THE WISCONSIN BOARD ON AGING AND LONG TERM CARE
Wisconsin is named by the federal Department of Health and Human Services as one of seven states to pilot a nursing home Ombudsman Program. The Wisconsin pilot program is located in the Office of the Lieutenant Governor. The pilot is limited to skilled nursing facilities only and is operated with only minimal policy and procedural direction. Ombudsmen will often enter facilities after hours and are reputed to have taken a more aggressive advocacy approach than is the rule today.
The Older Americans Act is amended to require all states to develop and implement a nursing home Ombudsman Program. It will take Wisconsin more than two years to develop our permanent Ombudsman Program. Governor Schreiber retains his involvement with the pilot program when he succeeds Governor Lucey.
Governor Dreyfus relocates the Wisconsin Nursing Home Ombudsman Program to the Executive Office by Executive Order #1979-22 dated 26 July1979. This action creates a Governor-appointed position of Executive Director who is to function as the State Long Term Care Ombudsman. Two months later, on 24 Sep 1979,Governor Dreyfus issues Executive Order 1979-25 which again moves the Ombudsman Program, this time to the Office of the Governor where the program name is changed to the Governor's Ombudsman Program for the Aging and Disabled. In addition, the Executive Order specifies that the principal office of the program shall be located in Milwaukee with other offices as necessary around the state.
The Legislature creates the Board on Aging and Long Term Care as an independent board attached to the Department of Administration composed of seven citizen members who are appointed by the Governor with the advice and consent of the Senate. Operational responsibility is vested in an Executive Director who is appointed directly by the Board. The first person named as the Executive Director is George Potaracke. The renamed Long Term Care Ombudsman Program is moved from the Office of the Governor to the Board on Aging and Long Term Care. This change was a part of a larger legislative reorganization of nursing home regulation and oversight. This model of a state operated Long-Term Care Ombudsman Program housed within a state agency is unusual among the other states. Over time, the Wisconsin program’s success in defining the practice and scope of its advocacy becomes a model that Ombudsmen in other states come to emulate.
Group homes (CBRFs) are added to the responsibility of the Ombudsman Program. This begins a steady increase in the scope of the program and its expansion to address the needs of increasing numbers of seniors.
Seven persons are appointed by Gov. Dreyfus to serve as the Board on Aging and Long Term Care. However, the Senate does not hold confirmation hearings for any of these appointees due to the anticipated shift in party control with the upcoming 1982 election. Following Gov. Earl’s taking office, a new slate of appointees is named. These appointees are quickly confirmed by the Senate and the first meeting of the Board on Aging and Long Term Care occurs in 1983.
The Board assumes responsibility for the Medigap Helpline, previously operated by a private, non-profit organization in Madison, the Center for Public Representation. The Helpline is the precursor to Wisconsin’s component of the federal State Health Insurance Information and Assistance Program (SHIP). This was clearly a logical expansion of the role of the agency to absorb the senior population’s increasing demand for accurate and timely information about Medicare supplemental insurance options which the former grantee was unable to keep up with.
The Legislature adds responsibility for advocacy to clients of the Medicaid waiver (Community Options) program to the Ombudsman Program mandate. This was the first expansion of the program’s direct advocacy role outside of the institutional setting.
The Ombudsman Program’s Residential Care advocacy is expanded to include residents of Adult Family Homes.
While the Board had previously employed attorneys, the Board is specifically authorized in statute to employ a permanent in-house counsel to support program operations. This change provides a dedicated legal resource to focus exclusively on the issues impacting the agency and its clients. Before this change, the agency was often required to approach the legal sections of DOA, DHFS or DOJ with inquiries relating to basic questions of law affecting the agency or our clients.
With the support and encouragement of Board member Louise Abrahams Yaffe, the agency establishes the Volunteer Ombudsman Program (VOP) to support the Ombudsman Program. The volunteers are limited to operations only in nursing homes. The Program initially operates only in four counties.
The Board staff plays a significant part in the negotiations between Legislators, LTC industry representatives, consumer representatives, elder advocates and others in the development of the new provider type to be known as Residential Care Apartment Complexes (RCAC). The Board’s effort to be allowed to directly advocate for tenants of these facilities is rebuffed. It is assumed that industry influence may have played a role in this decision to restrict Ombudsman access to RCAC residents.
In response to a proposal by BOALTC, the Legislature adds a statutory provision to protect persons who contact the Ombudsman Program from retaliation. This legislation was well-received and has served as a model for other similar statutory consumer-protective, anti-retaliation provisions in DHS and in some other states.
The Legislature, at the request of the Board, requires all agency staff members who have contact with clients or consumers to undergo pre-employment and periodic follow-up criminal background checks. This was one of the first such requirements to be applied to state employees (and volunteers) and it has been emulated in other parts of state government.
The Legislature again denies authority for the Long Term Care Ombudsman Program to access and advocate for tenants of Residential Care Apartment Complexes (RCACs).
