Ombudsman Activities Webinar March 7, 2012 NORS TRAINING PART IV

PURPOSE of TRAINING Improve consistency in NORS reporting Provide clarifying information on Ombudsman Activities required to be reported to AoA by: Reviewing the AoA definitions, Reviewing the activities and their corresponding measures or topic, Answering the Quiz coding scenarios, Answering questions related to the Quiz scenarios and answers, and Responding to other questions and examples.

Initial Comments on Coding Shelley Hitt, Colorado State Ombudsman Chair, NASOP WINC Working to Improve NORS Consistency (303) 722-0300 x 508 1-800-288-1376 skhitt@thelegalcenter.org Louise Ryan, Ombudsman Program Specialist Administration on Aging Washington, DC Patty Ducayet, Texas State Ombudsman

Ombudsman Activities Provide a National Snapshot Services provided in support of residents Represents the range of work LTCO routinely conduct States May Collect Additional Information States can use discretion in capturing program activities. States may choose a specific method to calculate percentage of time on TA or systems advocacy. States frequently capture information beyond the AoA requirements for NORS. These activities give AoA a nationwide snapshot of services provided in support of long-term care residents and represents the range of work that Ombudsmen routinely conduct. Training and consultation topics and calculation of percentage measures vary from state to state. For example, states can choose to develop consultation and training topics to reflect initiatives, such as, Culture Change or Money Follows the Person. States may also choose a specific method to calculate the estimated percentage of time spent on technical assistance and systems advocacy. Any methodology that a state chooses to use is acceptable.   SLTCOPs frequently capture information that goes beyond the federal requirements; for example, many states also record complaint related visits, care conferences or complaint investigation strategies. All ombudsman activities are critical to promoting and protecting resident quality of life, rights and care, even if not counted in NORS. The reporting of these activities at the state level is often essential to telling the ombudsman story, especially with regards to educating the media, legislators and policy makers.

Activity Chart Annotated chart lists and defines 12 activities. Describes measures for each activity. Intended to add clarity in reporting activities.

Activity Chart Software impacts how activities are calculated. Example: LTCO enter all routine visits into LTCO software program. When the State LTCO completes the NORS report, the software determines which facilities met the definition of facility coverage for AoA reporting. Example: LTCO enter primary topic for each training or consultation. When the State LTCO completes the NORS report, the software produces the top three topics to report to AoA.

Activity Chart Activities Training for LTCO Staff and Volunteers Perspective of the trainer Training for LTCOP staff Count and Report Number of sessions Number of hours Total number of trainees that attended Topics   1. Training for ombudsman staff and volunteers This activity is from the perspective of the trainer, reporting on training provided by or arranged by ombudsman program staff. NOTES: The number of sessions is unduplicated. A session is a meeting/training, whether it lasts for three hours, all day, or all week. The number of hours is the time the trainees spend receiving training. This measure captures the amount of training you provide. It does not capture the time spent preparing for training. The number of trainees is a count of all ombudsmen attending each training event. This may include the same ombudsman attending several different training sessions. Report the primary topic covered during the training. Number sessions Number hours Total number of trainees that attended any of the training sessions above (duplicated count) Topics for training

Activity Chart Activities Technical Assistance to LTCO staff and/or volunteers Staff time managing and administering local LTCOPs and LTCO volunteer programs Covers all aspects of working with LTCO Estimated percentage (%) of total staff time SLTCO provides guidance on how to measure   2. Technical assistance to local ombudsmen and/or volunteers This activity measures the percentage of staff time spent managing and administering local and volunteer programs, including time spent developing and delivering training. It covers all aspects of working with volunteers or paid staff such as conveying changes in procedures, reviewing others’ case records, researching regulations to provide assistance on specific complaints and providing guidance to staff and volunteers. NOTE: AoA only asks for an estimate; but your state may be very precise about how this percentage is calculated. The state ombudsman provides guidance on how to measure this activity. Estimated percentage (%) of total staff time.

