INSIDE OKDHS FEATURE STORY, OCTOBER 2014 - A CAREER IN CARING, ESTHER HOUSER

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(NO AUDIO) 1978 - State Long-term Care Ombudsman created by Federal Law

Esther Houser: The State Long-Term Care Ombudsman position was created in federal law in 1978 in the Older Americans Act Re-authorization. It is intended to be an official of state government who is an advocate for elders who live in long-term care facilities: nursing homes - in this day and age - it's nursing homes, assisted living and residential care facilities. 

The role of advocate is to help give voice to the residents' concerns, help to address their complaints and problems, as well as identify systems issues: whether it's regulatory, legislative or other, to try to get... my summary is to try to get the resident in the nursing home or assisted living what she wants. 

(NO AUDIO) 1979 - Appointed State Long-term Care Ombudsman

I took this job because I like visiting older people in nursing homes. I love them. I love the stories they tell, and the issues that they bring, and the fact that working with older people you get to work with folks who are pretty straightforward and honest by and large. They're not saints, but they tend to tell you what they really think. And I've always appreciated that in a person. But, to be able to help them get taken seriously and help to relieve the fear that they have or the torment that they might be experiencing has just been a motivator. You know, if I can be the front person, the talking head, the front man for the organization, then so be it. 

We started with half of a $50,000 grant. The Ombudsman shared the grant with the Legal Services development. It was an advocacy assistance grant. My perspective starting the program was: It's a grant. If the grant goes away, if the program goes away, if the funding or the mandate disappears, what can be left? What do I want to make sure people know? 

So, I toured the state. I went to a lot of public hearings and I held information workshops and talked to people about what was in the law at the time and helped people to know that yes, there were laws; there were rules about nursing homes. Most people hadn't a clue because Oklahoma has such a horrible heritage of failing to enforce those rules. Everywhere I turned I was able to inform people about their rights and help encourage them to speak up. 

I worked alone for the first year and nine months and was very blessed to be able to hire Eleanor Kurtz to work with me in the State Ombudsman Office. When we started, we had no staff in the Area Agencies on Aging. And so at first, that was a cooperative effort. Eventually we got half-time staff, finally some full-time staff, and now there are 24 Area Ombudsman staff. Well, there's no such thing as a problem without a gift for you in its hands. I think the reverse is also true because once we had the staff we had to supervise them. The training and the supervision has been an interesting business over the years because the State Ombudsman Office was in DHS while all of our area staff work in the Area Agencies on Aging and are their employees. That's been interesting and fun... but wonderful people out there. 

A major challenge that lasted for the better part of 20 years was the failure of the state to protect the residents, the failure of the State Health Department and the Medicaid Agency to enforce the rules, enforce the laws. 

(NO AUDIO) 1980 - Nursing HOme Care Act

In Oklahoma the Alliance on Aging formed late 1979, which was the year I was hired. And in 1980 legislative session passed the Nursing Home Care Act, which is still one of the best state laws for licensing of nursing homes in the country. But, trying to get it enforced, laws aren't self-effecting, you have to make them work. Getting it enforced in a corrupt system was a challenge. 

(NO AUDIO) 2000 - Investigation leads to arrests and convictions

May of 2000 when the Deputy Commissioner of Health was arrested, the next day, legislators who had been otherwise been unmoved by my pleas for their assistance began coming to me. I told the FBI I couldn't have been happier that they picked the legislative session as the timeframe for the arrest. Many legislators came, "What do you want in this bill, Esther? What do you want? What could we do?" So, we got protocols for investigation of complaints by the State Health Department. They had to interview the complainant. They had to do certain things. They couldn't call the facility. They had to not talk to the facility about a complainant before their first on-site visit. All those different things that happened. That also included legislation that increased staffing in nursing homes and addressed conflict of interest at the Health Department. So, those things are just huge. 

It has never been me working alone. It's always been with the whole cohort, the Aging Network, the Aging Advocates are wonderful. They will call, and they will confront their legislators, and they do vote. That makes a big difference. 

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The State Health Department... The Deputy Commissioner of Health was convicted in 2000 and went to prison in 2001 for soliciting and accepting bribes from nursing home owners. Some of those nursing home owners went to federal prison as well. That was part of what came from the information we fed to any federal employee I ever found over those 20 years. We had tape recordings from people who picked them up in facilities. We had issues of deficiencies that had been erased. We had much evidence of the corruption. 

