The frail woman in the wheelchair said she had been waiting 30 minutes for an aide to lift her into bed. But when Charise Jensen asked the woman if she had pushed her call button, she lowered her head.

"I lost it," she said in a small voice, staring at her thin hands.

Jensen, Salt Lake County Aging Service's long-term care ombudsman, reached over the bed and pressed the button. An aide quickly arrived to help the nursing-home resident. A crisis averted, a senior comforted.

It might not seem like much, Jensen said. But it's the small stuff that can cause the most friction in nursing homes.

As the ombudsman, Jensen and the 20 volunteers she supervises advocate for residents in long-term nursing homes and assisted-living facilities in Salt Lake and Tooele counties. They are on the lookout for abuse, neglect, exploitation and violations of residents' rights.

The volunteer visits aren't announced. Most of the time, the care facilities are doing their jobs properly. But, as with the broken-window theory — which says that neighborhoods suffer when no one fixes small problems — volunteers keep a sharp eye out for potential trouble.

Can nursing-home residents reach their water? Are they clean and well-groomed? Are they isolated or neglected? Are they wearing their own clothes? Are they upset or angry? Is the place clean? Are there bad smells?

When problems do arise, Jensen usually addresses them with firm suggestions. Sometimes, staffers just need reminding, she said. Long-term care facilities have frequent turnover, and the jobs are grueling.

"It is grunt work," she said, "and not well-paid."

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Heading off problems • During a walkthrough of two nursing homes in early March, Jensen knocked on open doors to check on residents.

At Midtown Manor in Salt Lake City, where many of the residents aren't elderly but need help with psychiatric medications, she found some people sleeping at 9:30 a.m. and others going about their business in the dayroom and hallways. She asked them about the food and how they were feeling. No one had any complaints.

At Hillside Rehabilitation Center, where administrators have been certified with Eden Alternative, a long-term-care reform organization, a resident told Jensen about a doctor who hadn't come through with the order she requested to see a cardiac specialist. She asked for one of the ombudsman's brochures that Jensen carried with her.

It was there Jensen encountered the woman who needed help getting into bed. The woman's roommate said she likes Hillside and considers it her home.

Jensen noticed the Aging Services poster listing residents' rights wasn't hanging in the hallway, though staffers had decorated a bulletin board with a colorful substitute based on Eden Alternative's principles. Jensen told an administrator to display the poster, as required.

It's up to regulators to do yearly inspections. The ombudsman and volunteers head off problems.

"We try to get in there before there's smoke showing, much less a fire," Jensen said. "We're constantly training these facilities."

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On the lookout • As so often happens, personal experience prompted Murray resident Chris Sebba to become a volunteer.

When her father was suddenly hospitalized in Arizona, discharge planners handed relatives a list of nursing homes to choose from for Sebba's father's care. There wasn't time to research, so the wife of Sebba's father chose a facility close to the hospital. The place was horrible, Sebba said.

"There was no water in his room, he had no energy," Sebba said. "He asked a nurse late at night for a soda, and she said, 'Do you have money?' "

He ended up back in the hospital due to dehydration and an intestinal infection caused by filth. After that, Sebba went to the Internet and researched nursing-home ratings and found a good one.

"It made a huge difference," she said.

Salt Lake City resident Mary Glauser, a businesswoman with nursing-home work experience long ago, has been a volunteer ombudsman for about six months. She is assigned to three facilities, generally goes to one a week and rotates her visits.

The care homes she checks do a good job, Glauser said.

In her experience, new residents go through a period of adjustment. Sometimes, their complaints are natural expressions of stress due to change. Other problems can surface if the facility has new nurses or administrators who might not immediately notice that a resident with Alzheimer's disease can't tell them he or she needs to have their fingernails clipped. Volunteers can help bring such matters to staffers' attention.

"It's a hard industry," Glauser said.

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A sympathetic ear • "I try and stay real vigilant because I'm one of those people who won't put up with stuff," Sebba said. "I'm only supposedly required to go to a place once a month. But I'll go back in a week, two weeks. Sometimes, just having someone show up can make a difference."

Residents don't automatically understand what to do when they move in.

"Some of these residents don't want to upset the flow," said Sebba, a retired businesswoman. She once encountered a woman who didn't know she had a call button. Another thought she was assigned to the chair aides took her to in the dining room when she first arrived.

The resident was unnerved because no one nearby talked to her, which she later learned had to do with their conditions. Sebba helped her understand she could sit anywhere she wanted.

"That's why they need a voice," she said. "Sometimes, they don't even realize they can say no."

Glauser said she hasn't seen the kind of neglect or abuse that makes people fear nursing homes.

"I've had people tell me, 'Well, it's a lot better than being on the street,' " she said. "It's not a comment against the facility. They want to be in their home, but they just can't, for whatever reason."

The saddest cases, she said, are the people who don't have friends or family around and don't want to be in a care facility.

"You just listen," Glauser said. "I can't tell you the lessons I have learned visiting with these people. If you want to know what endurance really is, all you have to do is visit with them." —

Protecting the rights of those receiving long-term medical care

Salt Lake County Aging Services' Long- Term Care Ombudsman Program serves people age 60 and older who are residents of nursing homes and assisted-living homes. The ombudsman and volunteers investigate and resolve complaints made by or for residents about conditions that may adversely affect their health, safety, welfare or rights.

Volunteers are trained before they do rounds. At first they are non-certified; after gaining experience and more training, they are certified, the second rung up on the ladder of protection Aging Services provides for elders who need help looking after themselves.

For more information:  http://www.aging.slco.org/html/omb_overview.html