1. The Wave of the Future for the Long-Term Care Ombudsman Program
The Consumer Voice Conference
Arlington, Virginia
November 3, 2016

2. Presenters
Becky Kurtz, Director, Office of LTC Ombudsman Programs, ACL
Louise Ryan, Ombudsman Specialist, ACL
Patty Ducayet, NASOP President and Texas State LTC Ombudsman
Cindy Englert, NALLTCO President and Ombudsman Coordinator, Centralina Area Agency on Aging (NC)

3. Part I: The Older Americans Act and the State LTC Ombudsman Programs Rule

4. Reauthorization of the Older Americans Act
Congress passed April 2016
Long-Term Care Ombudsman (LTCO) Programs:
Are authorized to serve residents, regardless of age.
May work on complaints for residents unable to communicate wishes.
Are to provide residents with private, unimpeded access.
Must actively encourage and assist in development of resident and family councils.
Are authorized to serve to residents transitioning from a LTC facility to a home-care setting.
Other LTCO-related highlights:
• State LTCO responsible for fiscal management of Office.
Program is a “health oversight agency” under HIPAA.
Clarifies requirements about information disclosure.
Provides examples of conflicts of interest, requiring remedy or removal.
Requires state LTCO participation in National Ombudsman Resource Center training.
For more information:

5. Federal Rule on State LTC Ombudsman Programs
Goals:
Long-term care facility residents in every state receive consistent approaches to person-centered problem resolution and advocacy.
States maintain flexibility in program structure and service delivery:
Centralized vs. de-centralized
Within State Unit on Aging, other state agency, or contracted to non-profit
Reliance on staff and/or volunteers
45 CFR Part 1324, published in Feb 2015; effective July 2016
For more information:

6. Federal Rule on State LTC Ombudsman Programs – current status
ACL Regional Offices are providing TA to every state to support implementation
Every state (plus DC, Puerto Rico) have received a review by an ACL Regional Office
States are responding to
issues identified by ACL

7. Part I: NASOP and NALLTCO Perspectives

8. Part II: ACL’s LTC Ombudsman Program Evaluation

9. Our Goals: Program Effectiveness and Public Accountability
(1) Understand how the program addresses a problem
(2) Inform improvements to program design or management
(3) Support or change resource allocations
(4) Identify promising practices or lessons learned
(5) Improve quality of program
The Federal Government is required to show program effectiveness and public accountability
Government Performance and Results Act 1993
Program Assessment Rating Tool
Government Performance and Results Modernization Act 2010
The President Obama’s management agenda for his second term was designed to deliver “a smarter, more innovative, and more accountable government for citizens. An important component of that effort is strengthening agencies' abilities to continually improve program performance by applying existing evidence about what works, generating new knowledge, and using experimentation and innovation to test new approaches to program delivery.”
Does the LTCOP actually improve and protect the lives of residents, the services provided by facilities, and give voice to residents and their families
Do local staff and volunteers receive enough training to be effective and provide high quality services? Is the service provided across staff and volunteers consistent?
Is current program management in terms of staffing, use of volunteers, frequency of facility visits effective and efficient?
How have State and local programs addressed a range of challenges and what can be shared with other programs facing similar challenges?
As we look to the forward, what kinds of policies and support would be helpful from ACL

10. Two Types of Evaluation
Process Evaluation: focuses on the program's operations, implementation, and service delivery
Currently underway for LTCO
Outcome Evaluation: focuses on the effectiveness of the program and its outcomes
Next step, as resources permit
For more information, see the Evaluation Design Report at:

11. Blue Print of the LTCOP
The definition of a blue print is ‘a detailed plan of how to do something’, and that is what a logic model is as well.

