In this chapter, the following terms have the meanings indicated. Terms Defined. “Legal representative” means a person acting under a power of attorney, as a representative payee (unless the facility is the representative payee), or as a guardian of the person or property. “Local ombudsman” means the Director of the local Nursing Home Ombudsman Program. “Patient advocate” means the director of the local Nursing Home Ombudsman Program, the Director of the State Nursing Home Ombudsman Program, or the professional staff and volunteers working in those programs. “Related Institution”. “Related institution” means an organized institution, environment, or home that: Maintains conditions or facilities and equipment to provide domiciliary, personal, or nursing care for two or more unrelated individuals who are dependent on the administrator, operator, or proprietor for nursing care or the subsistence of daily living in a safe, sanitary, and healthful environment; and Admits or retains the individuals for overnight care. “Related institution” does not include: An adult residential environment or home that is certified by the Department of Human Services; or A nursing facility or visiting nurse service that is conducted only by or for adherents of a recognized church or religious denomination, in accordance with tenets and practices that include reliance on treatment by spiritual means alone for healing. “Secretary” means the Secretary of Aging. “State ombudsman” means the Director of the State Nursing Home Ombudsman Program. The Secretary has the authority to receive, investigate, and seek to resolve complaints concerning the operations of related institutions and the authority to make on-site visits to related institutions on his own motion, to determine if these facilities are in compliance with applicable laws, rules, and regulations. The Secretary may delegate the powers specified in §A of this regulation to the director of a local office on aging if: The local office on aging has established a local nursing home ombudsman program within the agency or by grant, or contract; and The local nursing home ombudsman program complies with these regulations. The State ombudsman shall provide, and the local ombudsman shall participate in, the following training for local ombudsman: At least 14 hours of orientation to provide a working knowledge of the long-term care system and the Statewide Ombudsman Program; At least quarterly in-service meetings, each at least 1 day in duration; Technical assistance on a continuing, as-needed basis. The local ombudsman shall provide, and the patient advocates shall participate in, the following training for patient advocates: At least 20 hours of initial training to provide a working knowledge of the long-term care system and the Statewide Ombudsman Program; At least quarterly in-service meetings, each at least 3 hours in duration; Technical assistance on a continuing, as-needed basis. Training shall cover at least the following subjects: Physical, mental, and emotional aspects of aging; History, purpose, objectives of local ombudsman program, and relationship to State Ombudsman Program; Volunteer policies, procedures, and skills for handling complaints; Confidentiality; Overview of nursing home system; Patients' Bill of Rights—State and federal; Regulatory system—federal/State/local laws and regulations; Health care system profile and interrelationships between agencies; Family/resident council; Reading and understanding medical records. The Ombudsman Program is responsible for investigating complaints made by or on behalf of residents of related institutions concerning the provision of services to residents. Investigation responsibilities shall include but not be limited to: Personal contact with the resident who has made the complaint or on whose behalf the complaint was made; Interviews with appropriate officials and staff of the related institution and other appropriate resource people; Visits with residents other than the resident who has complained or on whose behalf the complaint has been made if it is necessary to verify the complaint or to protect the confidentiality of the complaint or resident; Documentation of the complaint and investigation; Periodic communication with the complainant and resident to keep them informed of the status of the investigation. The patient advocate shall visit related institutions between 9 a.m. and 5 p.m. and during regular visiting hours except when the nature of the complaint requires visitation at other hours. Upon entering a related institution, the patient advocate shall comply with any reasonable policy of the facility with regard to the identification of visitors and shall carry an identification card. The patient advocate shall knock on a resident's room door before entering and identify himself/herself and the program immediately. A resident shall have the right to refuse to communicate with the patient advocate. Any refusal shall be made directly to the patient advocate and not through an intermediary. The patient advocate may not disclose the identity of any complainant or resident unless: The complainant or resident, or a legal representative of either, consents in writing to the disclosure and specifies to whom the identity may be disclosed; or A court orders the disclosure. If the resident's room does not permit private consultation between the patient advocate and the resident or if the consultation infringes on the rights of roommates, the facility shall provide a private place for a consultation. After an investigation, if the patient