1. Ombudsman Program Specialist, ACL/AoA
What should a State Ombudsman expect from the Administration for Community Living/Administration on Aging?
Louise Ryan, MPA
Ombudsman Program Specialist, ACL/AoA
October 24, 2013

2. Administration for Community Living
An operating division within the Department of Health and Human Services (April 2012)
Administration on Aging (administers Older Americans Act)
Administration for Intellectual and Developmental Disabilities (administers the “DD Act”)
Center for Disability and Aging Policy
Center for Management and Budget
Office of the Administrator
Includes 10 Regions
DD Act = Developmental Disabilities Assistance and Bill of Rights Act of 2000

3. ACL Mission
Maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers.

4. Role of the Administration on Aging (AoA)
AoA administers Older Americans Act (OAA):
The OAA lays out duty and function of the Administration:
“serve as the effective and visible advocate for older individuals within the Department of Health and Human Services and with other departments, agencies, and instrumentalities of the Federal Government by maintaining active review and commenting responsibilities over all Federal policies affecting older individuals;”
Created, authorizes and funds grants to states
State units on aging
Area agencies on aging
“Aging network” leverages state, local, and other funds
AoA has an advocacy role in addition to being a grantee of OAA programs

5. OAA funded programs
OAA funds services to individuals age 60+, including:
In-home services and supports
Nutrition services (congregate and home-delivered meals)
Senior centers
Caregiver support
Services to tribes (American Indians, Alaskan Natives, and Native Hawaiians)
Elder rights services, including LTC Ombudsman
Note: with regards to LTCOP services there is no prohibition on serving people under age 60.

6. How ACL/AoA relates to your work
AoA helps states understand and implement the Older Americans Act (OAA) through:
Issuing grants to states (formula grants under OAA)
Reviews and approves the State Plan on Aging -- Did you know that your work is part of the State Plan on Aging?
Program guidance and interpretations
Technical assistance and/or other intervention when issues arise
Evaluation of OAA Programs
Providing a framework for the National Ombudsman Reporting System
Funding technical resource centers

7. analyze laws, regulations, programs, and practices; and
OAA requires AoA to establish and operate the National Ombudsman Resource Center
provide training, technical assistance, and information to State Long-Term Care Ombudsmen;
analyze laws, regulations, programs, and practices; and
provide assistance in recruiting and retaining volunteers for State Long-Term Care Ombudsman programs by establishing a national program for recruitment efforts that utilizes the organizations that have established a successful record in recruiting and retaining volunteers for ombudsman or other programs;
OAA requires NORC to assist State Long-Term Care Ombudsmen in the implementation of State Long-Term Care Ombudsman programs.
National Program for recruitment - For example AoA also funds the Volunteer collaborative that coordinates efforts with NORC.

8. State Planning Process:
AoA coordinates with NASUAD to provide TASC Planning Zone resources for State Plan development. (
AoA Regional Offices review State Unit on Aging state plans (every 2-4 years):
Evaluation of state aging population needs
Description of core and discretionary programs and services to meet the need
LTC Ombudsman Program is a “core program” and a “person-centered” service
New: FY 2014 Focus Area: elder justice
Assurances related to compliance with OAA
includes assurance of carrying out a State Long-Term Care Ombudsman program in accordance with section 712.
Goals and objectives for meeting needs of populations served
We review state plans; raise potential concerns; look for inclusiveness of LTCOP into the plan

9. State Plans & Long-Term Care Ombudsman
Specifically the plans should address how the state:
Operates and meets the LTCO program requirements in the OAA (including how the State assures performance of requirements when the LTCO program is not housed within the SUA)
Integrates LTCO plans into the broader Elder Rights context – as well as coordination with other aging services where applicable (for example, where does the LTCO help the SUA meet its objectives related to core programs and/or consumer control and choice?)
Expects to measure the results of its goals and objectives.
Additional Resources for Planning:
“State Long-Term Care Ombudsman Participation in State Unit on Aging Plans”

10. AoA Program Guidance and Interpretation
Older Americans Act provisions, especially Section 712
Regulations
Notice of proposed rulemaking for LTCO
Current OAA regulations from 1988
FAQs – Common TA Questions on
Program Instructions (PIs) – Examples relative to LTC Ombudsman Program:
Certification of minimum funding requirements (annually)
Appropriate use of Title VII funds
State Plan requirements