Activity Chart Activities Training for Facility Staff Number of sessions, unduplicated count Topics covered, primary topic Consultation to Facilities Via phone, email questions, or in person Number of consultations, unduplicated count of information and assistance   3. Training for Facility Staff NOTES: The Number of session to facility staff is an unduplicated count. Record the primary topic covered during the session. Number of sessions Topics covered 4. Consultation to facilities (providing information and assistance by phone, responding to e-mail questions, or in person) The number of consultations is an unduplicated count of information and assistance to facility managers and staff. Record the primary topic covered during the consultation.    Number of consultations

Activity Chart Activities Information & Consultation to Individuals Count each separate request for information and assistance, not each call related to the same request. Do not count conversations related to a specific case. Record the primary topic in each consultation.   5. Information and consultation to individuals (by telephone, responding to e-mail questions, or in person on a one-to-one basis) NOTES: Record the primary topic covered in each consultation. Count each separate request for information and assistance but not each call related to the same request. Do not count conversations related to a specific case Topics of requests Number of consultations

Activity Chart Activities Facility Coverage Facilities visited ≥ quarterly, Federal fiscal year Visited not in response to a complaint Unduplicated count of facilities Participation in Facility Surveys LTCO participation in surveys, including inspections in board and care facilities Participation in various parts of survey process counts Count participation in same survey only once Number of surveys   6. Facility Coverage This is an unduplicated count of facilities visited no less frequently than quarterly based on the federal fiscal year. The number reported indicates the facility was covered on a regular basis, not in response to a complaint, by paid or volunteer ombudsmen. Number Nursing Facilities visited (unduplicated) Number Board and Care or similar facilities visited (unduplicated) 7. Participation in Facility Surveys This number reflects a count of ombudsman participation in standard and abbreviated surveys (including inspections in board and care facilities). Participation in various parts of the survey process is acceptable. This includes pre-survey briefing, and attending the resident group interview or exit interview. Count participation in the same survey only once. Number of surveys

Activity Chart Activities Work with Resident Councils Resident council meetings attended by LTCO If ≥ one LTCO attends same meeting, count as 1 Do not count prep work that does not include attending a meeting Talking with residents during the meeting is not counted as consultations Number of meetings attended Work with Family Councils Report in same way as work with resident councils  8. Work with resident councils The count of all resident council meetings attended by an ombudsman. Report attendance to the same meeting by more than one ombudsman as one. Do not record preparation work that does not include attendance at a council meeting. Discussions with residents during the course of the meeting are not counted as consultations.   Number of meetings attended 9. Work with family councils The count of all family council meetings attended by an ombudsman. Report attendance by more than one ombudsman to the same meeting as one. Do not record preparation work that does not include attendance at a council meeting. Discussions with individuals during the course of the meeting are not counted as consultations.

Activity Chart Activities Community Education Number of presentations made and/or Other meetings where you represent the LTCOP Number of sessions  10. Community Education The total number of presentations made to and or other meetings where you represent the ombudsman program with community groups, students, churches, etc. This can include attendance at community and health fairs and similar gatherings where the LTCO has a display and staff available to provide information to attendees. Number of sessions

Activity Chart Activities Work with Media Primary topic covered Number of interviews/discussions and press releases If several discussions with same reporter on the same story, count as 1 Sending press release to several media outlets counts as one press release 11. Work with media NOTES: Record the primary topic covered. If several discussions occur with the same reporter on the same story, count as one. Sending a press release to several media outlets counts as one press release. Topics Number of interviews/discussions Number of press releases

Activity Chart Activities Monitoring/work on Laws, Regs, Policies and Actions Best estimate of percentage (%) of staff time working with others Includes time reviewing, commenting and developing proposed laws and regs Federal, state, and local level SLTCO provides guidance on how to measure 12. Monitoring/work on laws, regulations, government policies and actions A best estimate of the percentage of paid staff time spent working with other agencies and individuals, both inside and outside of government, on laws, regulations, policies and actions to improve the health, welfare, safety and rights of long-term care residents. This includes time spent reviewing, commenting and developing proposed laws and regulations at the federal and state and local level.   NOTE: AoA only asks for an estimate; but your state may be very precise about how this percentage is calculated. The state ombudsman provides guidance on how to measure this activity. Estimated percentage (%) of total paid staff time.

Quiz Answer the following questions. Tips What is the proper activity? What is the corresponding measure or topic? Tips Count activities by staff and volunteers. Count each activity only once. Choose most appropriate heading. Instructions For each situation, identify the proper activity and its corresponding measure or topic. In your answer, include every measure that is required. Reported activities may be completed by paid or volunteer ombudsmen at the state or local level. AoA directs ombudsmen to report exact numbers wherever possible; where not possible, provide a best estimate of the numbers requested. Record each activity only once, under the most appropriate heading.   The Annotated NORS Activity Chart included with this quiz lists and defines twelve activities. It also describes measures for each activity. Refer to the Annotated NORS Activity Chart as you complete the quiz.

