1. Ombudsman Program Process Evaluation: Progress and Initial Data
2017 National Consumer Voice for Quality Long-Term Care Conference, Arlington, VA
November 6, 2017
Kim Nguyen, PhD, NORC
Louise Ryan, MPA, ACL/AoA
Susan Jenkins, PhD, ACL/AoA

2. Evaluation Team NORC at the University of Chicago (NORC)
Process Evaluation and Special Studies Related to the LTCOP
NORC at the University of Chicago (NORC)
National Consumer Voice for Quality Long-Term Care (Consumer Voice)
Brooke Hollister, PhD, University of California, San Francisco
Helaine Resnick, PhD, Resnick, Chodorow & Associates
William Benson, Health Benefits ABCs
Human Services Research Institute (HSRI)

3. Research Questions
Process Evaluation and Special Studies Related to the LTCOP
How is the LTCOP structured and how does it operate at the local, State, and Federal levels?
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?

4. Data Collection Round 1 Data Collection Round 2 Data Collection
Process Evaluation and Special Studies Related to the LTCOP
Round 1 Data Collection
Telephone Interviews
Federal Staff (5)
Stakeholders (19)
State Ombudsmen (53)
Round 2 Data Collection
Online Surveys
State Ombudsmen (census)
Local Directors/Regional Representatives (sample)
Local Representatives (sample)
Volunteers (sample)

5. the transcriber heard…
Transcription Errors
Round 1 Data Collection
Instead of “systems advocacy,”
the transcriber heard…

6. “assistance advocacy.”
Transcription Errors
Round 1 Data Collection
“assistance advocacy.”

7. the transcriber heard…
Transcription Errors
Round 1 Data Collection
Instead of “ombudsman,”
the transcriber heard…

8. Transcription Errors
Round 1 Data Collection
“embossment.”

9. Transcription Errors
Round 1 Data Collection
[inaudible]

10. the transcriber heard…
Transcription Errors
Round 1 Data Collection
Instead of “Alzheimer’s Association,”
the transcriber heard…

11. “Old Timers’ Association”
Transcription Errors
Round 1 Data Collection
“Old Timers’ Association”

12. “My systems advocacy agenda is surviving the day.”
Outtakes
Round 1 Data Collection
On developing a systems advocacy agenda…
“My systems advocacy agenda is surviving the day.”

13. “I call it the shampoo approach. Rinse and repeat. Start all over.”
Outtakes
Round 1 Data Collection
On the continual re-education of coordinating entities and stakeholders, due to staff turnover…
“I call it the shampoo approach Rinse and repeat. Start all over.”

14. Respondent: “Well, you haven’t seen the drivers.”
Outtakes
Round 1 Data Collection
On challenges facing the Ombudsman Program…
Respondent: “[The program] isn’t sexy like home- delivered meals. That’s where it’s at.”
Interviewer: “I honestly have never heard of the meals program being described as ‘sexy’.”
Respondent: “Well, you haven’t seen the drivers.”

15. Preliminary Findings The Long-Term Care Ombudsman Program is unique…
Round 1 Data Collection: Stakeholders and Federal Staff
The Long-Term Care Ombudsman Program is unique…

16. Preliminary Findings and… confusing…
Round 1 Data Collection: Stakeholders and Federal Staff
and… confusing…

17. multiple levels. Preliminary Findings on
Round 1 Data Collection: Stakeholders and Federal Staff on
multiple levels.

18. Preliminary Findings Uniqueness of Program Mission Structure
Round 1 Data Collection: Stakeholders and Federal Staff
Uniqueness of Program
Mission
OAA
Federally mandated to advocate for individuals living in facilities
Role of the Ombudsman
Structure
Requirement for independence
Reporting
Funding
Volunteers
Heavy reliance on volunteers in delivering services
Attracts individuals with professional backgrounds
Work characterized by a high level of responsibility

19. Preliminary Findings Strengths of Program Mission Structure
Round 1 Data Collection: Stakeholders and Federal Staff
Strengths of Program
Mission
Serves as the voice of long-term care residents
Structure
Access to residents and greater flexibility in addressing issues than other entities (such as licensing and certification)
Degree of independence afforded to the Ombudsman
Program Staff and Volunteers
Passionate, knowledgeable, committed
Direct, face-to-face interactions with individuals

20. Preliminary Findings Program Visibility/Awareness Stakeholders
Round 1 Data Collection: Stakeholders and Federal Staff
Program Visibility/Awareness
Stakeholders
High visibility within aging service network
Factors facilitating visibility of program
Efforts of Kathy Greenlee and Becky Kurtz
Participation in coalitions, taskforces, etc.
Implementation of Final Rule
Consumers
Awareness is low at the consumer level
Among current residents, awareness is on an as-needed basis.
Among prospective residents, visibility is lower.

