Taking Healthcare by Storm: Industry Insights with Suzanne Messenger

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Suzanne Messenger, Esq., the West Virginia State Long-Term Care Ombudsman.

Learn more about the Ombudsman program.
Follow the West Virginia Bureau of Senior Services on Facebook and Twitter/X.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-GEN-031524-GK

Transcript

Welcome to Taking Healthcare by Storm, Industry Insights, the podcast that delves into the captivating intersection of innovation, science, compassion, and care.
 
 In each episode, Quality Insights Medical Director, Dr.
 
 Jean Storm, will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys.
 
 Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania, and the nation.
 
 Subscribe now, and together, we can take healthcare by storm.
 
 Hello, everyone, and welcome back to Taking Healthcare by Storm.
 
 I am Dr.
 
 Jean Storm, the Medical Director of Quality Insights, and I am so thrilled that you are joining us today, and I am very thrilled to have our guest today, Suzanne Messenger, is the Director of the Ombudsman Program in West Virginia, and it has come to my attention during my time in long-term care, how important the Ombudsman is to our long-term residents and families in all of our long-term care facilities all across the country.
 
 They serve such a important role, and so I am inspired by the work that they do.
 
 And so I am just delighted to bring Suzanne Messenger on the podcast today to let her share what her work entails.
 
 Suzanne, thank you for joining us.
 
 You're very welcome.
 
 I'm so excited to be here and help people learn a little bit more about the long-term care Ombudsman program and what we do and what we can't do for that matter.
 
 Great.
 
 So we're just going to jump into it.
 
 Why don't you tell us about yourself and your background?
 
 Sure.
 
 I grew up in Western Pennsylvania, and when it was time to choose an undergrad school, I had basically two choices that were delineated by my parents because they didn't want to drive too far.
 
 And one of those choices was West Virginia University.
 
 So I came to West Virginia as an undergrad.
 
 I majored in medical technology.
 
 My long-term plan was always to be a doctor, but you know how plans are.
 
 You have plans and they change.
 
 So I met my husband while I was working through undergrad and decided to take a little pause with the intent of going back to medical school.
 
 But as I was working in medical technology and I worked in a couple of hospitals, a couple of doctor's offices during my career as a medical technologist, I noticed how much physicians and nurses had to deal with ethics.
 
 And I thought, I don't really think I want to do that, so I'm going to change career paths.
 
 And once again, talk about jumping out of the pot into the fire.
 
 I had a friend who was a lawyer and she said, well, Suzanne, why don't you think about going to law school?
 
 So that's what I did.
 
 I applied to WVU's College of Law and was accepted.
 
 And I went through law school, really didn't have a clear path of what exactly I was going to do, except I had a lot more debt by then and really needed a job.
 
 I was very naïve about lawyers and law practice, even after three years of law school, really thought that you could choose a side based on what you thought.
 
 I didn't realize you had to get in a lane and stay there, either you were going to be plaintiff or defense.
 
 I thought there was some flexibility, but I realized that there wasn't.
 
 At that time, really only the big insurance defense firms came to the law school as far as student interviews.
 
 When I talked with them about my goals, I mentioned that I'd like to be a patient advocate.
 
 Of course, that was just not consistent with their line of thinking.
 
 They all suggested that I talk to Legal Aid.
 
 I didn't know what Legal Aid was or really how to connect with them.
 
 Thank goodness I had a professor who let me know late in my education that there was an opportunity at Legal Aid of West Virginia in the Charleston office for the attorney with the ombudsman program.
 
 Didn't know what the ombudsman was, didn't really have a clue, but I trusted the professor, I liked him, and I needed a job.
 
 So I interviewed for the job, was chosen, and I have been with the long-term care ombudsman program since then.
 
 I started in 1999.
 
 I was the attorney with the long-term care ombudsman program at that time and had that role for about eight years at Legal Aid.
 
 And I've been the state ombudsman now for about 16 years.
 
 That's just fantastic.
 
 So you came to West Virginia to go to undergraduate.
 
 And do you consider yourself like I just I love this question because I bet West Virginia has a special place in my heart and individuals who have kind of transplanted here have, I think, also West Virginia's special place in their heart.
 
 So is that why you stayed in West Virginia?
 
 Mostly, if I'm being totally candid, I stayed for my husband.
 
 He was born and bred in West Virginia and was not going to leave.
 
 But I have such an admiration for the people of West Virginia, the culture of West Virginia.
 
 I attribute that some to the fact that all West Virginians have go through the West Virginia history when they're in school.
 
 We didn't do that in Pennsylvania.
 