Quiz #1 One of your volunteers investigated a complex case of potential resident abuse. She called you several times for advice. You provided strategies for investigation and suggested additional questions to ask residents. You spent approximately two and a half hours researching relevant laws, discussing the case and advising the ombudsman.

Quiz #1 Answers One of your volunteers investigated a complex case of potential resident abuse. She called you several times for advice. You provided strategies for investigation and suggested additional questions to ask residents. You spent approximately two and a half hours researching relevant laws, discussing the case and advising the ombudsman. Activity? Technical assistance to local LTCO and volunteers Measures/topics? Measure: Estimated % of total staff time Topic: Not required 1. One of your volunteers investigated a complex case of potential resident abuse. She called you several times for advice. You provided strategies for investigation and suggested additional questions to ask residents. You spent approximately two and a half hours researching relevant laws, discussing the case and advising the ombudsman. What activity best fits this situation? Technical assistance to local ombudsmen and volunteers Identify all measures/topics required: Measure: Estimated percentage of total staff time. The State Ombudsman may have specific guidance on how to calculate this time. Because NORS only asks for an estimate, AoA does not prescribe a particular methodology to determine the estimated percentage.

Quiz #2 A nursing home association asks you to provide culture change training at their statewide annual convention. The audience is primarily nursing home administrators and other lead staff.

Quiz #2, Answers A nursing home association asks you to provide culture change training at their statewide annual convention. The audience is primarily nursing home administrators and other lead staff. Activity? Training for facility staff Measures/topics? Measure:1 session Topic: Culture change What activity best fits this situation? Training for facility staff   Identify all measures/topics required: Measure: 1 session Topic: Culture change

Quiz #3 You make an unscheduled visit to Mountain View nursing home, upon entering you ask for a list of residents so that you can see who is new to the home. You make rounds introducing yourself to new residents and checking in with residents that you know; one resident asks you about the Money Follows the Person program and facility staff approaches you with questions about a potential resident discharge.

Quiz #3, Answers Activities? Measures/topics? You make an unscheduled visit to M.V. nursing home, upon entering you ask for a list of residents so that you can see who is new to the home. You make rounds introducing yourself to new residents and checking in with residents that you know; one resident asks you about the Money Follows the Person program and facility staff approaches you with questions about a potential resident discharge. Activities? Facility coverage, Information & consultation to individuals, Consultation to facilities Measures/topics? Measure: Facility coverage: 1 visit Measure: Information & consultation to individuals: 1, Topic: MFP Measure: Consultation to facilities: 1, Topic: Transfer/discharge 3. You make an unscheduled visit to Mountain View nursing home, upon entering you ask for a list of residents so that you can see who is new to the home. You make rounds introducing yourself to new residents and checking in with residents that you know; one resident asks you about the Money Follows the Person program and facility staff approaches you with questions about a potential resident discharge.   What activities best fit this situation? Facility Coverage, Information and Consultation to Individuals, Consultation to Facilities Identify all measures/topics required: Facility Coverage: 1 visit Information and Consultation to Individuals: 1 Topic, Money Follows the Person Consultation to Facilities: 1 Topic, Transfer/Discharge

Quiz #4 Prior to the beginning of an annual nursing home survey, you call the team leader and leave a voice mail message with facility complaint information. The team leader calls you back to clarify some information. You then call the volunteer assigned to the facility to alert him to the upcoming survey. The volunteer is on site at the facility including at the exit meeting.

Quiz #4, Answers Activity? Measures/topics? Prior to the beginning of an annual nursing home survey, you call the team leader and leave a voice mail message with facility complaint information. The team leader calls you back to clarify some information. You then call the volunteer assigned to the facility to alert him to the upcoming survey. The volunteer is on site at the facility including at the exit meeting. Activity? Participation in facility surveys Measures/topics? Measure: 1 survey Topic: None required 4. Prior to the beginning of an annual nursing home survey, you call the team leader and leave a voice mail message with facility complaint information. The team leader calls you back to clarify some information. You then call the volunteer assigned to the facility to alert him to the upcoming survey. The volunteer is on site at the facility including at the exit meeting. What activity best fits this situation? Participation in facility surveys Identify all measures/topics required: Measure: 1 survey No topic is required

Quiz #5 During a routine nursing home visit the Social Services Director asked to speak to you. She reported that she has noticed an increase in the number of residents who request to return to the community but that families are preventing discharge planning. You explained residents’ rights and the role of power of attorney. The Social Services Director felt that with this additional information she would try to work on the issues with the residents, their families and facility staff.

