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Florida nursing home advocacy program riddled with conflicts, federal report says

A statewide volunteer advocacy program for nursing home and assisted living residents has been crippled by conflicts of interest and political meddling by the governor's office and state Elder Affairs administrators, a federal report says.

The U.S. Administration on Aging, which investigated the alleged political firing of an outspoken head of the state's Long-term Care Ombudsman Program, charged in a strongly worded, 31-page report Thursday that the volunteer group has become so hamstrung by politics that volunteers can not effectively advocate for frail elders and disabled people who cannot protect themselves.

Release of the report comes at a critical time: On Friday the state Department of Elder Affairs, which houses the ombudsman program, fired Miami administrator Clare Caldwell, whose most recent evaluation described her as "an invaluable employee who is committed to promoting the best care and quality of life for residents."

Caldwell said her bosses refused to tell her why she was fired, except to say that she served "at the will of the (agency) secretary,'' and her services were no longer desired. "I don't understand how this can happen," Caldwell said. "I don't have any idea why I'm being fired.

The office of Gov. Rick Scott refused on Friday to discuss Caldwell's firing, or the report, which tied interference in the program directly to the administration.

A spokeswoman for the Department of Elder Affairs, Ashley Marshall, declined to discuss the report, as well, though she did release the agency's eight-page response to federal aging administrators.

"Florida's Ombudsman Program exists to benefit and protect the residents of long-term care facilities, who are among the most frail and vulnerable populations in the … delivery system. The Department understands and respects the vital needs for an independent (ombudsman) to advocate on behalf of residents without the pressures of external influences," wrote Charles T. Corley, the agency's secretary.

Brian Lee, the former ombudsman at the center of the controversy, called the report "the first step toward vindication of the ombudsman program."

From the beginning, the report said, Florida's ombudsman program was beset by a conflict of interest: The Department of Elder Affairs develops licensing rules for all assisted living facilities, or ALFs. But the department also holds the authority to appoint or terminate ombudsmen who are supposed to have the authority to criticize such rules. Florida, the report said, "has created an organizational conflict of interest."

"As a result, the Long-term Care Ombudsman Program has been severely limited in its ability to carry out its mission … to advocate for residents and their interests," the report said.

The federal report suggests the volunteer advocacy group has long been under the thumb of Florida governors' administrations, which went so far as to forbid advocates from speaking publicly without clearing their messages in advance. The federal government says that policy violates the U.S. Older Americans Act, which governs long-term care ombudsmen.

The report zeroed in on the case of Lee, who was fired shortly after Scott took office. His dismissal came after sending nursing homes a letter requesting ownership and financial information to which, under the new federal health care reform legislation, he was entitled.

The governor's office told Elder Affairs administrators "that it was time for Mr. Lee 'to go'," and that the program needed to "go in a new direction," according to the report. Days later, Elder Affairs "leadership'' told the acting head of the ombudsman program that Lee's letter to nursing homes needed to be "fixed," the report added.

Though the Administration on Aging acknowledged in its report that the appointment and removal of ombudsmen was well within the administration's authority, the report said the state could not remove ombudsmen in order to achieve political aims.

Two months after Lee was fired, a local volunteer who was calling for an investigation into his firing was herself terminated. Elder Affairs administrators say she was fired for sending e-mails to other volunteers in violation of the state's public records law — though Lee says the e-mails also were sent to several reporters.

The federal report noted her departure with "grave concern," saying such an interpretation of Florida's Sunshine Law would deal a crippling blow to volunteers' ability to speak with each other. After Lee's departure, the Elder Affairs Department appointed a new ombudsman who came with the support of an important group: the assisted living industry.

In December, before Scott took office, the director of the Florida Assisted Living Association sent the governor-elect a letter recommending an AHCA inspector for Lee's job, praising the man, Robert Emling, for "proactively opening lines of communication … with the provider community and state and local agencies."

When Emling withdrew his name from consideration, Florida Assisted Living Association director Pat Lange recommended Jim Crochet, who was given the job. "We were impressed with Jim's expertise, and we felt he would bring a lot to the position," Lange told the Herald.

Read the federal report

See the Administration on Aging's audit of the Florida Long-Term Care Ombudsman Program and read the state's response at

Florida nursing home advocacy program riddled with conflicts, federal report says 09/02/11 [Last modified: Friday, September 2, 2011 10:36pm]
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