 And I really think that's so important because West Virginians know their history and they value and appreciate that history.
 
 And they love the state.
 
 And the people of West Virginia have just been so welcoming and kind.
 
 I'm happy now to be able to call myself a West Virginian.
 
 I would agree about that feeling.
 
 And so you said you've been working as an ombudsman since 1999?
 
 That's correct.
 
 Okay, so about 25 years.
 
 I was surprised when I did the math, yes.
 
 Yeah, time flies.
 
 So tell us about what is the typical day in the life of a state ombudsman?
 
 Well, it probably helps to know a little bit of difference between the state ombudsman and what we call in West Virginia our regional ombudsman.
 
 My office, the Office of the State Long-Term Care Ombudsman, is required by the Federal Older Americans Act, and every state is required to have an Office of the State Ombudsman.
 
 I work for the West Virginia Bureau of Senior Services, and then the Bureau has a contract with Legal Aid of West Virginia, and Legal Aid operates what we call our regional ombudsman program.
 
 We have 10 regional ombudsmen.
 
 They cover the whole state.
 
 Each of them have a multi-county area.
 
 Some of them have, I think the smallest area is three counties, and the largest one is nine.
 
 We tried to divide it up based on geography and facility distribution, but it's not perfect.
 
 My role as the state ombudsman is to oversee the contract that the Bureau has and to provide what the federal government calls programmatic oversight.
 
 I get involved in a lot of the case issues.
 
 If there are questions, provide folks with a lot of technical assistance.
 
 Even though I am an attorney, I was not hired as an attorney, although that has been a wonderful educational background for the job that I have because we have to be really familiar with all the rules and regulations that have applied to long-term care.
 
 But I can't provide legal advice, but I can look at the laws and try to apply those and help our ombudsman apply those.
 
 They all work for legal aid, but they are not attorneys either.
 
 Okay, so you said there are 10 regional ombudsman.
 
 Is that the number of ombudsman that are in the entire state?
 
 It is.
 
 We have, there are nine regions.
 
 We have an ombudsman program director.
 
 That's Ed Hopple.
 
 Ed works for Legal Aid of West Virginia.
 
 And then I neglected to say there's actually 11 ombudsman.
 
 The 11th ombudsman doesn't have a region.
 
 She, Susan Wolford, is our communications and training specialist.
 
 And she helps design materials for residents, newsletters.
 
 She does our social media.
 
 And she's been a really wonderful asset that we were able to bring on.
 
 We got a little bit of additional money during the pandemic to provide additional resources to our residents.
 
 And Susan's position is one of the ways we use that money.
 
 And she's been a wonderful asset to the program.
 
 I bet.
 
 To provide all that communication and education around the wonderful work you are all doing.
 
 So what is the population of individuals that you serve?
 
 Because I think there's a little bit of confusion out there around that.
 
 Sure.
 
 Each state defines who the long-term care ombudsman are going to serve.
 
 And our definitions are set in the West Virginia Code.
 
 So we serve individuals who live in residential long-term care in West Virginia.
 
 And that means we serve people who live in our nursing homes, in our assisted living residents.
 
 West Virginia has another little creature of residential long-term care called legally unlicensed homes.
 
 And those are just really people who live in their own houses, who decide that they're going to open them up to allow a couple of other individuals to come in, and they're going to provide assistance with their activities of daily living.
 
 They can't have more than three people that aren't related to them do that.
 
 But if they let the state know that they've opened their home and that they're doing that, it's considered legal for them to operate without a license.
 
 And whoever named that category of homes was really imaginative.
 
 They call them legally unlicensed homes.
 
 So those are the basic settings that we go into.
 
 There's two residential care communities in West Virginia.
 
 We can go into those are more like a continuum of care.
 
 They start with independent living and then work through assisted living and then nursing facility level of care.
 
 It's all on the same campus.
 
 We don't have authority to go into the independent living part of those residential care communities, but we can go into the assisted living or nursing home part.
 
 Then we also respond our what used to be the Department of Health and Human Resources.
 
 Now, it was split into three departments, the 1st of January, so I'm still having trouble keeping everybody straight.
 
 I think it's the Department of Human Services, the Bureau for Children and Families, overseas program called Adult Family Care, which is analogous to foster care for adults.
 
 We do respond in those facilities on a complaint only basis.
 
 The state takes care of the monitoring through the Department of Human Services, but we can go in to those homes.
 
 That's the general setting that we operate in, Dr.
 
 Storm.
 
 That's a large population, I will say.
 
 How would an ombudsman get activated or be brought into the picture?
 