12. Process Evaluation Questions
How is the LTCOP structured and how does it operate at the local, State, and Federal levels?
Including who the program serves, how it is staffed, and what data are collected about activities and outcomes?
How do LTCOPs use existing resources to resolve problems of individual residents and to bring about changes at the facility and governmental (local, State, and Federal) levels that will improve the quality of services available/provided?
With whom do LTCOPs partner, and how do LTCOPs work with partner programs?
How does the LTCOP provide feedback on successful practices and areas for improvement?
Drawing on data collected at the Federal, State, and local levels of the program, the process evaluation will assess the following areas:
The data collection capacity and practice of State and local LTCOP programs
How the program operates at the Federal, State, and local levels independently, and in conjunction with each other
3. The range of ways that ombudsmen (a) identify, investigate and resolve complaints about the care residents receive with respect to their health, safety, welfare and rights; (b) represent residents’ interests before government agencies and analyze, comment on, and monitor Federal, State and local regulations, policies and actions that potentially affect residents of long-term care facilities; and (c) provide information and consultation to facilities, residents, and their families as well as collaboration with other agencies
4. LTCOP use of volunteers and paid staffing
5. Program reach, including inclusion of residential care communities
6. Variability in program characteristics and the contextual differences that contribute to this variability, and
7. Promising innovations or adaptations that may strengthen program effectiveness and/or efficiency.

13. The LTCOP Evaluation: Special Study
Operates under a very different landscape now than it operated during its last comprehensive evaluation 20 years ago (Institute of Medicine, 1995)
Faces more intense challenges of:
an aging population in greater need of care,
competition for resources, and
a changing long-term care system with:
nursing homes focusing on post-acute services,
greater consumer options in residential care settings,
more older adults to “aging in place,”
greater use of home and community-based services.
If we know both what the programs does, how it works, its funding, partnerships, and context as well as whether it is meeting its goals, then we can develop a good blue print or model and guidance for how other sites can implement their programs to achieve the same results. And, context is important because as we know that we should plant palm trees in Northern Canada, not all program models will work under all circumstances.
The special study will help ACL better understand the circumstances or environment in which programs thrive or struggle.

14. The LTCOP Evaluation: Special Study
What are important, defining changes of the LTSS landscape currently and in the foreseeable future?
How is the LTCOP preparing for, addressing, or struggling with these features?
What are the implications of these changes and the ways that the LTCOP is adapting or not adapting?

15. Timeline Activity Timeframe
Apply for federal clearance to collect data
Summer 2016
Interview federal staff, national stakeholders, and state staff
Fall-Winter 2016
Survey Local staff and volunteers
Winter 2017
Draft final report and special report
Summer 2017
Final reports
September 2017
We are starting to plan for an outcome evaluation that may start in the Fall of 2017.

16. Part II: NASOP and NALLTCO Perspectives

17. Part III: Updating the National Ombudsman Reporting System

18. National Ombudsman Reporting System “NORS Next”
Goals:
Enhance ACL’s ability to understand and report on:
LTCO program operations,
implement regulatory requirements,
experience of long-term care facility residents and
changes in long-term supports and services policies, research, and practices.
Example: ACL would be able to analyze resolution by type of complaint:

19. “NORS Next” (continued)
Why? To address past criticisms* regarding -
inconsistencies across states and recommendations to:
increase reliability and accuracy of the data,
simplify codes and number of data elements,
streamline reporting by states and
reduce manual entry to avoid errors in complaint and activity data.
*HHS-ASPE, OIG, NASOP, recommendations from Bader Report, etc.
ASPE, OIG, Bader report, NASOP

20. “NORS Next” Process
Proposed changes to the National Ombudsman Reporting system (NORS) published in Federal Register:
August 8 for a 60 day public comment period which ended October 7
17 comments received from NASOP, NALLTCO, individual states and other stakeholders
Revisions under consideration based on comments
Once all comments considered and revisions made will go back out for a 30 day public comment period before final

21. “NORS Next” Process (continued)
ACL has obtained a contractor to work with ACL and stakeholders to develop software for ACL to receive states’ data
Requirements include:
Final design, testing and piloting
Development of training materials
Training
Implementation Goal – Federal Fiscal year 2019
First report to ACL January 2020

22. Part III: NASOP and NALLTCO Perspectives

23. Dialogue: Your questions and perspectives