Module 4: The Problem Solving Process- Investigation

Overview

The first function of a Long-Term Care Ombudsman Program (LTCOP) listed in the federal Older Americans Act is to:

Identify, investigate, and resolve complaints that are made by, or on behalf of, residents…

This module focuses on the investigation process and skills used by Long-Term Care Ombudsmen (LTCO). Investigation is the foundation of resolving problems. Another module, “The Problem-Solving Process: Resolution,” discusses the process and skills LTCO use to implement necessary changes after an investigation.

As a LTCO how you approach identifying, investigating, and resolving complaints directly affects:

• • your relationship with residents and staff,

  • your ability to achieve the desired outcome,

  • future relationship with residents, families, and staff, and

  • the reputation of the LTCOP.

Learning Objectives: At the conclusion of this module, individuals will know basic information about:

• • The problem-solving process as a framework for dealing with concerns;

  • The ombudsman role in investigations;

  • The primary tools or components of an investigation;

  • Fundamental skills and other factors that influence investigations; and

  • The principles of documentation.

Duration: 2 hours

If you are having trouble viewing the module, click here for some technical tips.

SECTION 1: Ombudsman Approach to Problem Solving

This section will detail the uniqueness of the Ombudsman approach to problem solving; help you to understand what barriers a resident may have to self-advocacy and the ombudsman role in advocating on behalf of residents.

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SECTION 2: Policy Considerations

This section will detail the importance of accurate documentation, confidentiality and the encouragement of resident self-advocacy throughout the problem solving process.

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SECTION 3: Dilemmas in Receiving Complaints

You will inevitably find yourself in a number of complaint situations that pose ethical dilemmas or call for special handling. The key to knowing how to respond to many of these situations is to remember that you represent the resident. The Ombudsman Code of Ethics in the module, “History and Role of the Long-Term Care Ombudsman Program,” can be helpful in clarifying your role. Click on the window below to view a table that lists seven typical situations that may occur and gives suggestions for dealing with these dilemmas.

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Ombudsmen Need to Know!

Using the Three Stages of Problem Solving

The problem-solving process includes three major stages of action, as indicated in the table below. The stages are the following: Stage 1, Intake and Investigation; Stage 2, Analysis and Planning; and Stage 3, Resolution and Follow Up.

The first stage is discussed at length in the following section. Stage 2 and Stage 3 are discussed in Module 5, “The Problem Solving Process: Resolution.” The stages are simply a way of organizing your work as you seek to resolve problems. If you ever wonder what to do next, consult the table below, the narrative discussion of each stage in the modules, and Guidelines for Practice in the Additional Resources, to check your work and get additional ideas.

SECTION 4: Stage 1 - Intake, Investigation and Verification

Intake and investigation is the initial stage in problem solving. It is fundamental to your ability to successfully resolve an issue. This stage includes three steps that are discussed below: recognizing and receiving complaints; gathering information; and verifying and defining the problem.

1. Intake: Recognizing and Receiving Complaints

Click here to learn more about identifying unvoiced complaints and determining the sources of complaints.

2. Investigation: Gathering Information

Before you can resolve most complaints, you will need to gather additional information about the situation from a variety of sources. This process, which is the second step in Stage 1, is frequently referred to as investigation. Click here to read more.

Preparation for an Investigation

When you receive a complaint (intake), take time to adequately prepare before jumping into an investigation. How do you decide what information is relevant and how you might collect it? There are some basic steps to follow. Click here to take a look at these steps and see how they apply to your work by reading about Mr. Michards’ experience.

Interviewing

Interviewing is possibly the most frequently used method of gathering information. In order to discover the facts of a case (the who, what, when, where, why, and how), you might interview a resident, administrator or operator, or an employee of another agency or institution. Regardless of the position of the person being interviewed and the personal style of the interviewer, there are several factors to consider when preparing for an interview. Following a few guidelines will increase your likelihood of success. You need to be skillful in listening, questioning and note taking. Click here to learn more.

VIDEO: Interview Process

Watch this clip of an ombudsman (Mary) conducting the interview process with a resident (Mrs. Woods).

Observation

Observation is the second most common method of gathering information. Many complaints can be understood and verified only by sharing in the experience of the complainant. Complaints that have to do with items such as staffing, sanitary conditions, and food often can be fully checked only through observation. This section includes tips for observation and a list of questions intended to help you focus on the information that is presented to each of your senses. Click here to learn more.

VIDEO: Observation

Watch this clip of Mary making observations as she walks through the nursing home, and make a few notes of what you see and hear

Using Official Documents

Using official documents is the third most common method of gathering information. Documents such as laws and regulations tell you the legal requirements that apply to facilities and the legal protections that residents (consumers) have. Other documents such as survey records or resident records provide information about a facility’s actions.

There are many types of documents you might review during an investigation. Focus on the ones that are likely to give you the additional information that you need to verify and resolve a complaint. In the early stage of an investigation, it is helpful to read the sections of the laws and requirements or regulations that apply to the complaint. Knowing the applicable provisions helps you decide what to cover in an interview, who to interview, and what to observe. Click here to learn more.

3. Verifying and Defining the Problem

Verifying and defining the problem is the third and last step in Stage 1 of the problem-solving process. It involves verifying that the complaint is valid and then defining the underlying problem. Click here to read more.

VIDEO: Follow-up Visit

See what Mary learned during her investigation by watching this clip.

ADDITIONAL RESOURCES

• The Problem-Solving Process: Investigation - Guidelines for Practice

Review Quiz

Click on your state or territory in the list below to take the Review Quiz.