Long-term care ombudsman hopes to chart a ‘new direction’ for office

Two years ago, the troubled state agency tasked with advocating for Iowans in nursing homes was in the midst of what one critic called a “death spiral.”

Data from the Iowa Long-Term Care Ombudsman’s Office showed that the staff had dramatically scaled back their visits to care facilities, with visits made in response to complaints dropping from 636 per year to 163. At the same time, the office had cut its participation in nursing home inspections in half, and decreased training sessions for nursing home workers.

Among the states, Iowa ranked last in on-site visits made to care facilities by the ombudsman’s staff, was no longer lobbying state lawmakers on issues affecting older Iowans and was considering a plan to outsource some of the office’s basic functions.

All of that appears to be changing now.

A year ago, Long-Term Care Ombudsman Cynthia Pederson resigned and accepted a contract-writing position with Iowa Department on Aging. She was replaced by Angela Van Pelt, once the public information officer and legislative liaison at the Department on Aging. Van Pelt has a master’s degree in public administration from Drake University and a bachelor’s degree in human services from Upper Iowa University.

At her urging, the Iowa House recently approved legislation that would award her office an additional $300,000 – enough money to increase the number of regional ombudsmen working around the state from six to eight and allow for the hiring of one additional staffer.

Having eight regional ombudsmen on staff would only get the office back to pre-2018 staffing levels, and would still leave Iowa with fewer staff than other, similarly sized states. But it would represent a significant turn-around in the direction of the office, which advocates for 29,000 older Iowans in 435 care facilities.

Van Pelt says she was motivated to take the job in part because she recognized an opportunity to affect change. “I really felt like there was a better way to move forward with things,” she says. “I just felt strongly about the program going in a different direction than it was.”

Another factor was her personal experience in 2019, when she placed her parents in long-term care and later tried to place them back at home.

She says although she was relatively knowledgeable about that process, it was difficult for her. But it also instilled in her, she says, “an increased passion” for the work of the ombudsman’s office and gave her personal experience she could draw upon in her work.

During the past year, she says, she has focused on “rebuilding the team” in her office, noting that it had been years since the staff had last gathered to meet in person. Then it was a matter of determining what the needs of the office were and assessing the obstacles faced by the staff in advocating for older Iowans.

She also set goals for herself, such as restoring the integrity of the office, increasing public awareness and boosting the overall visibility of the office.

With only a year in office, Van Pelt says she’s still working on those early initiatives, but progress has been made. For example, all of the regional ombudsman – officially, they’re called “local ombudsmen” but each serves an area of more than a dozen counties – now have cars to facilitate visits to care facilities. That wasn’t always the case.

“There’s a lot that actually occurred in the first nine or 10 months as far as getting things back on a path that works better for Iowa,” Van Pelt says. A recent realignment of the workload among the regional ombudsmen has also fostered a better understanding of each care facility’s issues, management and residents, she added.

She says improving outreach to seniors and lawmakers has also helped her understand that there’s still a “lot of work to be done as far as the perception of our office.” The challenge, she says, is making sure more Iowans know of her office and the work that it does, while making sure she has the resources needed to meet any increased demand for service.

Office has a history of interference from others

The office is an outgrowth of a federal law that requires each state have a long-term care ombudsman who acts as an independent voice for seniors, investigating complaints about nursing home care without interference from the industry or from other state agencies.

Iowa’s compliance with the “independent” aspect of the law has long been a recurring issue.

In 2010, interoffice emails revealed that the then-director of the Department on Aging, John McCalley, had instructed Jeanne Yordi, then the long-term care ombudsman, that the governor’s office would be dictating her position on all legislative issues.

The U.S. Administration on Aging investigated and instructed McCalley to change his department’s policy barring the ombudsman from voicing her opinion on legislation. McCalley resigned soon after.

Even after that change, emails showed Yordi sought Gov. Terry Branstad’s approval before taking a position on a legislation, and also told her staff she didn’t think it was appropriate for her “to publicly criticize the decision of another state department.”

Donna Harvey, McCalley’s successor as head of the Department on Aging, later wrote to the state’s eight regional ombudsmen and instructed them not to speak out regarding Branstad’s decision to eliminate 10 nursing home inspectors’ jobs.

In 2017, the Department on Aging opted to keep more than $200,000 of federal grant money that normally would have been routed to the ombudsman’s office for administrative expenses. That decision, combined with state spending cuts, forced the ombudsman’s office to terminate visits to Iowa nursing homes.

That same year, the then-assistant director at the Department on Aging complained in an email to his boss that that the ombudsman’s office had issued an annual report that shouldn’t have gone out without the two of them seeing it first. He also wrote that the Department on Aging needed to make it clear to the ombudsman’s staff that they “operate under the umbrella of the department and are not an autonomous executive branch agency.”

Van Pelt says that in her first year on the job, she hasn’t faced any interference from the Department on Aging or elsewhere. “I feel good about it,” she said, noting that the $300,000 in additional money for her office was not in the governor’s budget.

“I did ask for it, and it wasn’t in there,” she says. “But that doesn’t mean I stop there, right? I decided I would go ahead and still pursue that at the legislative level.”

The most recent national data on the various states’ long-term care ombudsman’s offices is from 2020, which means that it doesn’t reflect any of the changes made in Iowa since Van Pelt took over in 2021. But it does show how far behind Iowa has been in recent years when compared to other states.

For example, only one other ombudsman’s office – in Indiana – visited a lower percentage of nursing homes than Iowa’s office. Over the course of a year, the Iowa ombudsmen visited just 22% of the state’s 435 nursing homes. The national average for such visits was 87%.

“We’ve got a lot of work still to do in this office, to be honest,” Van Pelt says, but she adds that she’s optimistic that with support from legislators, the changes she has begun to implement will pay dividends for the older Iowans her office was created to serve.

“These are the people who surrounded us when we were growing up,” she said. “They are the people who helped guide us, and it really feels like society has taken the wrong viewpoint toward them – in terms of the value they have. I really hope that our office can let people know there are advocates out there and there are people who want to help and are willing to help.”