By Joel Warner
By Michael Roberts
By Alan Prendergast
By Michael Roberts
By Michael Roberts
By Amber Taufen
By Patricia Calhoun
By William Breathes
Nobody knows what's going on inside Colorado's nursing homes better than Virginia Fraser.
One recent morning, Fraser spent several hours visiting the Cherrelyn nursing home in Littleton, introducing herself to residents as their ombudsman. "I'm here to advocate for the people who live here," she told an elderly woman with carefully coiffed red hair, who simply smiled and nodded.
Walking down the corridor of one of the state's largest nursing homes, Fraser stopped to visit with a woman named Dorothy, who suffers from multiple sclerosis. Dorothy has been in Cherrelyn for several years; Fraser helped her when she needed to move to a new room.
"The ombudsman is a mediator," says Dorothy, who uses a wheelchair. "They showed me a room that was decorated too fancy; it was too feminine. I didn't like it. The ombudsman met with the manager and helped me find this room."
Dorothy enjoys sports and doesn't like the room too hot, unlike many of Cherrelyn's other female residents. With the ombudsman's help, she found a roommate who shared her interests.
"Heaven knows how long things would have gone on without the ombudsman," she says.
For two decades, Fraser served as director of the Colorado Ombudsman Program, which advocates for residents of long-term-care facilities in the state. The ombudsman's office assists seniors, asking them if they're having any problems and taking their complaints to management. Fraser transformed Colorado's ombudsman office from a one-person operation into a widely admired force, a program recognized as one of the best in the country. In the process, Fraser has earned a national reputation among advocates for the elderly.
"She's been a national leader on residents' rights," says Elma Holder, founder of the National Coalition for Nursing Home Reform. "She's always been relied upon to be wise and supportive of other people around the country."
Fraser is in the unusual position of being respected by both the nursing-home industry and its critics.
"I think she's done a wonderful job," says Arlene Miles, head of the Colorado Healthcare Association, which represents 178 nursing homes around the state. "She's dedicated her whole life to working toward positive ways of improving care."
Despite this record of achievement, Fraser stepped down as state ombudsman last month. Her resignation was prompted by a proposal from the Department of Human Services that would have restricted the ombudsman's ability to talk to legislators and the media about problems in Colorado's homes for the elderly.
"The restrictions from the state were getting worse and worse," says Fraser. "It was ridiculous."
By this past spring, Fraser directed a staff of forty paid and a hundred volunteer ombudsmen across Colorado. They are charged with visiting 242 nursing homes as well as 507 personal-care boarding homes, which provide assisted living and other services for the more able-bodied elderly. For many of the 30,000 residents of these facilities, the visiting ombudsman may be the only person who bothers to ask how they are doing and whether they're receiving the care they need. Last year the ombudsman's office collected nearly 12,000 complaints from residents of long-term-care facilities.
The ombudsmen have no legal authority to fine nursing homes or force owners to improve care; they simply act as the residents' eyes and ears and try to get the management to respond. And although the ombudsman program's director prepares an annual report for the Colorado Legislature on issues related to long-term care, she has no real power other than that of persuasion.
Still, the ombudsman's office has made powerful enemies, and they just happen to be some of the biggest campaign contributors to the state Republican party and Governor Bill Owens: Ralph and Trish Nagel, owners of the Meridian chain of retirement communities.
Governor Owens has appointed both Nagels to important state positions. Ralph Nagel serves as chairman of the Colorado Commission on Higher Education, which sets budgets and policy for the state's colleges and universities. In 1998, Trish Nagel served on a transition committee that helped the newly elected governor choose a director for the Department of Public Health and Environment -- the very agency that regulates nursing homes and assisted-living facilities. Later, she was appointed to the state Science and Technology Commission.
And the Nagels haven't hesitated to play politics. Ralph Nagel has publicly described the ombudsmen as "vigilantes," and the Nagels' company has prevented ombudsmen who show up at Meridian homes from talking to their residents. Since Meridian doesn't accept any Medicare or Medicaid payments, the Nagels insist that the ombudsmen have no legal right to be in their facilities, even though Colorado law doesn't make a distinction between private-pay facilities and those that accept federal funds. According to the statute that established the State Long-Term Care Ombudsman Program, "The State shall ensure that representatives of the Office shall have access to long-term care facilities and residents."
And the Nagels have fought other proposals intended to help protect nursing-home residents, even opposing a state regulation requiring nursing homes to publicly disclose unexplained deaths, medical mistakes and reports of sexual abuse. Such allegations, the Nagels argue, should be investigated by the health department before being revealed to the public.
The Nagels' well-known antipathy toward the ombudsman program has led others in the health-care field to speculate that their influence may have been a factor in the proposal to prevent the ombudsman program's director from speaking out on behalf of the elderly.