 Can you give us maybe a sample scenario that would illustrate how the ombudsman would be brought into a situation?
 
 Sure.
 
 There's a couple of different ways.
 
 Anyone can call us, email, text.
 
 We get calls from residents.
 
 We get calls from their families.
 
 You might be surprised that sometimes staff call us to brainstorm with them about a problem.
 
 The important thing to remember is while we can take those intakes, if you will, from virtually anybody, we can't really take any action until we know what the resident wants.
 
 So in 100% of those times, we're going to circle back to the resident and find out what their perspective is and what's going on with them.
 
 And then we need permission to investigate or to take further action from the resident or if they're not capable of giving us permission from the appropriate legal representative before we can do anything.
 
 We're not like a licensing or enforcement agency.
 
 We can't just go in and pull records and start trying to figure out what's going on.
 
 We're not like Adult Protective Services.
 
 We can't go in and pull back the covers and see what's under there.
 
 We need permission.
 
 Then another way that we can get involved is we might see an issue that needs addressed.
 
 We can open up a complaint or an investigation based on what we see.
 
 One of the services that we provide is what we call routine access to the ombudsman.
 
 That means we try to be in the facilities on a regular basis.
 
 For nursing homes, that's at least quarterly.
 
 Basically, that's just a meet and greet, if you will.
 
 We talk to as many residents who want to talk to us, who are able to talk to us about what's going on, what their experience has been.
 
 Obviously, we're going to talk to the staff.
 
 Then if there are issues that they bring up, we can get involved that way.
 
 Or if we see issues, we can get involved that way.
 
 Once again, though, even if the ombudsman sees issues, if they involve a specific resident, we have to circle back to that resident and get their permission to get involved.
 
 That's a really key principle of long-term care ombudsmaning, if you will.
 
 We speak for the residents, and we can't do anything unless they give us a voice.
 
 That makes complete sense to be the ultimate advocate for the resident.
 
 That is who you represent.
 
 What are the typical issues that an ombudsman will address?
 
 Those issues can run the gamut from things that could be relatively simple, from lost laundry or cold food to much more complicated issues involving eligibility for long-term care, concerns with their medication regime, abuse and neglect issues, or even sometimes issues with a legal decision-maker like a guardian or conservator or power of attorney.
 
 So it runs the gamut.
 
 That's really good to know.
 
 And what about any specialized training that an ombudsman has to acquire?
 
 Is there any specialized training?
 
 There is.
 
 The job description, oddly enough, is actually set out in the West Virginia Code.
 
 So in order to be a long-term care ombudsman, you have to have a certain educational background.
 
 And that's typically a background in either health or geriatrics or social work.
 
 There's some exceptions, some wiggle room.
 
 Generally, it has to be a four-year degree, but we can substitute certain levels of experience for up to two years of that college work.
 
 So once you make cross that basic hurdle, then it's a 36-hour initial training before you can start as a long-term care ombudsman.
 
 We go over a number of things, topics are really set out both in code and in federal regulation.
 
 We talk about an overview of the program.
 
 We talk about the people that we serve, who lives there, the kind of settings we work in.
 
 We give people a basic training on complaint investigation, on documentation, the kinds of medical conditions they're apt to run into.
 
 So it is quite extensive.
 
 It also includes a shadowing component, where they're going to spend time with other ombudsman and see how they carry out their duties.
 
 Each of the ombudsman brings different skills and different backgrounds.
 
 So they all operate a little bit differently, but that's really the beauty of being an ombudsman, because each area of the state actually has different attributes, and the resident complexion looks a little different in each area of the state.
 
 So since our ombudsman are embedded in those areas, they're part of that flavor and culture, if you will, and they do have the flexibility to customize their services to the population that they serve.
 
 I think that's so important to have an individual who understands the cultural interests, the differences in the culture and the region.
 
 So important.
 
 So when I was doing a little research about volunteer opportunities in my area, I came across a description of the volunteer ombudsman program.
 
 So can you tell us the difference between an ombudsman and a volunteer ombudsman?
 
 Sure.
 
 One of the most obvious differences is a long-term care ombudsman or what we call a staff ombudsman, they're paid.
 
 They're actually employees of Legal Aid of West Virginia.
 
 They get a salary, benefits, they are paid.
 
 Volunteer ombudsmen are not.
 
 They offer their services in exchange for the benefit and goodwill of providing services to others.
 
 The training component in West Virginia is the same initially.
 
 It's quite a bit of training.
 
 We don't require the same educational background, but it's the same initial 36 hours, same topics, really the same background and information.
 
 They would be required to have about, I think it's nine hours of continuing education every year to maintain their certification.
 