Quiz #5, Answers Activity? Measures/topics? Consultation to facilities During a routine nursing home visit the Social Services Director asked to speak to you. She reported that she has noticed an increase in the number of residents who request to return to the community but that families are preventing discharge planning. You explained residents’ rights and the role of power of attorney. The Social Services Director felt that with this additional information she would try to work on the issues with the residents, their families and facility staff. Activity? Consultation to facilities Measures/topics? Measure: 1 consultation Topic: Resident Rights 5. During a routine nursing home visit the Social Services Director asked to speak to you. She reported that she has noticed an increase in the number of residents who request to return to the community but that families are preventing discharge planning. You explained residents’ rights and the role of power of attorney. The Social Services Director felt that with this additional information she would try to work on the issues with the residents, their families and facility staff. What activity best fits this situation? Consultation to facilities   Identify all measures/topics required: Measure: 1 consultation Topic: Resident Rights

Quiz #6 You attend a resident council meeting. During the meeting, you respond to several resident concerns and questions as well as a question from a staff member about the upcoming resident’s rights celebration.

Quiz #6, Answers Activity? Measures/topics? You attend a resident council meeting. During the meeting, you respond to several resident concerns and questions as well as a question from a staff member about the upcoming resident’s rights celebration. Activity? Work with resident council Measures/topics? Measure: 1 resident council meeting Topic: Not required 6. You attend a resident council meeting. During the meeting, you respond to several resident concerns and questions as well as a question from a staff member about the upcoming resident’s rights celebration.   What activity best fits this situation? Work with resident council Identify all measures/topics that are required: Measure: 1 resident council meeting Topic: Not required Note: Resident concerns and questions discussed during a resident council are not considered consultations because it is taking place in a group setting. Resident Councils may choose to use part of their time to problem solve including talking to the ombudsman.

Quiz #7 A family council president asks you for advice about an upcoming family council meeting. You discuss agenda items and recommend a speaker to present on the requested topic of pressure ulcers. You are invited but unable to attend the meeting.

Quiz #7, Answers Activity? Measures/topics? A family council president asks you for advice about an upcoming family council meeting. You discuss agenda items and recommend a speaker to present on the requested topic of pressure ulcers. You are invited but unable to attend the meeting. Activity? Information and consultation to individual Measures/topics? Measure: 1 information & consultation to individual Topic: Family council 7. A family council president asks you for advice about an upcoming family council meeting. You discuss agenda items and recommend a speaker to present on the requested topic of pressure ulcers. You are invited but unable to attend the meeting.   What activity best fits this situation? Information and consultation to individual Identify all measures/topics required: Measure: 1 information and consultation Topic: Family council

Quiz #8 You are invited to speak to a group of older adults with hearing impairments who live in the community. The organizer states that she will arrange for a sign language interpreter. At the presentation you talk about long-term care options and provide information about nursing homes, hospice, and assisted living facilities.

Quiz #8, Answers Activity? Measures/topics? You are invited to speak to a group of older adults with hearing impairments who live in the community. The organizer states that she will arrange for a sign language interpreter. At the presentation you talk about long-term care options and provide information about nursing homes, hospice, and assisted living facilities. Activity? Community education Measures/topics? Measure: 1 community education Topic: Not required 8. You are invited to speak to a group of older adults with hearing impairments who live in the community. The organizer states that she will arrange for a sign language interpreter. At the presentation you talk about long-term care options and provide information about nursing homes, hospice, and assisted living facilities.   What activity best fits this situation? Community Education Identify all measures/topics that are required: Measure: 1 community education Topic: Not required

Quiz #9 You receive a request to have a display table for the Long-Term Care Ombudsman Program at “Senior Day” at the County Fair. During the fair, you hand out information about the Long-Term Care Ombudsman office and talk to people passing through.