advocate and the local ombudsman determine that the complaint has no merit, the patient advocate shall explain the situation fully to the complainant, and educate the complainant as to his rights and responsibilities. After an investigation, if the complaint is fully or partially verified, the patient advocate shall seek to resolve the problem. Complaint resolution responsibilities shall include but not be limited to: Development of a plan for corrective action through discussions with the complainant, resident, and appropriate officials and staff of the related institution; Establishment of a timetable for resolution; Follow-up within 30 days to determine if the problem giving rise to the complaint has been resolved. Complaints of conditions adversely affecting residents that cannot be resolved shall be referred by the State or local ombudsman to the appropriate governmental agency. The Maryland Department of Health shall designate an employee of the Division of Licensing and Certification to serve as a liaison between the Ombudsman Program and the Maryland Department of Health. If a local or State ombudsman has reason to believe that a related institution is in violation of any statute or regulation which is enforced by the Maryland Department of Health, and the patient advocate is unable to resolve the situation, the local or State ombudsman shall refer the matter to the Maryland Department of Health designated liaison for investigation and appropriate enforcement. The State ombudsman shall provide the Maryland Department of Health with an annual statistical summary of the complaints handled by the Nursing Home Ombudsman Program. The respective local and State ombudsman shall maintain records related to complaints received by or on behalf of residents of related institutions which shall include: Name, address, and phone number of the complainant; Name of the resident; Relationship of the complainant to the resident; Name of the facility; Nature of the complaint; Steps taken to investigate the complaint; Outcome of the investigation; Resolution and follow-up. If the complainant refuses to identify himself or the resident, it should be so indicated in the record. The local and State ombudsman shall store complaint records in file cabinets which are locked when not in use. Access to these file cabinets shall be limited to the patient advocates and project staff authorized by the local or State ombudsman. In accordance with federal statutes, information or records maintained by the Ombudsman Program may not be disclosed unless authorized by the respective State or local ombudsman. A related institution shall grant access to a resident's medical record or provide a copy of a medical record to a patient advocate if: The patient advocate presents written authorization from the resident on whom the record is kept; In the event that the resident has been adjudicated a disabled person, the patient advocate presents written authorization from the court appointed guardian; or In the event that the resident has not been adjudicated disabled but is unable to communicate with others or is found to be medically incompetent by the attending physician of the resident, the patient advocate presents written authorization from the next of kin of the resident, the sponsoring agency of the resident, or, unless the facility is the representative payee, the representative payee that the Social Security Administration designates for the resident. The Department of Aging shall conduct an annual review of each local ombudsman program. The annual review shall be conducted to ensure local program compliance with all applicable federal and State statutes and regulations. The Long Term Care Ombudsman Program shall support the organization and development of family and resident councils in nursing homes. Organizing a Resident or Family Council. The Ombudsman Program shall promote the development of family and resident councils in nursing homes in their local jurisdictions. If a nursing home does not have a resident council, the local ombudsman shall provide assistance to the residents and the facility in developing an active resident council. If a nursing home does not have an active family council, the local ombudsman shall provide assistance and make recommendations to the family members and facility in developing an active family council. Local ombudsman involvement in the development of resident or family councils may include: Providing information about resident or family councils to residents, family members, or the nursing home; Referring residents, family members, or the nursing home to appropriate resources for assistance; Speaking to groups on the role of the Ombudsman Program, family councils; or resident councils; and When invited, participating in organizational meetings for family councils and resident councils. Involvement in Existing Resident or Family Councils. The local ombudsman shall inform the head of each resident and family council in the service area of: The role of the Ombudsman Program; The availability of the Program to assist resident and family councils; and The topics or subject matter on which the local ombudsman is able to provide training. The local ombudsman shall make every effort to attend a resident or family council meeting to which the ombudsman has been invited. Human Services Article, §10-213, Annotated Code of Maryland Effective date: May 9, 1983 (10:9 Md. R. 792) Chapter recodified from COMAR 14.11.05 to COMAR 32.03.02, October 2000 Regulation .10 adopted effective February 26, 2007 (34:4 Md. R. 404)