Welcome to Dayton Ombudsman
The Ombudsman Office investigates complaints about government agencies and services for residents of Montgomery County. We also have a wealth of knowledge about government programs which can assist our neighbors. The Long-Term Care Ombudsman program investigates complaints about the care provided in nursing homes, adult care facilities, group homes, and in-home care services. We welcome your questions, inquiries and complaints!
The Ombudsman Column
"Citizens appreciate getting some help with PIPP process" - November 9, 2023
The Ombudsman received a complaint from a woman about her recertification for the Percentage of Income Plan (PIPP) through the Miami Valley Community Action Partnership. She reported having submitted her documents to recertify for the program three times and she emailed the Ombudsman the documents she had submitted to the agency. Read More...Nonetheless, her PIPP subsidy was canceled, and her utilities are in arrears over $700. She asked the Ombudsman to assist.
The Ombudsman contacted the agency on the woman’s behalf, explained her report and shared the documents the woman had sent with the agency. The agency responded that the woman’s application has been processed, and that the staff person at the agency would contact the woman to inform her of the application status. The Ombudsman contacted the woman and she reported that she did receive a telephone call from the staff person at the Miami Valley Community Action Partnership informing her that the application was processed and apologizing for the inconvenience.
The woman thanked the Ombudsman for the resolution and for her professional services.
A veteran also contacted the Ombudsman Office about the delay in processing his application for PIPP. He submitted his award letter from the Social Security Administration to the agency over two months ago. The man had been notified that he was about to receive a shut off notice for his utilities. He requested that the Ombudsman find out what is taking so long. The Ombudsman learned that the man’s application was in the queue. The next day the Ombudsman received a call from the man. The man informed the Ombudsman he received a call that his application had been processed. He thanked the Ombudsman for helping him. ...Read Less
"Catch-22 situation with medical records is quickly solved" - September 7, 2023
A woman contacted the Ombudsman for help obtaining copies of medical records. The woman had been granted Social Security Disability based on medical reports obtained from physicians and submitted to the Social Security Administration (SSA). The woman had been directed by the physicians to contact the SSA for copies of the reports. When the woman contacted the Social Security Administration, she was told to contact the physicians. The woman felt caught in a catch-22 situation and contacted the Ombudsman for assistance. Read More...
The Ombudsman contacted the SSA concerning the woman’s request. Staff at the agency reported a high volume of citizen requests and agreed to send the woman a CD of her electronic records. The CDs are provided rather than paper copies when the citizen’s folder with the agency is completely electronic, as in the case of this woman. The woman later called to report that she had received a CD from the SSA. The CD contained a great deal of information, but not the medical reports she was seeking.
The Ombudsman is familiar with the agency CDs and believed the CD to be complete. The Ombudsman instructed the woman on how to check the CD for further information. The woman called later to report that a friend had been able to open the medical reports on his computer, and that now the woman had all the information she had been seeking and was satisfied.
...Read Less
"Post-surgery ‘cut-letter’ prompts strong response" - August 11, 2023
The Ombudsman’s office was recently contacted by an individual who was completing physical therapy at a local nursing home after undergoing hip replacement surgery. The nursing home resident was upset because they had just been given a letter from Medicare that stated Medicare would no longer pay for the nursing home and physical therapy. The letter went on to explain the resident would be required to return home in three days. Medicare stated in the letter they had been reviewing the resident’s medical records on a weekly basis and determined the resident was no longer making progress in physical therapy and would be required to return home. Read More... The Ombudsman explained to the resident that Medicare monitors each person’s progress while at the nursing home to make certain they are progressing in their treatment. If the resident is not progressing, Medicare typically sends the resident a “cut-letter,” which informs the person they will need to leave the nursing home in three days because they are not progressing in their treatment. The letter further states the resident will be required to personally pay any bill accumulated after the three-day period.