Quiz #9, Answers Activity? Measures/topics? You receive a request to have a display table for the Long- Term Care Ombudsman Program at “Senior Day” at the County Fair. During the fair, you hand out information about the Long-Term Care Ombudsman office and talk to people passing through. Activity? Community education Measures/topics? Measure: 1 community education Topic: Not required 9. You receive a request to have a display table for the Long-Term Care Ombudsman Program at “Senior Day” at the County Fair. During the fair, you hand out information about the Long-Term Care Ombudsman office and talk to people passing through.   What activity best fits this situation? Community Education Identify all measures/topics required: Measure: 1 community education Topic: Not required

Quiz #10 You receive a telephone call from an anonymous person. He states that he recently resigned from a nursing home on good terms. He wants to go back to visit some of the residents whom he considers friends and wants to know if there are any laws restricting him from visiting.

Quiz #10, Answers Activity? Measures/topics? You receive a telephone call from an anonymous person. He states that he recently resigned from a nursing home on good terms. He wants to go back to visit some of the residents whom he considers friends and wants to know if there are any laws restricting him from visiting. Activity? Information & consultation to individuals Measures/topics? Measure: 1 information & consultation Topic: Resident rights 10. You receive a telephone call from an anonymous person. He states that he recently resigned from a nursing home on good terms. He wants to go back to visit some of the residents whom he considers friends and wants to know if there are any laws restricting him from visiting.   What activity best fits this situation? Information and Consultation to Individuals Identify all measures/topics required: Measure: 1 information and consultation Topic: Resident Rights

Quiz #11 You serve as an information source for a reporter investigating the quality of assisted living facilities. Over a period of two months you have five discussions with the reporter related to the story.

Quiz # 11, Answers Activity? Measures/topics? You serve as an information source for a reporter investigating the quality of assisted living facilities. Over a period of two months you have five discussions with the reporter related to the story. Activity? Work with media, interview Measures/topics? Measure: 1 interview Topic: Facility quality 11. You serve as an information source for a reporter investigating the quality of assisted living facilities. Over a period of two months you have five discussions with the reporter related to the story.   What activity best fits this situation? Work with media, Interview Identify all measures/topics required: Measure: 1 interview Topic: Facility quality

Quiz #12 An ombudsman program develops materials in preparation for this year’s Residents Rights Month, including a press release. The program distributes the release to four regional newspapers.

Quiz #12, Answers Activity? Measures/topics? An ombudsman program develops materials in preparation for this year’s Residents Rights Month, including a press release. The program distributes the release to four regional newspapers. Activity? Work with media, press releases Measures/topics? Measure: 1 press release Topic: Resident rights 12. An ombudsman program develops materials in preparation for this year’s Residents Rights Month, including a press release. The program distributes the release to four regional newspapers.   What activity best fits this situation? Work with media, press releases Identify all measures/topics required: Measure: 1 press release Topic: Resident rights

Quiz #13 You are a member of a coalition to support expansion of Home and Community Based Programs. A primary goal of the coalition is to comment on proposed legislation related to the Medicaid Waiver to ensure increased consumer access and quality assurance. The group meets monthly and the agenda includes reports from stakeholders and review of other state programs.

Quiz #13, Answers Activity? Measures/topics? You are a member of a coalition to support expansion of Home and Community Based Programs. A primary goal of the coalition is to comment on proposed legislation related to the Medicaid Waiver to ensure increased consumer access and quality assurance. The group meets monthly and the agenda includes reports from stakeholders and review of other state programs. Activity? Monitoring laws and regulations Measures/topics? Measure: Estimated % of total staff time Topic: Not required 13. You are a member of a coalition to support expansion of Home and Community Based Programs. A primary goal of the coalition is to comment on proposed legislation related to the Medicaid Waiver to ensure increased consumer access and quality assurance. The group meets monthly and the agenda includes reports from stakeholders and review of other state programs.   What activity best fits this situation? Monitoring laws and regulations Identify all measures/topics required: Measure: Estimated percentage of total staff time. The State Ombudsman may have specific guidance on how to calculate this time. Because NORS only asks for an estimate, AoA does not prescribe a particular methodology to determine the estimated percentage. Topic: Not required Note: For this activity, participating in each meeting can be counted in the estimated percentage.

