As a long-term care ombudsman, Toni Nelson Huff says there is no ambiguity whatsoever in what her job demands day in and day out.
It's to be a 100 percent advocate for the rights of those residing in nursing homes, assisted-living facilities, personal care homes and community living arrangements. Period. Exclamation point.
"We're working to make sure that residents' rights are honored," says Nelson Huff, 60, a Columbus resident by way of Jamestown, N.Y., where she grew up, and Tallahassee, Fla., her home for three decades.
Nelson Huff's work requires visiting facilities in the 16-county River Valley Area Agency on Aging, one of more than 600 such organizations nationwide that aim to make sure older Americans and those with disabilities aren't forgotten and that their voices are heard.
Direct Services Corp., a nonprofit entity, was formed in 1979 to provide various services to that population in the Georgia counties of Chattahoochee, Clay, Crisp, Dooly, Harris, Macon, Marion, Muscogee, Quitman, Randolph, Schley, Stewart, Sumter, Talbot, Taylor and Webster.
Aside from the ombudsman program, Direct Services also offers home-delivered meals, congregate meals, senior center enrichment programs, homemaker aid services and community care services, according to its website.
For Nelson Huff, who has worked in the area of aging and disabilities her entire life, long-term care ombudsman is a dream job and one she loves deeply. And it's a challenging one, with she and two colleagues tasked with covering those 16 counties. In Columbus alone, there are about 150 facilities and homes geared toward those growing older and with various disabilities.
The Ledger-Enquirer visited with Nelson Huff at her Second Avenue office in Columbus to discuss her job, why she does it, and what she encounters along her journeys into the living facilities, be it from a simple phone-call complaint or routine visits to speak with home residents and staffers.
This interview has been edited a bit for length and clarity.
When did you first know in your life that this is what you wanted to do?
I came about it accidentally because when I graduated with my bachelor's degree I wanted to work with troubled children, and the only job I could find was in a nursing home. But I never left working in aging since that time. I was hooked. I became a nursing home social worker and just fell in love with the population and realized that so many people don't appreciate the wisdom and value of our elders, that we kind of place them somewhere rather than honoring them.
There's a sense that their lives have been lived and they're simply waiting for the end?
Yeah. When you hear someone's story, the amazing things they've done with their lives. They've served in the military for us and done wonderful things for our country, and you don't know that just seeing this older person in a bed or a wheelchair.
What went through your mind that first time you were in a nursing home?
I remembered when I was a Girl Scout, when we used to go caroling in nursing homes at Christmas, and that was the only connection that I had. But I remembered being impressed and thinking I would like to come back and visit these people. It looked like they could use some company. A lot of them just looked kind of lonely.
You sensed loneliness in them?
I did, I did. And I see that today. So many people feel like my loved one is safe in a nursing home, someone is taking care of them. You get busy with your life and you don't visit them as often as maybe you intended to do. So, yeah, there is some loneliness there and some feeling of being forgotten.
Do you have a personal experience to relate with a nursing home stay?
The only personal experience I have is with my grandmother, which was very difficult because I had promised to never have one of my relatives go into a nursing home, that I would provide care at home. My grandmother decided that she wanted to go into a nursing home and I had to honor her wishes. It's one of those things where you don't decide for someone because they've gotten older. They have that choice and that's what an ombudsman does. We honor that resident's choice whether it's what we might agree would be best for them or not. We're their advocate for their choices.
Your job is visiting nursing homes and checking on folks?
We (as an ombudsman) visit every long-term care facility in the country. The ombudsman program was put in place through the (1965) Older Americans Act, so every nursing home in the country has an ombudsman to visit them. In Georgia, we also do personal care homes, community living arrangements and assisted-living facilities, and there are about 150 of them in the River Valley area that three of us routinely visit. We go into them, visit with people, ask questions, see if they have any concerns or problems, and we also go in if someone calls us with a complaint to investigate and advocate for a resident.
Do you get calls from residents themselves?
We get calls from residents. We get calls from family members. And we get calls from facility staff who are concerned about a resident who may be living with them, and they feel like needs someone to advocate for them.
How far geographically do you go to visit nursing homes and facilities?
