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Neutering the watchdogs

Interference in state's Long-Term Care Ombudsman Program could mean less oversight of nursing homes and assisted-living facilities

It’s been nine months since Brian Lee was given an ultimatum by his superiors at the state Department of Elder Affairs: Either turn in his resignation as the state’s Long-Term Care Ombudsman, in charge of advocating for residents of assisted-living facilities and nursing homes across the state, or be fired.

Lee, who was often perceived during his seven years on the job as a thorn in the side of the industry administrators he was paid to be critical of, reluctantly resigned. Less than three months later, Jim Crochet, a veteran employee of the state’s Department of Elder Affairs, under which the Long-Term Care Ombudsman program operates, was named as Lee’s replacement.

If the state thought that it had closed the chapter on Lee’s activism on behalf of the residents in the state’s 4,039 long-term care facilities, it was wrong. If anything, Lee is more outspoken and critical than ever because he doesn’t have to abide by the state rules that used to keep him from speaking directly to the media when he was the Long-Term Care Ombudsman.

Lee is now executive director of a Tallahassee-based nonprofit citizen advocacy group called Families for Better Care, which tries to raise awareness about poor conditions in nursing homes and assisted-living facilities across the nation, and part of his role is to stay on top of situations – such as the one playing out in Florida right now – in which politicians sympathetic to the health care industry are eroding the protections in place to ensure that residents aren’t neglected, abused or treated unfairly.

So on Friday, when state Rep. Matt Hudson (R-Naples), told a crowd of ombudsmen who’d gathered in Altamonte Springs for a meeting of the state’s Long-Term Care Ombudsman Council that he introduced a bill during the 2010 legislative session that would have limited the purview of ombudsmen to investigate conditions in facilities, that he’d done so for “shock value” and to initiate a conversation about the role of ombudsmen, Lee wasn’t shy about voicing his response.

“You want to start a conversation and initiate shock value at the harm and expense of residents of nursing homes and assisted-living facilities? To me, that in itself is shocking,” says Lee, who attended the meeting. “Right now, the ombudsman’s office is being systematically dismantled from the inside out.”

Per the federal Older Americans Act, which mandated that each state establish a long-term care ombudsman program to investigate and resolve concerns about the quality of care offered in nursing homes and assisted-living facilities, ombudsman programs are supposed to operate independently and impartially, without political interference, intimidation or meddling. Lee says that over the past five years, the long-term care industry in Florida – which contributes heavily to both Democratic and Republican political causes – has attempted to interfere with the ombudsman program’s reach. But it wasn’t until 2010, when it looked like Rick Scott – a former health care executive with a business-friendly, deregulation-minded platform – was making headway in his campaign for governor of Florida, that the effort to put a wedge between nursing home residents and the ombudsmen picked up. In December 2010, the Florida Assisted Living Association, the state’s largest association representing nursing homes and assisted-living facilities, wrote newly elected Gov. Scott a letter recommending that it replace Lee with a candidate it favored; less than two months later, Scott’s office contacted the Department of Elder Affairs and said that it was time for Lee “to go” because it wanted the ombudsman program to “go in a new direction.” That same day, Lee was told to quit or be fired. Long time ombudsman volunteers voiced concerns about the manner in which Lee was let go and sent a letter to the U.S. Administration on Aging asking it to investigate “acts of retaliation and willful interference” with the program. Shortly thereafter, some volunteers close to Lee, including Lynn Dos Santos of Venice, Fla., were let go. Other volunteers have quit the program in frustration – there used to be approximately 400 volunteer ombudsmen in the state; now there are only about 250.

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