Long-term care program in Walla Walla in need of advocates amid shortage

Starr Knutson is on a mission to fill a need not many people know about and even fewer step up to meet.

At least twice a week, the Walla Walla woman visits eldercare facilities, where she sits down with the residents who live there.

It won’t be unusual if Knutson is the only visitor some of folks see on those days. And it’s likely her voice will stand alone in helping them resolve issues with their care.

For five years, Knutson has volunteered for Washington state’s Long Term Care Ombudsman program, more commonly known as “ombuds” in both informal title and to describe the folks who do the work.

More ombuds are needed, officials say.

Here’s why: There are over 4,300 licensed care facilities across Washington, housing about 78,000 people who need assistance on a number of levels to get through their day as safely and in the best health possible.

One of the most unfortunate numbers in the equation is that more than 75% of those who live in congregate care situations don’t get visitors. At all.

There are various reasons why that happens, including family dynamics, geographical distance, impaired mobility and more. None of those are happy situations, experts say.

This is where ombuds like Knutson can be life-changing, for people in care facilities who don’t get visitors and for those who do.

Under the federal Older Americans Act, every state is required to have an Office of the LTC Ombudsman to address complaints and advocate for improvements in the long-term care system.

Washington state law charges its regional programs with coordinating volunteers, protecting confidentiality, using reported data to look for trends in complaints and living conditions, and providing resources to ensure safety and dignity to everyone whose address is at a long-term care center or adult family home.

The program sends certified, trained volunteers like Knutson into facilities to become bridges between administrators, families and residents. In the Southeast Washington region there are 119 facilities that need the outside eyes and ears of a volunteer.

Currently there are just eight ombuds in the six counties overseen by Betsy Claridge in the program’s Walla Walla office.

That number is just too small to cover a service area that runs from Benton County east to Asotin County, Claridge said.

“I’d love to have 15 to 20, but if I could get even 17 volunteers then I would be free to go to the adult family homes.”

Across Southeast Washington, Patricia Hunter is hoping to recruit 200 people to become ombuds.

Hunter has been the state regional ombuds director for 11 years and has worked in the field of aging for more than 20 years.

Finding enough volunteers for all the needs is a chronic challenge for any direct-service organization and the same has long been true for this one, Hunter said.

“Typically we have had 350 to 400 volunteers, and right now we have 150.”

Observing and advocating

When the COVID-19 pandemic arrived, it shut doors for everyone.

In Washington and Oregon that was even more true for the elderly living in care facilities when governors of both states mandated access be closed for visitors. Residents were kept in their rooms to prevent transmission of the infection that was killing nursing home residents first and fastest in early 2020.

No population was more harmed by the pandemic than residents and staff of long term care, Washington ombuds officials said, noting that population has accounted for nearly 40% of deaths in the state from the virus.

Pandemic restrictions demolished the ranks of long-term care volunteers, as well, Hunter said.

Added to that, eldercare staff are exiting that kind of work in crisis-level numbers, which might be the bigger threat to the well-being of residents, she pointed out.

“We are seeing egregious cases of abuse and neglect. We’re seeing such low levels of staffing we’ve never seen before.”

This is where outside visitors do the really important work, Hunter said.

“They see how (residents) are eating, how they are looking, are they getting what they need.”

What most people don’t understand — until they do — is that anyone at any time can suffer a debilitating injury or illness and end up in a nursing home, Hunter said.

“Tomorrow.”

Being an observer and advocate for people in care facilities is not for everyone, Claridge said.

“I have learned to be brutally honest with people about what they are getting into. This is not volunteering for wimps. This is serious business. Frequently it is really serious business.”

She advises people they need to be comfortable with others being angry at them in their mission to keep a resident safe, Claridge said.

Working through solutions

It’s often people who have watched someone in their family go through the eldercare system who have the passion and spirit for the job, she said.

Knutson said her work as a labor arbitrator for the state and as a professional mediator have given her a foundation in her role as an advocate for seniors.

“You learn to be neutral. I learned early on to ask questions, keep my mouth shut and work on mutually acceptable solutions.”

Knutson employs those tactics at the assisted living and memory care facilities she visits.

When she’s approached about a problem — or the perception of a problem — Knutson starts a process that begins with listening.

Sometimes it just takes talking it through to settle an issue. Other times, the ombuds will get consent to look at relevant records to help a resident take action.

Or maybe her role is to simply support a person as they meet with administrators over a grievance, Knutson said.

In one example, a woman was unhappy about a situation was more than capable of speaking for herself, but wanted Knutson to be an observer in her meeting with staff.

“We met with everyone … But it became obvious she didn’t understand all that had happened. As I was sitting next to her I said ‘Let’s stop. Let’s calm down and listen to what is being said.’”

There were many tears and hurt feelings, but in the end, “we were able to resolve,” she recalled.

The food in congregate care is often a bone of contention for those who have few choices in what and where they eat.

Knutson makes a point of arriving at mealtimes on occasion to taste the offerings for herself. That lets her empathize but also point out realities — few facilities can offer a restaurant-sized menu, but there are options for diners.

Laundry, too, can be a thorn when residents can’t get their clothing back in a timely manner. Knutson also hears about mail that doesn’t get delivered soon enough, she said.

Effects of the pandemic

When the pandemic separated her from clients, she mailed postcards bearing her personal phone number.

People began calling. As soon as Gov. Jay Inslee said ombuds could enter facilities to help residents, Knutson donned the protective gear and went to work, trying to quell rumors and address fears as much as possible.

“People really didn’t know what was going on, they couldn’t even come out of their rooms. They couldn’t talk to anyone except staff delivering their meals.”

She saw the evidence up close as lonely residents, unable to socialize or get exercise, sank into depression.

It was the fall of 2020 when Knutson used her advocacy muscles to ask administrators to allow those in their care to sign up to walk in the hallways in 15 minute slots, or sit in doorways to chat with neighbors across the hall.

It took a month of talking with the center’s executive director to bring the idea to fruition, Knutson recalled. Not that she blames administrators for what they had to do, she added.

“They were doing what they had to do to make sure it didn’t spread like wildfire through their facility.”

Everything about COVID-19 has been terribly difficult for the nation’s elders, and the pressure of the pandemic continues to wear on their lives, Knutson said.

“They don’t seem to want to do things now.”

More than ever, society needs trained advocates for such treasured citizens, she believes.

“I think the public doesn’t realize how much it is needed.”

People in care centers fear being discharged, left with nowhere to go, if they raise complaints, Knutson said, noting the level of such uncertainty and doubt is the highest she’s seen.

“It’s one of the things I am working on right now, that people understand what their rights are.”

Frankly, the work is not a bad deal for her, either, Knutson said.

“Being an ombuds gives me the satisfaction of being able to help people and provide a listening ear. It’s very satisfying.

“I hope I am improving their quality of life.”