11. ACL Regional Support Centers
Technical Assistance to States, AAAs and others in Aging and Disabilities Networks
Includes TA letters & visits, examples:
Iowa, (systems advocacy),
Utah (abuse investigations),
California (minimum funding, reimbursement for bankruptcy work)
Florida(designation of local ombudsman volunteers, legislative advocacy, and information dissemination)
State plan assistance and review.
Generally, your first point of contact with questions for ACL (OLTCO works closely with regions)
Some RSCs host regular dialogues among SLTCOs in the region.
Relationship with other HHS agencies on regional level.
Site visits to States; compliance reviews when necessary
On-site travel is not common

12. Office of Long-Term Care Ombudsman Programs
Becky Kurtz, Director
Support States’ implementation of OAA grants for LTC Ombudsman programs
Advocate for interests of LTC facility residents within federal government
Louise Ryan, Ombudsman Program Specialist
Support State program operations (in coordination with Regions)
Programmatic lead for National Ombudsman Reporting System (NORS)
Project Officer for National Ombudsman Resource Center

13. Frequent State Issues
State Ombudsman ability to fulfill role as required by OAA:
An independent problem-solver focused on individual resident interests
Ability to perform effective system-level policy advocacy for residents of LTC facilities (includes recommendations to legislature)
Ability to communicate to the general public and media
Full-time position (some states have had other elder rights’ protection duties assigned)

14. Frequent State Issues (continued)
Designate individuals (and local entities, in many states) to represent the Office of the State Long-Term Care Ombudsman
Relationship with local Ombudsman entities
Confidentiality of Ombudsman information
Access to adequate legal counsel
The proposed rules address many of these issues.

15. Living with the inherent tensions within the aging & disability tent:
The LTC Ombudsmen experience:
The interests of elder rights advocates often conflict
with the interests of service providers;
To succeed, the Aging Network must be explicit about its roles and clarify its boundaries;
It’s not personal, it’s systemic – the OAA creates both service providers and advocates;
Persons receiving LTC services & supports need leaders to embrace, not fear, their advocacy mandate under the OAA.
Without clear understanding of and respect for the unique benefits of each program/service, we risk losing effective services for consumers. ACL staff seeks to support LTCO to live within the tent and to be effective in representing the interests of residents.

16. Current ACL/AOA Activities
AoA Office of Performance and Evaluation
NORC University of Chicago – completed a LTC Ombudsman Program Evaluation Study Design
Developed a methodology to evaluate LTCO program:
Efficiency and Effectiveness and Outcomes
Next step: Implement the evaluation – once funding available
“NORS Next” – NASOP, NALLTCO and ACL staff involved in a workgroup. Focus groups will occur next year.
Continued work with CMS on nursing home initiatives, Medicaid Admin claiming, accessing Civil Monetary Penalty funds and
ACL/AoA staff - HCBS regulations, PASRR, Olmsted Planning, injury prevention, to name a few

17. Notice of Proposed Rulemaking
published June 2013 – comment period ended August 18, 2013
State Agency Policies
Definitions:
B. Immediate Family
C. Office of the State Long-Term Care Ombudsman
D. Representatives of the Office of the State Long-Term Care Ombudsman
E. Establishment of the Office of the State LTC Ombudsman
F. Functions and Responsibilities of the State LTC Ombudsman
G. State Agency Responsibilities Related to the LTC Ombudsman Program
H. Functions and Duties of the Office of the State LTC Ombudsman
I. Conflicts of Interest
Find proposed rule and comments at:
NPRM limited to areas of greatest inconsistency/need for guidance to States.

18. What should a State Ombudsman Expect from the ACL?
You should expect us to:
Help you be able to do your job as a problem-solver for LTC residents
Represent the LTC Ombudsman Program at the federal/national level
Represent the interests of residents to other federal agencies
so keep us informed!

19. “Our nation has been conducting investigations, passing new laws and issuing new regulations relative to nursing homes
If the laws and regulations are not being applied to [the individual], they might just as well not have been passed or issued.”
U.S. Commissioner on Aging
Arthur S. Flemming, 1976
We take these words seriously and aim to help you to live out the mandate to be an effective advocate for the individuals that your program serves.

20. Contact information:
Becky Kurtz
Louise Ryan