1. The Long-Term Care Ombudsman Program
History and Responsibilities
under the
Older Americans Act
Sara S. Hunt, Consultant
National Long-Term Care Ombudsman Resource Center
May 2004
This presentation provides a brief overview of the LTCOP, its development, and responsibilities under the Older Americans Act (OAA). It is intended as a brief introduction or a quick review of the program. For specific provisions of the OAA, refer to the language in the federal law.

2. History Growth in Nursing Homes What Happened
1965 Medicare and Medicaid
Provided public money for care
What Happened
Abuse
Neglect
Substandard care
Fires resulting in deaths
Publicity About Poor Care and Owner Profits
Congressional Hearings 1970
Apparent that systems to protect individuals had failed
Improvements in quality of care needed
This presentation begins with the growth of the nursing home industry in recent times. To generate discussion, ask, “What pre-dated nursing homes as we know them today?” To amplify discussion talk about the connection between public funding for care and the development of the industry.

3. Development Ombudsman Program Idea developed by Dr. Arthur Flemming
Influenced by Swedish model
Proposed to President Nixon and included in his nursing home agenda in 1971
Presidential directive — help states establish units to respond to complaints made by or on behalf of individual patients
Nursing Home Ombudsman Demonstration Projects contracts granted in 1972
Refer to the narrative materials for supplemental points about the precipitating events leading to the creation of the LTCOP.

4. Development—Initial Steps
Projects had impressive record of complaint resolution
In 1975 all states could seek funds for ombudsman activities
Funding through the Administration on Aging (AoA)
To develop capabilities of Area Agencies on Aging for ombudsman activities
From the demonstration projects emerged an effective model that shaped the national program. Because the program was envisioned as a community program responsive to individual residents, the first nationwide grants were “to enable the State Agencies to develop the capabilities of the Area Agencies on Aging to promote, coordinate, monitor and assess nursing home ombudsman activities within their service areas.” (AoA-PI-75-30) Therefore from the beginning, the LTCOP was designed to be locally based throughout each state.

5. Development—Growth
1978 All states were required to operate a Nursing Home Ombudsman Program
Enacted in amendments to Older Americans Act (OAA)
1981 changed to Long-Term Care Ombudsman Program due to expanded responsibilities
The requirement for all states to operate a Nursing Home Ombudsman Program came in the 1978 amendments to the OAA. Since then there have been several changes in the program enacted through various amendments to the Act. All of the changes have amplified, not altered, the original model of the program. The changes have added clarity and specificity to the ombudsman role and responsibilities. Individual states have also enacted laws establishing the program within each state.

6. Evaluation Success of first Ombudsman Programs judged by
Number of community programs
Effectiveness in receiving and resolving complaints in
An effective and
A constructive manner.
AoA Commissioner Flemming
1976
How do these indicators of success compare to what you heard residents say about the Ombudsman Program on the video, “Advocates for Residents’ Rights?” Point out the importance of each student in fulfilling the community and effectiveness components of the program.

7. Conclusions
The laws and regulations enacted will be of little avail unless
“…communities are organized…to deal with the individual complaints of older persons living in nursing homes.
The individual in the nursing home is powerless.”
AoA Commissioner Flemming
1976
Read this quote and ask, “What does this mean?” Discuss the meaning and the connection to the LTCOP. Briefly discuss why individuals in nursing homes are powerless and connect these reasons with the intent of the LTCOP.

8. Job Description
The Ombudsman Program was created to represent individuals in long-term care facilities.
Ombudsmen help individual residents benefit from relevant laws and regulations.
This slide summarizes the intent of the LTCOP.
Key points are:
The LTCOP began due to failures in the licensing and certification (regulatory and enforcement) system designed to protect residents,
The LTCOP was intentionally structured to operate outside of the licensing and certification system, and
The LTCOP is responsible for calling on the licensing and certification system to fulfill its responsibilities to residents.
Because the regulatory, enforcement, and care delivery (providers) systems still fall short in providing good care for each resident, the intent of the LTCOP remains as important today as it was in 1978.