The Board on Aging and Long Term Care is designated as the contracting agency to oversee advocacy for members of the Family Care Pilot. The contract to provide this advocacy is awarded to the forerunner of Disability Rights Wisconsin
The contract for Family Care advocacy is defunded. Budget considerations are the official cause, although some believe that industry influence may again have played a role. Formal independent advocacy for Family Care clients ceases.
The VOP expands; adding two additional Volunteer Coordinators, increasing coverage from four counties to eleven and establishing a new presence with one coordinator each in Milwaukee, Racine and Kenosha, and one coordinator in Central Wisconsin (Marathon, Wood, Portage, Waupaca, and Shawano Counties).
A decision by a Milwaukee County circuit court in a case involving a CBRF results in an award of $75,000 to the Board on Aging and Long Term Care with the specific requirement that these funds be used to pilot a volunteer Ombudsman Program in assisted living facilities. This pilot was in operation for approximately 18 months. As the pilot neared the end of its funding, a proposal was advanced in the Legislature to make the pilot a permanent part of the Volunteer Program. The Legislature declined to extend the project and the Assisted Living Volunteer Ombudsman Project was ended in 2008.
George F. Potaracke, Executive Director of the Board on Aging and Long Term Care since its creation, retires from state service. Heather A. Bruemmer, Long Term Care Ombudsman Program Supervisor, is appointed to be the Executive Director of Board on Aging and Long Term Care and the State Long Term Care Ombudsman.
The Legislature grants the Ombudsman Program the authority to access and advocate for tenants of RCACs
The Legislature designates the Board on Aging and Long Term Care as the advocacy agency for members of the Family Care Program who are age 60 or over. This re-establishes the advocacy that was defunded in 2001 although, in this new system, the Long Term Care Ombudsman Program is the direct provider of advocacy rather than the administrator of a contract with a separate non-governmental agency. Disability Rights Wisconsin is awarded a contract to advocate for Family Care Members who are under age 60.
The agency creates a project position within the Long Term Care Ombudsman Program for a full-time Relocation Ombudsman Specialist who will serve clients statewide in facilities that are closing, downsizing or otherwise requiring residents to relocate. This is another first for the agency and for Wisconsin.
The VOP has second and largest expansion in the history of the agency: hiring a Volunteer Services Supervisor, replacing a Coordinator and adding three additional Volunteer Coordinators and increasing the VOP staff to seven and extending Volunteer coverage from twelve counties to thirty.
Budget cuts require reduction in the VOP staff of one coordinator and loss of coverage of five counties.
The VOP begins ongoing substantial transitions leading to re-evaluation and rearrangement of regions and the counties that are covered. The program currently serves facilities in twenty seven counties; Adams, Brown, Clark, Columbia, Dane, Door, Jackson, Juneau, Kenosha, Kewaunee, La Crosse, Lincoln, Manitowoc, Marathon, Milwaukee, Monroe, Outagamie, Portage, Racine, Rock, Sauk, Taylor, Trempealeau, Vernon, Waupaca, Winnebago, and Wood.
The Board on Aging and Long Term Care assumes responsibility for the Medicare Part D (prescription drug) Helpline. Action by DHS at the termination of the existing contract with a non-profit organization brings the program under the auspices of state government as an expansion of the Medigap Helpline. Two full-time, dedicated Part-D counselors are hired and trained. A volunteer Part D counseling program is considered and is now under development. A Medigap Supervisor position is authorized by the Legislature and filled.
The Relocation Ombudsman Specialist position has, until now, been supported using grant funding from the federal Civil Money Penalty (CMP) funds derived from forfeitures imposed on licensed care provider facilities who have been cited for code violations. These funds are held by DHS and awarded as grants to projects that will serve to improve the quality of the care provided across the delivery system. Recently, the federal Center for Medicare and Medicaid Services (CMS) has determined that the Long Term Care Ombudsman Program is a continuing program and not an “innovative project” designed to demonstrate an improved process for assuring quality care and, therefore, ineligible to receive CMP funding for this position. The Department of Health Services is enthused about the value of the position and they have offered to divert money from their reserves to fund the Relocation Ombudsman Specialist position. The Legislature recognized the value of this position and approved permanent authority and funding for the Relocation Ombudsman in the Biennial Budget bill. The Budget bill was signed by the Governor in late June.
The Medigap program has been using the services of volunteers for some time to assist with routine operations. At this time, a more formalized volunteer program is established to assist with processing of requests for information related to Medicare Part D prescription drug plans as well as general office functions.
The agency celebrates the twentieth anniversary of the formation of the Volunteer Ombudsman Program.
The Legislature, in the 2015-2017 budget as signed by Governor Walker, adds an Ombudsman Lead, a dedicated Ombudsman to address issues arising from the State's three Veterans' residential care facilities, and two additional regional Long Term Ombudsmen. These additions bring the total compliment of BOALTC employed staff to 40.5 full-time equivalent positions.