 Candidly, we have struggled in West Virginia with developing a good volunteer program.
 
 We are really interested in having volunteers that make things better for our residents rather than volunteers that just give us numbers of volunteers, and we have struggled through the years of finding quality volunteers that are able to do the job, that are willing to run their hurdles because it is a bit of a hurdle to get certified, that 36 hours is a big obstacle.
 
 Currently, we don't have any volunteers, but we will be starting a new pilot program here in the spring where we will be looking for qualified, interested, party individuals who want to be a volunteer with a long-term care ombudsman program to work in assisted living.
 
 We're hoping by the end of the year or the end of the next state fiscal year, which would be next June, to have at least one volunteer working in assisted living in each of our nine regions.
 
 So can anyone become a volunteer ombudsman?
 
 Anyone is eligible, but we do have very strict conflict of interest prohibitions.
 
 And what that means is we want to make sure one of the key attributes of an ombudsman is our objectivity.
 
 We don't want to be influenced by other things other than what our residents' directions are.
 
 We are advocate ombudsman, and that's really our role.
 
 So to help assure that, we do pretty strict conflict of interest screenings.
 
 And what that means is we can't really have individuals who've worked recently in long-term care or in long-term care settings.
 
 We can't really have individuals who've been involved in adult protective services or in the enforcement aspect of long-term care providers, medical providers who've been recently doing that in West Virginia.
 
 The general timeframe is two years.
 
 It might be longer depending on the situation.
 
 Like I said, we do a fairly in-depth conflict of interest screen.
 
 So that's another hurdle to being a volunteer with the long-term care ombudsman program.
 
 We are welcoming and we allow, we consider anyone, but the doorways are pretty narrow to get through.
 
 Sure.
 
 So what about during the pandemic?
 
 Did the ombudsman role change at all as the pandemic started and then during it and after the public health emergency ended?
 
 It absolutely did, Dr.
 
 Storm, and I know that's no surprise to you and probably no surprise to any of your listeners.
 
 We didn't know what we didn't know and what we knew was the virus in long term care settings spread very easily and impacted long term care residents quite harshly.
 
 And we lost many long term care residents during the pandemic.
 
 So we operated while Governor Justice did not prohibit us from going in.
 
 We worked with the Bureau of Public Health and really limited our in person visits to only those that were necessary.
 
 Unfortunately, that's the same advice that other agencies were following.
 
 And more importantly, families and visitors were restricted during that time.
 
 That was based on what we knew at the time and what everyone thought was best for infection prevention.
 
 But what we learned from all that was that infection prevention isn't the only piece of good care.
 
 And the other piece of good care is preventing isolation and maintaining socialization.
 
 And we didn't do very good at that during the pandemic.
 
 So what we learned as ombudsman is we learned a lot of different ways to contact residents.
 
 We do some virtual visits now.
 
 We do a lot of residents are text us now, which didn't really happen a lot during before the pandemic.
 
 But what we also realized is there is no substitute for that in the building presence, that face-to-face contact with our residents that is so important in establishing trust, building relationships, and just letting our residents know that we're there and that we're available for their services.
 
 Yeah, I agree.
 
 That was I think the biggest lesson to come out of the COVID pandemic is that residents do need that.
 
 They need isolation is not good for anyone's health.
 
 So how does someone, just a final question, how does someone learn more about the Ombudsman Program?
 
 You can go to www.wvseniorservices.gov.
 
 www.wvseniorservices.gov.
 
 You can call 1-800-834-0598 and ask to speak to an Ombudsman.
 
 Or you can visit one of our social media platforms.
 
 And I apologize, Dr.
 
 Storm, my mind has gone totally blank.
 
 No worries.
 
 But if you search Twitter or Facebook or Instagram for West Virginia Long-Term Care Ombudsman Program, we are the only program that those search results should yield.
 
 And you can find us on all of those platforms.
 
 Fantastic.
 
 And those are usually, they're easy to find.
 
 Well, Suzanne, thank you so much for joining us today.
 
 And I learned so much that I know everyone listening learned so much.
 
 So thank you so much for explaining this important program to us.
 
 You're very welcome.
 
 Thanks so much for the opportunity.
 
 Bye-bye.
 
 Bye-bye.
 
 Thank you for tuning in to Taking Healthcare by Storm, Industry Insights, with Quality Insights Medical Director, Dr.
 
 Jean Storm.
 
 We hope that you enjoyed this episode.
 
 If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.
 
 If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website.
 
 We would love to hear from you.
 
 So until next time, stay curious, stay compassionate, and keep taking healthcare by storm.