9. Job Description Prevention Provide information to residents
Promote development of citizen organizations
Provide technical support for resident and family councils
Recommend changes in laws, regs, and policies to benefit residents
Provide access to ombudsman
Assist residents in asserting rights
Identify, investigate, and resolve complaints made by, or on behalf of, residents
There are numerous responsibilities of the LTCOP delineated in the OAA. Some of these are specific to the State Agency on Aging, others are for the Administration on Aging or for designated local ombudsman programs (entities). The majority of them relate to the duties of the Office of the Long-Term Care Ombudsman, the State LTCO, and by delegation to local LTCO. The next few slides provide an overview of LTCO responsibilities. These are grouped according to type of service and are not a complete list of mandated responsibilities. Explain that “regs” means regulations.

10. Job Description Intervention
Seek legal and other remedies to protect residents
Analyze, comment on, and monitor laws, regs, and governmental policies on behalf of residents
Facilitate public comment pertinent to residents
Give brief examples of each of these activities. Obviously the emphasis is on linking each LTCO responsibility to working on behalf of residents. Reiterate the point that ombudsmen are the voice, the messenger, of residents, not acting on the agenda of the ombudsman. The responsibility and the credibility of the LTCOP lies in its ability to consistently represent residents.

11. Job Description-Summary
On behalf of residents, ombudsmen are advocates for
Resolving Individual Complaints
Resolving Systems Issues
Laws, Regulations, Policies
This summarizes the range of responsibilities of the LTCOP. If the responsibilities of the students are exclusively focused on resolving individual complaints and/or resolving systems issues within a facility, make this clarification. This also illustrates the grounding of all LTCOP work in issues arising from, or affecting, residents. Thus the original intent of the program is carried throughout the federal law listing ombudsman responsibilities. From the beginning, the focus of the LTCOP has been on resolving issues for individuals residents.

12. Rewards Ombudsman perspective on the job:
“The opportunity to speak up for someone who cannot do so for herself, to advocate for individuals or groups of people who otherwise might have no voice, no ‘seat at the table,’ keeps every day fresh and gives every meeting the potential to be important.”
Esther Houser, Oklahoma State LTCO
This slide and the following one give a personal perspective on what it’s like to be a LTCO.

13. Rewards Ombudsman perspective on the job:
“The greatest experiences I have had working as an ombudsman are listening to people and treating them as a valued human being; working with citizens to become volunteer ombudsmen, and facilitating staff, residents, and families to communicate with each other.”
Vivian Omagbemi, Maryland Local LTCO
Just as LTCO help residents and deal with very frustrating situations, the residents and their families enrich the life of the ombudsman. The responsibilities of the LTCO can be daunting but they can also be very gratifying and personally enriching.
This presentation reviewed the foundation of the LTCOP and its federal framework. When an individual becomes a LTCO, he or she joins a state and a nationwide network working toward a common goal!

14. Rewards Ombudsman Perspective on the job:
“The handshake and thank you from a family member after a 2 hour care plan meeting…$500 That beautiful smile lighting up the face of the resident that you just promised to come back and chat with again real soon…$50,000 Filling out monthly reports and progress notes…$5

15. Rewards
The look on the administrator’s face when you tell her that you personally have observed the facility in making a mistake that she considered nothing more than complaining by family member whose expectations were too high…Priceless

16. Rewards Ah, the power of… an ombudsman!”
Carol Schmidt, Maryland LTCO Volunteer

17. Thanks to the
Administration on Aging for their support in the development and distribution of this presentation
Provide a quick review of the major points regarding the uniqueness of the LTCOP. Ask for questions or comments. Challenge the students to be just as special as unicorns in serving residents as LTCO!

18. The National Long-Term Care Ombudsman Resource Center thanks all ombudsmen who work so diligently on behalf of long-term care residents.
Provide a quick review of the major points regarding the uniqueness of the LTCOP. Ask for questions or comments. Challenge the students to be just as special as unicorns in serving residents as LTCO!