LUFKIN, Texas — Tonya Jackson recently stepped out of an Angelina County nursing home, feeling grateful for her role in resolving a situation involving a resident facing eviction. Communication issues between the elderly woman’s family and the facility had led to this predicament, prompting Jackson to intervene. As the Deep East Texas managing local ombudsman for long-term care facilities, she acts as an independent advocate for residents living under care.
“Ombudsmen do not come into nursing facilities to cause trouble,” Jackson emphasized. “Our purpose is to assist and advocate for residents who feel voiceless. We strive to repair broken communication lines.” Unfortunately, there aren’t enough advocates like her in Texas, where the state’s record on long-term care facilities has been subpar. According to a 2018 AARP evaluation, Texas ranked 42nd in safety and quality, highlighting a pressing need for change.
The shortage of ombudsmen—comprising both paid staff and volunteers—poses a significant challenge across Texas, particularly in Deep East Texas, which includes Angelina, Nacogdoches, and Newton counties. Currently, only five individuals—two of whom are paid staff members—serve 48 long-term care facilities in the region, amounting to 34 nursing homes and 14 assisted living establishments. “They play a pivotal role in the long-term care community, but there is a dire need for enhanced support,” noted Andrea Earl, the associate state director of advocacy and research for AARP.
To address these concerns, in early December, the Deep East Texas Council of Governments, a coalition of local government representatives, urged for more volunteers to assist the ombudsman program. Jackson hopes that an influx of volunteers could provide much-needed support, believing that one volunteer assigned to each facility would significantly benefit residents. “Volunteers can often observe things we might miss, due to the limited time we have at each facility,” Jackson explained.
In parallel, state officials are optimistic that the Legislature will offer additional assistance when it reconvenes in January. Patty Ducayet, the state’s lead ombudsman, has expressed a desire for lawmakers to allocate more funds for additional staff, regulate Medicaid usage, and develop a system for handling involuntary discharges—incidents where residents are evicted. With the Legislature signaling a focus on dementia care and related research, Earl is hopeful that this will extend to enhancing the ombudsman program as well.
The role of an ombudsman is to operate independently from the Health and Human Services Department, allowing them to advocate for residents without fear of reprisal. Full-time ombudsmen investigate complaints regarding the health, safety, and rights of residents and work to resolve issues, supported by a network of volunteers who contribute a few hours each week. Jackson aims to visit 15 to 20 individuals during her monthly visits to facilities, seeking to ensure that each resident is spoken to at least once annually.
Her work requires deep empathy and understanding. Often, ombudsmen are the only contact residents have with the outside world, and her visits not only connect her with residents but also facilitate rapport building with the facility staff. Without this connection, ombudsmen may be seen as troublemakers rather than advocates. Earl pointed out that tension has arisen in the past, particularly in 2023, when legislation was proposed that would have limited ombudsman access to patient files, a critical aspect of their job.
Carmen Tilton from the Texas Assisted Living Association clarified that their intention was not to restrict access but to align Texas regulations with federal standards. The previous system allowed even volunteer ombudsmen to access sensitive resident information without consent, which led to privacy concerns. Despite the pushback, the legislation was withdrawn before reaching a vote, allowing discussions to continue about improving the framework without necessitating legislative change.
Implementing effective change within care facilities can be a slow process, and issues can reoccur even after resolution. Jackson’s effectiveness hinges not just on her interactions with residents, but also on her established relationships with facility staff. As Lynne’ Nix, the business office manager at Shady Acres Health & Rehabilitation, observed, Jackson plays a crucial role in addressing resident concerns, particularly when residents may feel uncomfortable advocating for themselves.
However, in 2024, the state ombudsman program is grappling with a staggering 25% turnover rate for paid staff—the highest on record. According to Ducayet, those who remain are overwhelmed by the workload. Currently, Texas has one ombudsman for every 2,514 licensed care facility beds, compared to the ideal ratio of one for every 2,000. More staff would allow a greater focus on recruitment and support for volunteers, improving advocacy efforts statewide.
Local volunteers, often family members of current residents or prospective visitors, are essential assets in ensuring care quality. Unfortunately, the number of active volunteers in Texas has dropped significantly since 2019, leaving only about 300 to fulfill this vital role. The nature of the work can be emotionally taxing, as volunteers often form bonds with residents, some of whom may pass away. Ducayet noted the impact of these experiences on staff and volunteers alike.
With fewer staff and volunteers available, the frequency of visits to care facilities increases. More eyes on the ground can lead to quicker resolutions to problems before they necessitate state involvement. Ducayet plans to advocate for several changes in the upcoming legislative session, including a call for approximately $3 million in additional funding for the ombudsman program, which would allow the hiring of 22 extra full-time personnel.
One of her primary intentions is to address compliance issues related to state and federal discharge regulations. Involuntary discharge has been a common complaint among residents and their advocates. By creating an online portal for nursing homes to submit discharge notices and enhancing penalties for noncompliance, she hopes to alleviate some of these pressing issues.
Increasing staffing levels at long-term care facilities is another crucial objective. Both Ducayet and AARP are pushing for regulations requiring nursing homes to allocate 85% of their Medicaid reimbursements toward payroll. This approach aims to ensure that funds are directed toward caregivers rather than corporate profits. Although similar proposals previously failed to receive full votes in the state House, Earl believes this year could see more success.
While these initiatives may not entirely resolve the systemic challenges within Texas’s long-term care industry, they have great potential to boost accountability and improve residents’ quality of life. Ducayet has spent significant time educating lawmakers on the ombudsman program to bolster progress. As she works on systemic improvements, Jackson remains focused on recruiting additional local volunteers to ensure that the needs of vulnerable populations in Deep East Texas are met effectively.
By securing one volunteer for each of the 48 facilities in the area, Jackson hopes to enhance the program’s impact and support the residents who rely on their advocacy.