The Ombudsman asked the resident if the letter discussed “appeal rights.” The resident found a portion of the letter explaining the appeal rights each person has who receives a “cut-letter.” The Ombudsman went on to explain how the resident could appeal the “cut-letter” by calling a phone number provided in the letter and stating they wanted to appeal the letter they just received while at the nursing home. The Ombudsman further informed the resident they would have an opportunity to explain to the individual on the phone why they believed they were still benefiting and improving from their treatment (physical therapy). The Ombudsman suggested the resident write down specific treatment goals they had not yet achieved but believed would be achieved with additional treatment (physical therapy). The Ombudsman explained to the resident they could, during the call, explain the treatment goals and the desire to make those goals a reality with further treatment.
The Ombudsman finally explained to the resident they would not have to pay for any additional time spent in the nursing home as a direct result of the appeal. The Ombudsman explained that Medicare would issue a written decision, usually within 48 hours, and a new discharge date would be indicated in the decision. However, the resident was informed any further appeals may result in the resident being personally responsible for the cost of the nursing home beyond the date identified in Medicare’s decision. The resident did call and appeal the cut-letter issued by Medicare. The resident made the arguments discussed with the Ombudsman as to how they are still improving and would benefit from additional treatment. The next day, one of the medical professionals hired by Medicare to review the appeal issued a decision and agreed the resident would benefit from additional treatment (physical therapy). The decision further stated the matter would be reviewed again for 14 days and the resident would remain at the nursing home. The nursing home resident thanked the Ombudsman for their help and stated were excited to continue with physical therapy in the nursing home. ...Read Less
"A man without a county has medical coverage restored"- June 1, 2023
A man contacted the Ombudsman office because his Medicaid coverage had stopped. When he contacted the Montgomery County Department of Jobs and Family Services, he was told that his case had been transferred to a neighboring county because his home address was in another county. Read More...He was directed to contact the other county’s department of Job and Family Services to restore coverage. When he followed the instructions and contacted the department in the other county, he was informed that he did not live in that county either. Confused and dismayed, he contacted the Ombudsman for assistance in restoring medical coverage.
Ombudsman office staff investigated the matter, and the investigation revealed a series of problems. The first was that the property where the man lives is in Montgomery County but has a postal address in a neighboring county. Some of the houses on the man’s street are in Montgomery County, and some are in the neighboring county. The man’s case had been transferred to the neighboring county’s office of Job and Family Services last July, but the man did not know the transfer had taken place. The other county mailed a request for bank statements and proof of income to complete a recertification of the man’s eligibility. The man did not respond to the request from the neighboring county because he did not understand why the other county was requesting the information. Because he did not understand the request, he ignored the request and did not respond. The transfer of the case, with the subsequent lack of response to income verifications, led to the man’s case being closed.
The Ombudsman recommended that the Montgomery County Department of Job and Family Services request the case be returned to them because the home is in Montgomery County. The case was returned, and the man submitted the required income verifications. The man’s medical coverage is now restored.
...Read Less
"Potential transportation provider stuck in neutral" - March 2, 2023
A man contacted the Ombudsman Office to gain better understanding of his unsuccessful attempts to become a transportation provider through the State of Ohio Office of Medicaid. Read More...
He had made several online applications and had submitted supporting paperwork but had received a denial. He had contacted the office several times trying to get information about the reasons for his denial. Each time he received a generalized answer that had nothing to do with his application. On one occasion he was told that it takes several months. On another he was told that the system was backlogged.
Because he was not receiving any specific information, he requested assistance from the Ombudsman. The Ombudsman arranged a conference call with a staff person at the agency, the Ombudsman and the man. During the call, the staff person researched the man’s applications and found that he had made an error when submitting his application so that it was not completely submitted. The final submit selection had not been chosen. The man was grateful to learn exactly what had been happening with his applications so that he could correct the problem and have his application considered .He felt certain that he would not have been able to get the information he required without the intervention of the Ombudsman and he is now looking forward to a successful outcome.
...Read Less
THE OMBUDSMAN column, a production of the Joint Office of Citizens’ Complaints, summarizes selected problems that citizens have had with government and social services, utilities, schools and nursing homes in the Dayton area. Contact the Ombudsman by writing to 11 W. Monument Ave., Suite 606, Dayton 45402, or call 937-223-4613, or send email to ombudsman@dayton-ombudsman.org
