HJBR Sep/Oct 2025

HEALTHCARE JOURNAL OF BATON ROUGE I  SEP / OCT 2025 19 CASE STUDY: “DON’T TAKE AWAY MY RIGHTS” Clara, 82, a retired schoolteacher, entered a nursing home for rehabilitation after a hip fracture. She always had a smile and was rarely seen without her hat. Clara was clear about her intentions to everyone: “I will soon be able to go home.” Her son, who held power of attorney, disagreed. He claimed the house was unsafe and she was “too old to live alone.” Clara began to notice her daughter-in-law wearing some of her jewelry. When she asked about it, her son responded, “You’re not wearing it, so what’s the problem?” Clara contacted the ombudsman. “This isn’t right,” she said. “It’s still my life.” The ombudsman helped Clara access OLAP support. She wanted to “handle her own affairs” and wanted the OLAP attorney to revoke the POA she had given her son. After meeting with the attorney, who explained her rights and made sure Clara understood what she was signing and the possible consequences (family tension), Clara chose to revoke the POA. Then Clara disappeared. During a routine visit sometime later, the ombudsman found Clara was gone, trans- ferred to another facility without notice. Clara had been interdicted (legally declared incompetent), and her son was now her court-appointed guardian. The ombudsman at the new facility was contacted and reported that Clara mostly stayed in bed, withdrawn. Her trademark hat was gone. Her smile had vanished. After a long and gentle conversation, Clara said quietly, “I didn’t agree to this.” She asked for help to challenge the guardianship. The ombudsman initiated OLAP support. While the legal battle unfolded, Clara and the facility’s social worker prepared for her anticipated return home with a HCBSWaiver safety assessment for home modi- fications. Her dream was now a plan. Clara’s rights were eventually restored. Her home was nearly ready. But Clara passed away before she could return. RESIDENTS HAVE THE RIGHT TO: • Be notified of transfers or discharges. • Contest POA or guardianship arrangements. • Return home if competent and safely supported. DID YOU KNOW? Capacity is a spectrum. The ability to understand and make choices is not an on-off function. Capacity varies in subtle degrees, from no or very low levels of understanding to the ability to understand and make decisions on very sophisticated and complex issues. Capacity is affected by health, pain, medication, and illness or injury. Regardless of capacity, residents make decisions daily about how they want to spend their time. A resident may not know what year it is, but may be able to communicate whether they want a specific family member or friend to visit them, or what food they prefer. A resident may not be able to manage their finances, but can determine who they want to manage their affairs. (Carlson 2021). CASE STUDY: “INVOLUNTARY DISCHARGE DENIED” Henry, a retired executive, had lived in a nursing facility for eight years. He enjoyed the garden and made friends. But as his hearing declined and speech became harder, staff began describing him as “aggressive.”He was sent for psychiatric evaluation three times — and was cleared to return each time. On the fourth discharge from psychiatric care, the nursing home refused to take him back, stating that the facility could not provide the care Henry needed. The ombudsman, reviewing a transfer log, noticed Henry’s name. She traveled to the psychiatric facility. At first denied entry, she insisted on Henry’s right to see his ombuds- man, if he agreed. When they met, Henry was clear: “I want to go back. That’s my home.” With his permission, the ombudsman met with the nursing home administrator and reminded her of federal regulations prohibiting involuntary discharge without cause, due process (including a written notice), and a safe plan in place. Henry was readmitted. The ombudsman and Henry worked with staff to develop a person-centered sup- port plan: • Staff initiated a plan for communication training to better understand Henry’s needs. • A counselor was scheduled to visit weekly. • A friend volunteered to coordinate helpers to accompany Henry to church. • Garden time was added to his weekly schedule. DID YOU KNOW? Federal law permits involuntary discharge only if: • The facility cannot meet the resident’s needs. • The resident no longer requires nursing home care. • The resident’s safety is at risk. • The resident poses a risk to others. • The resident has not paid. • The facility is closing. In all cases, written notice and appeal rights are required.