The farthest I go is Fort Gaines, which is about an hour and a half south of here. Then we go to the Americus area. We do the 16 counties that are in the River Valley catchment area, with most of the facilities being in Muscogee County because it has the largest population. But facilities are scattered throughout the other counties as well. Another ombudsman goes to Harris county.
What's a day like for you?
The first thing in the morning you listen to the messages that were left overnight with people calling in with questions and concerns. We don't always investigate complaints. We also provide people with information, such as what to expect in a nursing home. We focus on residents' rights. So a lot of our questions are: Can the residents do this? My mother was told she can't do that. I was told I had to do this. What legally are the residents' rights when they enter a long-term care facility. So that's really the focus of most of our calls.
Sometimes we're educating facilities on residents' rights. Sometimes we're actively advocating for a resident, for their right to make their own choices.
How often might you visit facilities?
We come in unannounced and try to do it during normal business hours. But the facilities don't know that we're coming. So when we're planning our time we'll look at where have we not visited in the last quarter. We try to visit a facility at least once a quarter. If there are complaints, we're there more often trying to resolve them and advocate for the residents. So a typical day might be listening to phone messages, returning calls and then prioritizing your day, because whatever you thought you were going to do yesterday, today's priorities come in and juggle that.
That's somewhat like a news reporter?
(Laughs) It can be, yes. You can have your whole day planned and an urgent call will come in and you handle that one. So it's juggling what's truly important and what's urgent, and trying to get to both of them. If it's a larger nursing home, because we have some that have 200 or 300 residents in them, that can take most of the day. If we're visiting a personal care home that has two or three residents, that's quite often a shorter visit, so you can do more of them.
What would you classify as urgent?
Something urgent might be someone who is being discharged inappropriately from a facility. You want to get there before that happens and make sure that their rights are protected. Even being discharged without proper notice. The law requires proper notice for a discharge. So a lot of our complaints are in regard to improper discharge.
We have a lot related to smoking, because people have smoked since they were very, very young, before we knew the difficulties of smoking. It's one of the few joys they have left in life. More facilities are going smoke-free, so regardless of your own personal opinion smoking, you want to advocate for someone's right to do one of the few things that gives them pleasure in life.
So you advocate for them to continue lighting up?
If that's what they want, yes. And we advocate for them if they want different food. Food is a very popular topic in nursing homes. You can imagine cooking for that many people and trying to please everyone. But if someone wants a specific food, we will advocate for their right to have a diet change.
Is physical treatment an issue at times, such as someone saying, hey, they let me fall?
Abuse, neglect, exploitation, that kind of thing, yes. And sometimes adult protective services might get involved, depending on who did the abuse. But we always act on the residents' wishes. That's one thing that's different with the ombudsman program, than probably most other jobs in this area, is we are always a resident advocate. We don't look at, well, that's not in your best interest, so that's not appropriate. We advocate for what they want.
Someone in a nursing home needs that because there are so many rules and regulations that the facility has to follow to keep them safe, that sometimes what they want kind of falls by the wayside. So that quality of life versus safety continuum veers toward safety, and we're there to represent the residents' right to having some quality in their life and some choices, even if it's a risk that people think might not be safe for them to do.
You guys are pretty powerful it would seem?
We're determined. I don't know how much power we have, but we have a lot of determination and drive and true desire to honor facility residents' rights to exercise what is basically everyone's right as an American. You don't leave your rights as an American at the door when you enter a long-term care facility. You retain all of them and sometimes that gets forgotten.
You would seem to have a sense about the facilities in Columbus. Are we doing a good job taking care of folks in this area?
I think, for the most part, everyone's hearts are in the right place. Health care is a difficult field. It truly is. But sometimes it's hard to come up with what's the best answer, what's the best solution to a problem. So they're challenged.
Do some nursing home staff resist your efforts at times?
Sometimes, and then after a while you work out a working relationship and they understand we're there to advocate for the resident regardless. I think once they understand that ... it's not our role to look at what's health-wise the best choice, safety what's the best choice, and that we're there to advocate for the residents' wishes, even if it doesn't make a lot of sense to them sometimes.
Do you have an example of impact you made in a facility?
(Ombudsman colleague Cat Young brings up an example): There was a gentleman who relayed to me that he did not wish to be in a nursing home. When I was looking into everything, the facility had told him that his wife had put him there and that he would need to stay ... We wanted to make sure he wasn't there under guardianship, that he wasn't there under court order. In talking with him, he was quite the comical character. He could tell me where he was, the name of the president. He obviously was able to be on his own.
