome Barriers to Problem Solving
Negotiation Basics Case Discussions
“Show Me the Money”
“Discharge – Unable to Meet Needs”
Walking the Fine Line: Ombudsman Role with Residents, Families, and Facility Staff
September 2011 2 Chapter 8: Problem Solving
Overview
Ombudsmen use a five-step basic problem-solving process. They work to solve
problems after getting the resident or complainant’s consent unless the problem affects multiple residents and the system created the problem. The following example shows a resolved complaint from start to finish: “I don’t want a bath.”
Presenting problem per the administrator: Mr. Flynn will not bathe and wears the same clothes every day. His body odor is unpleasant for his roommate, caregivers, and others. The ombudsman opens a case and begins to collect information.
Step
1 Identify the problem from the resident’s perspective and research statutory support
Mr. Flynn really likes to wear overalls. The pair he prefers fit well and he likes the color best. Several old favorite outfits were lost and damaged in the
laundry, so he doesn’t trust that he will get this pair back if he lets laundry take them. Bathing is not something he looks forward to because the aides rush, use water that isn’t hot enough, and do not let Mr. Flynn wash himself.
Direct caregivers report he refuses a bath no matter what they try, including letting him bathe himself. He used to let one CNA bathe him, but she quit.
Other residents complain of Mr. Flynn’s odor. His roommate does not view it as a problem.
Residents have the right to refuse treatment and care
Residents have a right to a decent living environment
Residents have a right to have their choices and preferences respected and to secure their personal property from theft or loss
The facility must help maintain Mr. Flynn’s highest practicable level of functioning, allow him to participate in his care plan, and maintain or enhance his quality of life.
2 Consider possible underlying causes and determine scope of the problem
Bathing environment is unpleasant.
Mr. Flynn is embarrassed by some part of the bathing process.
Bathing times do not match his preferences.
Caregivers are not well trained.
Caregivers do not know or respect Mr. Flynn’s bathing preferences.
He needs some new clothes that are clearly labeled.
Laundry sorting process does not ensure residents get their laundry returned.
Scope: the problem primarily affects Mr. Flynn.
3 Explore possible ways to resolve and take action
Mr. Flynn identifies he wants to bathe in the afternoons and to have all the time he wants in the shower. He agrees to allow a CNA to check on him at regular intervals and to pull the call light when he is finished or if he needs help.
Mr. Flynn agrees to the purchase of new overalls and shirts of the same brand and size, using his trust fund. He will allow the activity director to label his clothing. Laundry bags will be used to distinguish his clothes.
The ombudsman sets a meeting with the social worker in Mr. Flynn’s room and lets Mr. Flynn take the lead with these requests. The social worker says they may need to set a limit on the shower time and Mr. Flynn agrees to 20 minutes.
The social worker confirms the nursing home should replace any items lost in the laundry.
4 Check on progress and outcomes
The first day of Mr. Flynn’s requested scheduled bath is successful. He has to persuade staff to allow him to bring his soiled clothes back to his room for the laundry, but is also successful. He wears a temporary pair of overalls since no one had shopped for his new clothes.
The social worker writes down a procedure for bathing with his input and gives him a copy. She places a copy in his medical records and updates his care plan. His direct caregivers are briefed on the procedures.
Later that week, the administrator brings Mr. Flynn his new clothes to approve and sign receipts for the purchases. He likes all the shirts and four pairs of overalls.
5 Determine resident’s or complainant’s satisfaction with the outcome Mr. Flynn reports he is very satisfied with the outcome. If he encounters problems, he plans to speak with the social worker or administrator first, then the ombudsman if needed.