A Passion for Long-Term Care in D.C.

For 31 years, many of Washington’s low-income, long-term care recipients were allowed to keep only $70 of their monthly income to pay for their personal needs—from haircuts to clothes to hygiene products. The rest went to help pay for their nursing home or other care.

Now, residents of nursing homes and other facilities covered by Medicaid can receive about $100 per month for personal items that are not provided by their facilities. And D.C. officials have agreed to automatically adjust the personal needs allowance for inflation each year.

The changes came after a push by the D.C. Long-Term Care Ombudsman’s office, led by Mark C. Miller, who until April was also president of the National Association of State Long-Term Care Ombudsman Programs.

The D.C. ombudsman’s office is administered by Legal Counsel for the Elderly, an AARP charitable affiliate. In addition to financial and in-kind support from LCE, the ombudsman’s office receives funding through the federal Older Americans Act and from D.C. Medicaid, the joint federal-state insurance program for low-income Americans.

Miller and his staff advocate on behalf of the 9,000 District residents in nursing homes, assisted living facilities, mental health group homes and those who receive long-term care services in their homes.

They also operate at the juncture of local and national policy when it comes to long-term care.

The D.C. office is on “the front lines in the facilities and also working on advocacy issues at the state and national level,” says Nicole Belanus, one of the office’s six ombudsman specialists. “We're all very, very, very passionate,” she says, and the work is increasingly vital as America’s older population grows.

For example, Miller recently met with U.S. Health and Human Services Secretary Xavier Becerra to discuss the Biden administration’s now-finalized rules requiring nursing homes to meet certain staff-to-resident ratios and to have a registered nurse onsite 24 hours a day.

Miller, who was previously the state ombudsman in Virginia and New York, says he got “hooked” on long-term care advocacy 40 years ago, after he helped a local agency on aging win funding to start an ombudsman program.

In fiscal 2023, Miller’s staff investigated 262 complaints and had a successful resolution rate of 83 percent. The national average is about 71 percent, according to federal data.

Genesis Cachedon, another ombudsman specialist, says her days are often a blur as she investigates complaints, attends care plan meetings and makes routine nursing home visits. If she ever starts to feel a little overwhelmed, she reminds herself that for those older adults who have no one else looking out for them, “you may be the world.”

Miller says D.C. is small enough that he gets to see the impact of their advocacy up close. “Visiting residents in long-term care facilities reminds me why I do this work,” he says.

If you or someone you know is in long-term care in D.C. and wants to file a complaint, call 202-434-2190 or send an email to DCOmbuds@aarp.org. Calls and emails are confidential.