But his daughters had also tried to come and get him and the facility had told them that if they came they would call the police, that he could not leave. The law states that a resident can leave the facility whenever they get ready. All they've got to do is make a plan to leave and be discharged. So I was able to educate the facility that the wife did not have the right to make him stay at the facility if he chose to leave.
Through the investigation we learned that it was financially based, that (the wife) wanted him to stay there, and the facility was made aware of that. We showed them the laws, the regulations, and we were able to work it out to where his daughters were able to come and get him ... The gentleman was able to live with his daughters in two opposite places part-time and enjoy life and was zip lining, volunteering and sent a thank-you note giving permission to give information about that. He sent something to the state ombudsman about it.
So we were very pleased that we were able to assist him and educate the facility. That facility no longer, ever says that we can't discharge someone. The law reads that every staff member, before working on the floor, is educated on residents' rights. Upon admission, families and residents are suppose to be educated on residents' rights. But we've gone to more than one (facility or home) and said: How many of you have had education on residents's rights? And none of the staff raise their hands. And we have our posters in all facilities.
What's the most rewarding aspect of your job at the end of the day, at the end of the week?
(Back to Nelson Huff): I think the most rewarding part to me is when I walk into a facility door and people are smiling and say, the ombudsman's here, and they want to talk to you. And I'll start to leave and hear a call from down the hallway: Wait a minute, there's one more person who wants to talk to you before you leave. And having the residents thank you for making a difference.
Is this occupation or profession something that should see growth because of Baby Boomers getting older and the need for more nursing homes and assisted-living facilities?
And I am one of those Baby Boomers. (laughs) But, definitely, as our generation gets older there's going to need to be more facilities. As I said in the beginning, the Older Americans Act federally says that there needs to be an ombudsman for every facility. So as there are more facilities, there probably will be the need for more ombudsmen.
And when it comes to disabilities, that is an issue in nursing homes?
There's getting to be more and more younger disabled residents in nursing facilities, and that's requiring that we look at what activities are offered and even what meals are offered. Older residents might want meatloaf and younger ones want pizza, and the older ones want bingo and younger ones want something age-appropriate for them ... computers, interactive things. So nursing homes are struggling with how to meet the needs of very different populations.
What qualities does someone need to be an effective long-term care ombudsman?
I think you have to have compassion, determination and really thick skin, because people will tell you off pretty regularly if you don't say what they like to hear. And just be able to remain calm and focused. Be able to manage your time really, really, really well because you can get so involved in something and suddenly realize you've spent two hours on it and there's more to do in the day.
And have good investigative skills?
We do have to do the complaint investigations, and sometimes that involves talking with people and looking at the records and making a determination if a complaint is valid.
But there are some good nursing homes and happy people in them, correct?
There are residents who love being in a nursing home. They're rolling down the hallways in their wheelchairs and smiling and waving to all the staff, and welcoming new residents and helping them fit in. So it's not all doom and gloom and I'm sitting here all lonely. They can become a community in a home for some people. Those are the residents that wave when I come in and tell me who I need to go talk to and who could use a listening ear and tell me about what they've been doing to make a difference. So, yes, there are some nursing home residents who are advocates themselves for other nursing home residents.
Name: Toni Nelson Huff
Hometown: Born and raised in Jamestown, N.Y., but lived 30 years in Tallahassee, Fla.
Current residence: Columbus
Education: 1972 graduate of Jamestown High School in Jamestown, N.Y.; earned her bachelor's degree in social work from Buffalo State College, N.Y., in 1983; earned her master's degree in social work from Florida State University in 1985
Previous jobs: She's worked in the field of aging and disabilities all her adult life, including nursing home social work, hospice social work, home health social work, rehab discharge planner, geriatric care manager and professional guardianFamily: Husband, Brad Huff, a history and geography professor at Columbus State University; a son and grandchildren in Colorado Springs, Colo., and a daughter in Hartford, Conn.
Leisure time: Shen enjoys gardening and watching the butterflies, hummingbirds and other critters in her backyard habitat; and she bakes her own bread and cooks from scratch whenever possible; she also belongs to the Greater Columbus chapter of AARP, and serves as a legislative chair for the organization