21. Preliminary Findings Program Effectiveness
Round 1 Data Collection: Stakeholders and Federal Staff
Program Effectiveness
Overall, the LTCOP is perceived to be effective.
Effectiveness also understood to vary across and within states.
Basis of Assessment (Metrics Used)
Observations and Anecdotes
Direct experience with complaint handling process
Stories shared by State Ombudsman or other stakeholders regarding activities
Interactions with State Ombudsman at trainings and conferences
NORS data
Frequency of visits, description of resident concerns and how they were addressed

22. Preliminary Findings Program Structure
Round 1 Data Collection: State Ombudsmen
Program Structure
Types of state LTCOP structures:
State-level: Most often in an SUA, but can be in another state government agency or a nonprofit
Local level: Centralized or decentralized (local programs in AAAs or other entities)
Trade-offs with each type of organizational placement:
Location in an SUA or related government agency allows access to a variety of resources and facilitates relationships to coordinating entities
Location in an independent state agency or nonprofit facilitates autonomy
SUA support is valuable regardless of structure
Final Rule helped clarify LTCOP role and need for autonomy within program structure

23. Preliminary Findings Resources and Program Capacity
Round 1 Data Collection: State Ombudsmen
Resources and Program Capacity
Insufficient funding commonly reported as a challenge and source of frustration to provide desired level of service, or in many cases, service to meet federal mandates
Funds were perceived to be insufficient with respect to staffing, salaries, travel, and data systems
However, some ombudsmen did feel that their program has sufficient funding to carry out responsibilities
Ombudsmen noted the need to identify and advocate for resources to supplement federal funding to ensure program success

24. Preliminary Findings Resources and Program Capacity
Round 1 Data Collection: State Ombudsmen
Resources and Program Capacity
Many programs struggle to visit all long-term care facilities quarterly and to conduct non-complaint-related visits
Barriers to regular visits include staffing, distance of facilities from local programs
Some reported difficulty taking on fiscal management responsibilities (OAA and Final Rule requirement) due to lack of expertise and sufficient access to budget information

25. Preliminary Findings Prioritizing Resources
Round 1 Data Collection: State Ombudsmen
Prioritizing Resources
Funding challenges compel State Ombudsmen to prioritize resources and program activities
Programs may prioritize:
Facility visits and individual case work over systems advocacy
Case/complaint work over non-complaint visits
Cases where a resident’s health or safety is at risk
Visits to some facility types (such as nursing homes) over other facility types
Handling cases over the phone when possible (to reduce travel costs)

26. Preliminary Findings Volunteers
Round 1 Data Collection: State Ombudsmen
Volunteers
Successful recruitment strategies included the following:
Working with an educational institution to recruit students with community service requirements
Human interest stories in the media that highlight the LTCOP and the difference it has made in the lives of those served
Media stories about volunteers
Advertising through radio, television, and newspapers
Outreach in community settings such as churches, health fairs, and senior centers
Working with AARP to educate members about the program

27. Preliminary Findings Volunteers
Round 1 Data Collection: State Ombudsmen
Volunteers
Successful management strategies included the following:
Hiring a volunteer coordinator to help recruit, train, and supervise volunteers Potential benefits:
Increase volunteers
Improve training
Support volunteers in addressing challenging issues, may reduce stress and help with retention
Interested volunteers required to shadow another volunteer before they undergo training
Allows the prospective volunteer to better understand the role and confirm their interest
Ensures commitment before investing valuable staff time in onboarding process

28. Preliminary Findings Coordinating entities
Round 1 Data Collection: State Ombudsmen
Coordinating entities
Benefits. Many ombudsmen described relationships with coordinating entities as positive and critical to carrying out their work. State agencies and other stakeholder organizations assist the program with:
Providing referrals to services and resources to residents
Supporting systems advocacy work to improve quality of care for residents
Providing the “teeth” to compel nursing homes and facilities to improve care
Education on how to meet the needs of special populations
Barriers. Developing relationships can be challenging due to:
Lack of understanding of the LTCOP’s role and responsibilities
Different perspectives or priorities
Time constraints for staff at both LTCOP and coordinating entities

29. Looking Ahead Process Evaluation – Round 2 Outcomes Evaluation
Upcoming Data Collection
Process Evaluation – Round 2
Online Surveys
State Ombudsmen (53)
Local Directors/Regional Representatives (27 states)
Local Representatives (27 states)
Volunteers (27 states)
Outcomes Evaluation
Longitudinal Study
Interviews
Focus Groups

30. Kim Nguyen, PhD