Jurisdiction, lack of an ombudsman impede supervision of the nursing home


After 40 COVID-19 deaths were reported on the Winslow Campus of Care two weeks ago, members of the Navajo Committee on Health, Education and Human Services sought clarity about oversight of nursing homes.

But clear answers were difficult to come by, at least initially. At the February 3 meeting, the committee learned that with multiple state, regional, and tribal units with different responsibilities in multiple jurisdictions, effective oversight of long-term care facilities depends on communication and coordination between them, which is a challenge in normal times and difficult times even more so during the pandemic.

“I didn’t really research it on my end,” Jill Jim, director of the Navajo Department of Health, first told the committee. “I think we can work with the local health department and the state,” said Jim. “If they are government licensed, I think these agencies can be vetted to make sure that services are being provided.

“I would need to speak to Ms. Neswood-Gishey and HEHSC (Director of Social Services) about strengthening some kind of coordination with our elders,” she said. Jim said DSS contracts should contain provisions that enable the nation to ensure that the elders are safe and receive the best possible care.

She then cut the HEHSC conference call call and delegated it to Ramona Antone-Nez, director of the NDOH Epidemiology Center, to speak on her behalf.

“We were made aware yesterday that there have been a number of COVID-19 cases and deaths on the Winslow Campus of Care,” said Antone-Nez. “I have questions about why we didn’t understand or know beforehand what would enable us to react to this situation.”

Antone-Nez said the Navajo COVID-19 Health Command Operations Center works with multiple sectors of the health system and includes tribal health coordination and outreach representatives in the state of Arizona and counties.

“What we may have missed is if this is a cluster that occurred in a border urban region. We may not have seen these all come from one place,” she said. “We need to have a better understanding of what happened on the Winslow Campus of Care from the start. Please give us time to investigate. “

Antone-Nez reiterated that prior to becoming aware of the WCC outbreak, the HCOC had not received any notification of their need for assistance. She said it was “a great revelation” to learn about the serious adverse event.

However, according to Antone-Nez, it is not uncommon for it to take time to identify a particular group of cases in an area that is experiencing a surge in certain cases. “We learn that these multiple cases are from one facility,” she said. There is also a delay in receiving death dates “due to state review,” according to Jim.

‘Our Duty’

“We were completely surprised by this incident in Winslow, I can say,” said Delegate Thomas Walker, who represents the communities adjacent to Winslow, to HEHSC members. “Nobody is willing to say, in the event of death on this scale, ‘Here are the logs, this is the authorities on this matter, and here is something families should know.’ “The immediate concern today, at this time, is whether our precious relatives are safe in these facilities?” He asked.

Photo courtesy | Thomas Walker
A COVID-19 outbreak at the Winslow Campus of Care nursing home killed 40 residents, including some Navajos.

Wayne Claw, director of the Navajoland Nursing Home, which has no COVID-19 deaths, also expressed concern about the care of “Masanis and Cheiis” and what happened at the WCC, where some of its residents are being referred by IHS when you need rehabilitation. “We had some elders sent there,” Claw said. “We know them very well. We were hoping they would come back and they didn’t. We died over there. “

Claw stressed that the Navajo National Council and the President have every right to know how their elders are treated and what the conditions are like in long-term care facilities. “I’m very concerned about where there is no action,” said Walker. “I don’t know where this will lead, but we have our job, our duty and our responsibility to look after our people. We are talking about the loss of life, 40 losses in an environment, a program. “

HEHSC Vice Chairman Carl Slater committed to investigating Arizona state oversight. He did not respond to a Navajo Times request for a progress update.

Ombudsman “abolished”

HEHSC chairman Daniel Tso asked Antone-Nez what happened to the NDOH Navajo Area Agency’s former “Ombudsman” on aging, who used to oversee long-term care facilities.

In general, an ombudsman is a civil servant who can investigate complaints about the administration or human rights violations and help find a solution. “That particular individual had the authority and ability to go to assisted care or long-term care facilities to examine the Navajo citizens at a specific facility adjacent to the Navajo Nation,” Tso said. Antone-Nez replied that she believed that the position of ombudsman was currently vacant. She said that when NDOH updated its master operating plan in 2018, the NAAA became the Department of Elderly and Long-Term Care Assistance.

Claw informed HEHSC that the position of ombudsman had been vacant for the past two years. “We had a lady in that position who was very helpful, but there has been no replacement since she left,” said Claw. The day after the HEHSC meeting, the Aging and Long-Term Care Department confirmed that the Ombudsman position had indeed been eliminated in 2015, although ombudsman services are still listed on the outdated DALTCS website.

To an email query from Legislative Counsel Ron Haven and Antone-Nez on February 4, newly hired DALTCS Health Services Administrator Valerie Jones continued to respond. “In reviewing previous DALTCS documents, the position of ombudsman was advertised in 2015 but never filled as nobody applied and the position was eliminated,” said Jones. “Currently, DALTCS does not monitor long-term care facilities.”

In her email, Jones said she would work with the human resources department to restore the position and train a new ombudsman. “The Navajo Nation Ombudsman DALTCS will be responsible for Navajo Nation facilities as well as tribal members at facilities across the state,” said Jones.

On Tuesday, Jim said NDOH was “in the process of applying for that position”. Jim, Human Resources Manager Perphelia Fowler, and DALTCS Administrator Leonora Henderson were asked to provide HEHSC with further details on the NDOH Ombudsman position on February 10th. Follow-up (sub) The President’s Office confirmed that the Navajo Department of Health and Health Command Operations Center will only provide assistance if there is a request.

“NDOH / HCOC receives many inquiries from many individuals and others every day, and do their best to respond to each one,” the OPVP stated. “There was no request to NDOH / HCOC at this nursing home.” In response to the Navajo Times’ Feb. 9, Antone-Nez said HCOC partners have been gathering information and discussing the situation (WCC) internally since the HEHSC meeting in order to understand.

“These include the Navajo Department of Health, the Navajo Region Indian Health Service and the Winslow Indian Health Center,” said Antone-Nez. There will also be follow-up with Navajo County, the Navajo Division of Social Services, and the Winslow Campus of Care, she said.

The President’s Office added that there was “no disruption to communications” within the HCOC that the Unified Command Group, made up of the Navajo Nation, Navajo Territory IHS, Public Law Representatives 93-638, BIE and BIA, information had received bi-weekly meetings about the WCC outbreak in their country. “We are bound by HIPAA restrictions and it is important to note that this facility is outside of the Navajo Nation,” the OPVP stated.

Neswood-Gishey made it clear that DSS has no jurisdiction or oversight over nursing home facilities in border cities. “The county health departments where nursing home facilities are located are responsible,” she said. “The Navajo-Arizona Long Term Care System within the Department of Social Services has an interstate agreement with the state of Arizona for case management services only for certain facilities with Navajo residents.”

She said IGA allows quarterly reviews for assisted living and home care, as well as a six-month review for nursing home facilities. However, due to the public health emergency, the state has allowed these reviews to be carried out over the phone.

Neswood-Gishey said that although DSS has no control over the WCC, the Navajo ALTCS program manager contacted the facility to inquire about residents.

“The investigation found that until the pandemic outbreak, the WCC was COVID-19 free by December 2020. An isolation unit was deployed, but the virus continued to spread,” she said. “The admissions have been suspended until recently (and) WCC leadership is closely coordinating with the Arizona Department of Health and the Navajo County Department of Health.”

In addition, Neswood-Gishey said the majority of WCC residents and staff have now been vaccinated through Winslow Indian Health Care Center Inc. and Walgreens.

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