So, the investigative work that was done to bring about those convictions, I give all the credit to the FBI and the Attorney General's Medicaid Fraud Control Unit as well as HHSIOG. People I didn't know were working behind the scenes, working underground, doing wiretaps. They did find that there were many ghost employees at the Health Department. I was less aware of that than I was just the outright corruption. 

The kinds of things we saw, Brent Van Meter, the Deputy Commissioner of Health, would send one of his minions to shut down a residential care facility that housed primarily people with mental health needs who didn't need nursing home care but needed a residential setting. Then, they would move all of those people to another residential care, sort of like money laundering with humans, and then, move them to Dub Giles' facility Oak Hills in Jones, that he owned then. Then Dub was able to get Medicaid reimbursement for it. 

So, it was that sort of corruption and taking money for it. Brent was taking money for making deficiencies go away and not levying fines that were recommended under the federal rules. I didn't care, and I said this many times to our friends in the AG's office, "I don't care if they're taking money, they're just not doing it right." Well, apparently taking money is what makes it Medicaid fraud or taking Medicaid money or Medicare money and not providing the care. So, it was an odd confluence of all the information we have and kept because I never let anybody purge a file. We had nursing home records from the late 1980s that the FBI was able to take with them, you know, onionskin carbon copies with the little red mark of who that went to so that they could do sort of a track on certain owners. 

There were lots of moments of grief on the way to that, and you don't think anything is ever going to be solved because you've spent 20 years trying to make it better and not seeing it get better. 

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(NO AUDIO) 1983 - Published in Longterm Care and the Law. 1987 - OBRA 87 Nursing Home Reform

People who live in those facilities come with a whole lifetime of experience in solving their own problems. As a social worker by training and disposition, I feel like part of my job is to empower others so that the more you pass that on and don't expect to be the end-all and be-all to everybody, to encourage them to speak up, you get the expansion of that power and the role modeling to other residents and other family members. 

I have said more than once that the generation who lived in the nursing homes when I became an Ombudsman in the late 70s was the generation or generations who had been taught that if you can't say anything nice, don't say anything at all. They have mostly passed away. What we have in the nursing homes now or as their family members or their grandchildren are mostly baby boomers and people who have dealt with baby boomers as their parents. So, people now in a societal way, as well as in the long-term care setting, have more of an expectation that: a) They have rights, and b) They get to express themselves, and c) There should be somebody around to help them to get redress for something that's been done to them or problems that they experienced. 

(NO AUDIO) 2003 - Appointed Oklahoma Womens's Hall of Fame

In 2003, some of the advocates nominated me - I'm going to cry. Don't make me cry - to be inducted into the Oklahoma Women's Hall of Fame. That was sort of mind-boggling. I didn't know it existed. I thought it was a joke when someone called to tell me that I was being inducted. 

Eleanor Kurtz was the person who presented me to the group on the occasion when the award was presented, and as I said in my comments, it's very disorienting to get an award for me that Eleanor's name isn't on, too because we were like peas in a pod. We shared the same phone for I don't know how long it took. We were in a little tiny cubicle, the two of us sharing a phone for a long time. Even when we had an office, there were two of us on one phone. We investigated complaints together. We developed the program together. We interviewed staff together. Eleanor has the other half of my brain. So, it's inexplicable to me that I should get an award that Eleanor's name isn't on. 

(NO AUDIO) 1994 - Published in The Oklahoma Bar Journal. 2014 - Social Work Hall of Fame

The message that I've tried to convey to Ombudsman over the years is to shake it 'till it's dead, to not let go of an issue just because it's hard. Something might take a decade or two to achieve. That doesn't mean you quit. It doesn't mean that you stop working on it. You eat the elephant. You eat him one bite at a time. Addressing an issue until you achieve resolution is what I want them to think about, what I want them to know, and to not fail in the mission. The mission may change and may morph, but there is an obligation to the residents, and it's all about the residents. It's not about me. It's not about the other Ombudsman. It's about the residents, and it's about getting the residents what they want. 

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(NO AUDIO) 2014 - Achievement in Aging, Oklahoma Advocate of the Year. October 1, 2014 - Official Retirement

I think that my retirement celebration will be a different sort of celebration for some people who probably will come just to make sure I'm leaving. 

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(NO AUDIO) Oklahoma's First and the Nation's Longest Serving Long-term Care Ombudsman