Quiz # 14 A local ombudsman provides training for 14 volunteer and two staff ombudsmen. The training is from 1:00 to 5:00 p.m. on the first day and 9:00 a.m. to 1:00 on the second day, which includes a working lunch. The agenda includes training on ombudsman investigation techniques and resolution strategies. Several outside speakers, as well the State Ombudsman, serve as presenters.

Quiz #14, Answer Activity? Measures/topics? A local ombudsman provides training for 14 volunteer and two staff ombudsmen. The training is from 1:00 to 5:00 p.m. on the first day and 9:00 a.m. to 1:00 on the second day, which includes a working lunch. The agenda includes training on ombudsman investigation techniques and resolution strategies. Several outside speakers, as well the State Ombudsman, serve as presenters. Activity? Training for LTCO staff and volunteers Measures/topics? Measure: 1 session Measure: 8 hours, 16 LTCO Topic: Investigation strategy 14. A local ombudsman provides training for 14 volunteer and two staff ombudsmen. The training is from 1:00 to 5:00 p.m. on the first day and 9:00 a.m. to 1:00 on the second day, which includes a working lunch. The agenda includes training on ombudsman investigation techniques and resolution strategies. Several outside speakers, as well the State Ombudsman, serve as presenters. What activity best fits this situation? Training for ombudsman staff and volunteers Identify all measures/topics required: Measure: 1 session Measure: 8 hours, 16 ombudsmen Topic: Investigation strategy   Does the State Ombudsman count this as a state training activity? No – NORS instructions read: “When state staff provides all or part of the training, but the training is arranged by local program staff, the training is counted as local.”

Bonus Question #1 A family council asks the local ombudsman program to give a presentation on residents’ rights at a monthly family council meeting. Two ombudsmen attend the meeting and each participates in the presentation.

Bonus Question # 1, Answer A family council asks the local ombudsman program to give a presentation on residents’ rights at a monthly family council meeting. Two ombudsmen attend the meeting and each participates in the presentation. Activity? Work with family councils Measures/topics? Measure: 1 Family council meeting Topic: Not required 1. A family council asks the local ombudsman program to give a presentation on residents’ rights at a monthly family council meeting. Two ombudsmen attend the meeting and each participates in the presentation. What activity best fits this situation? Work with family councils Identify all measures/topics required: Measure: 1 Family Council Meeting Topic: Not required   In this scenario participation in family council can only be counted by one ombudsman. The measure that AoA wants to know is how many meetings were attended which reflect support for family councils, not how many ombudsmen attended the meeting.

Bonus Question # 2 An assisted living facility director asks you to present training on resident abuse and neglect. In the audience are staff members from three long-term care facilities, a new ombudsman who is observing the training, and a few family members who also are interested in the information.

Bonus Question # 2, Answer An assisted living facility director asks you to present training on resident abuse and neglect. In the audience are staff members from three long-term care facilities, a new ombudsman who is observing the training, and a few family members who also are interested in the information. Activity: Training to facility staff Measures/topics? Measure: 1 Training Topic: Abuse and neglect 2. An assisted living facility director asks you to present training on resident abuse and neglect. In the audience are staff members from three long-term care facilities, a new ombudsman who is observing the training, and a few family members who also are interested in the information. What activity best fits this situation? Training to facility staff   Identify all measures/topics required: Measure: 1 Training Topic: Abuse and neglect There is only one activity entered by the ombudsman, training to facility staff. Although there is an ombudsman and several family members in the audience, the bulk of the trainees are facility staff. Count your training activity based on the primary composition of the audience.

QUESTIONS?

SUMMARY Activities = range of LTCO work LTCO staff and volunteers Local level and State level activities States can use discretion in capturing topics and percentage measures. States may collect more information than is required to be reported to AoA in NORS. Need more clarity related to coding? Contact WINC, Shelley Hitt, Chair (303) 722-0300 ext.508 or 1-800-288-1376 skhitt@thelegalcenter.org

Posted on the NORC website NORS Training Posted on the NORC website http://ltcombudsman.org/ombudsman-support/training#NORS Watch for an announcement about the posting of Q & A’s related to NORS coding. Check NORC website for most recent NORS training materials prior to conducting training.

The National Long-Term Care Ombudsman Resource Center (NORC) www.ltcombudsman.org The National Consumer Voice for Quality Long-Term Care (formerly NCCNHR) http://www.theconsumervoice.org/ This presentation was supported, in part, by a grant from the Administration on Aging, Department of Health and Human Services.