The Division shall establish a long term care ombudsman program pursuant to W.S. 9-2-1301 through 9-2-1309(2005) (1986 cum. supp).
(a) Definitions: - (i) "Complaint" is a concern brought to, or initiated by, the ombudsman for investigation and action:
- (A) On behalf of one or more residents; and
- (B) Relating to health, safety, welfare or rights of a resident.
- (ii) "Consultation" is providing information and assistance to an individual or a facility.
- (iii) "Long term care service" means any service, provided by an assisted living facility, adult day care facility, boarding home, home health agency, hospice, hospital swing bed, nursing care facility, personal care agency, or other type of service subject to regulation, certification or licensure by the Department, but not including habilitative care.
- (iv) "Older Americans Act" means the federal Older Americans Act, as amended.
- (v) "Resident" means any adult who is receiving a long term care service.
(b) Responsibilities of the Long Term Care Ombudsman include: - (i) Investigation, advocacy and mediation on behalf of adults applying for or receiving long term care services to resolve complaints concerning actions or inactions that may adversely affect resident's health, safety, welfare, or rights and that do not involve determination of compliance for maintaining a license or certification;
- (ii) Monitoring the development and implementation of federal, state and local laws, regulations and policies with respect to long term care services in the state;
- (iii) Establishment of a statewide uniform reporting system to collect and analyze data relating to complaints and conditions in long term care facilities for the purpose of identifying and resolving significant problems, with provision for timely submission of such data to the state agency responsible for licensing or certifying long term care facilities and to the Division;
- (iv) Providing information to public agencies about the problems of residents receiving long term care services and;
- (v) Referring all complaints which involve conditions, actions or omissions which are reportable to Adult Protective Services pursuant to WS 35-20-101 through 35-20-116.
(c) Investigations: - (i) The ombudsman shall conduct an appropriate inquiry into all complaints and shall notify any provider of a long term care service affected by the inquiry.
- (ii) In conducting an inquiry, the ombudsman shall engage in appropriate actions including:
- (A) Making inquiries of affected parties or those with the knowledge of matters necessary to establish, deny or resolve the complaint;
- (B) Entering, at any reasonable time, the facility of a provider of any long term care service subject to regulation, certification or licensure by the Department; and
- (C) Presenting proper identification to any long term care service provider, if requested.
- (iii) Any inquiry which requires the inspection of or obtaining of medical records or other resident records which are pertinent to the inquiry shall comply with all established privacy notification requirements.
(d) Resolution of complaints: - (i) The ombudsman shall attempt to resolve the complaint using mediation and negotiation whenever possible.
- (ii) Following an investigation, the ombudsman shall report the findings and recommendations to the resident or the resident's guardian and may report the findings to any other entity deemed appropriate.
- (iii) The provider of the long term care service complained against shall have a reasonable opportunity to respond to the complaint.
- (iv) If the problem seriously threatens the safety or well-being of a resident, the ombudsman shall refer the complaint to an appropriate agency.
(e) Retaliation. No person shall discriminate against any resident, relative or guardian of a resident, employee of a long term care service provider, or any other person because of making a complaint or providing information, in good faith, to the ombudsman.
(f) Grant applications and reports will be submitted annually in accordance with the specifications set by the Division.