1. Louise Ryan, MPA Ombudsman Program Specialist, ACL/AoA May 3, 2017
What should a State Ombudsman expect from the Administration for Community Living/Administration on Aging?
Louise Ryan, MPA
Ombudsman Program Specialist, ACL/AoA
May 3, 2017

2. Welcome!
Purpose:
To give new State LTC Ombudsmen an overview of the role of the Administration for Community Living and the Administration on Aging
To discuss what State Ombudsmen can expect from ACL/AoA and the Office of LTC Ombudsman Programs
Provide an opportunity for Question & Answer

3. ACL Mission
Maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers.
ACL Vision
All people, regardless of age and disability, live with dignity, make their own choices, and participate fully in society.

4. Administration for Community Living
An operating division within the Department of Health and Human Services formed in April 2012
Administration on Aging (administers the Older Americans Act)
Administration on Disabilities, which includes the Administration on Intellectual and Developmental Disabilities (administers the “DD Act”)
Includes the DD Councils and
Protection & Advocacy Systems
Office of the Administrator
Includes 10 Regions
Center for Integrated Programs
Includes Duals Ombudsman Program
State Health Insurance Assistance Programs (SHIP) was
transferred to ACL from CMS
DD Act = Developmental Disabilities Assistance and Bill of Rights Act of 2000

5. Programs transferred to ACL include:
Additional new growth continues as a result of the Workforce Innovation and Opportunities Act of 2014 (WIOA)
Assistive Technology (AT) Act Programs
Independent Living (IL) Programs
National Institute on Disability and Independent Living Rehabilitation Research (NIDILRR) Programs
In addition to the group of programs listed above, ACL is responsible for the Interagency Committee on Disability Research and the Disability, Independent Living, and Rehabilitation Research Advisory Council.
Opportunities for coordination with P & A’s; CIL’s especially regarding nursing home transitions

6. Our structure has not changed

7. ACL Leadership
Dan Berger currently serves as the Acting Assistant Secretary for Aging and Acting Administrator of the Administration for Community Living (ACL), assuming both roles in February 2017.
Edwin Walker currently serves as the Acting Assistant Secretary for Aging and Director of the Office of Long Term Care Ombudsman Programs
James Toews - Acting Principal Deputy Administrator, Administration for Community Living
Bob Williams - Deputy Commissioner, Administration on Disabilities, Director, Independent Living Administration
John Tschida - Director, National Institute on Disability, Independent Living and Rehabilitation Research
ACL is in leadership transition until the President appoints and the Senate confirms new leadership

8. 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; OLTCOP represents the interests of residents within HHS and other federal agencies

9. 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 justice services, creating a “ federal home” for Adult Protective Services” and the LTC Ombudsman
Note: with regards to LTCOP services there is no prohibition on serving people under age OAA reauthorization has removed the 60 and older language.

10. Title VI - American Indian, Alaskan Native, and Native Hawaiian Programs
OAA Section which establishes parallel services for Tribal Elders
Parts A&B—Nutrition, Transportation, Information and Assistance, in-home support; Part C—Caregiver Services
Tribes are allowed to establish their own age for eligibility
Elders in facilities may feel a sense of cultural dislocation because their family is not nearby or may not have transportation.
OLTCOP – has worked with Title VI Office to cross-train including development of a NORC Toolkit on tribal elders & Ombudsman services
Encourage you to find out what tribes are in your state and to look for opportunities to learn of their needs.

11. 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 regulations, 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, such as National Ombudsman Resource Center

12. Office of Long-Term Care Ombudsman Programs
Edwin Walker, 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
Hilary Dalin – Director of Elder Justice & Adult Protective Services is now Louise Ryan’s direct supervisor

13. What is ACL’s Office of Long-Term Care Ombudsman Programs?
Serve as a visible and effective advocate:
OLTCOP makes policy recommendations to benefit LTC facility residents and participates in a variety of initiatives:
Within ACL
Developing guidance to grantees re: Medicaid Managed LTSS “beneficiary support systems”
Within ACL’s Office of Elder Justice & Adult Protective Services
Protection & Advocacy
Independent Living Centers

14. What is ACL’s Office of Long-Term Care Ombudsman Programs? (continued)
OLTCOP makes policy recommendations to benefit LTC facility residents:
Within Health and Human Services
CMS Long-Term Care Facility Revised Requirements
CMS – Home and Community Based regulations
SAMHSA-Olmstead Planning working group
Assistant Secretary for Preparedness & Response (ASPR)
SAMSHA=Substance Abuse and Mental Health Services Administration
With other federal agencies/partners
Department of Justice Elder Justice Task Forces
With non-federal stakeholders – hear their perspectives
Provider associations re: CMS HCBS Settings Rule impact on Assisted Living;
Advocacy organizations – Dementia Action Alliance, CMS hosted advocates workgroup,

15. OLTCOP works on program needs to benefit LTC facility residents
Goal to strengthen the effectiveness and credibility of Ombudsman services across the country
Examples of programmatic needs addressed:
Final Rule (Regulation) for LTC Ombudsman programs
FAQs – Including new FAQ’s on the LTC Ombudsman Rule
National Ombudsman Reporting System (NORS)
States report their data to AoA in accordance with reporting requirements of the Older Americans Act

16. OAA requires AoA to establish and operate the National Ombudsman Resource Center
Purpose:
provide training, technical assistance, and information to State Long-Term Care Ombudsmen and to representatives of the Office
analyze laws, regulations, programs, and practices for purposes of offering technical assistance to Ombudsman programs on current issues
Examples:
Provide assistance in recruiting and retaining volunteers for State Long-Term Care Ombudsman programs
Development of on-line training
NORS training materials
Toolkits – Tribal Elders, LGBT, Emergency Preparation and Response, etc.

17. OLTCOP in ACL Context
LTCO is one of several ACL-funded programs providing individual and/or systems advocacy. Examples:
Elder rights programs (includes OAA legal services)
Protection and advocacy networks
Developmental disability councils
Independent Living Councils
LTCO is not the only ACL ombudsman-related work:
ACL is the Technical Assistance Center for Duals Demonstration Ombudsman Programs
OLTCOP is not the only entity participating in federal policy advocacy (Center for Policy and Evaluation)
ACL often comments on rules, policies of other agencies
OLTCOP has expertise on LTC facility resident issues, largely because of information we receive from your work (including through NORS)

18. OLTCOP in ACL Context (continued)
ACL Regional Offices
Primary point of contact for OAA grantees (i.e. state units on aging)
Led by Regional Administrator
RO state liaisons work with SUAs on state plans on aging
2016 state plan reviews include focused review of LTCO Rule compliance
Significant coordination with OLTCOP
on TA related to states’ LTCO programs

19. ACL Regional Support Centers
Technical Assistance to States, AAAs and others in Aging and Disabilities Networks
Includes TA letters & visits, examples:
Iowa, Texas (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
Planning “welcome calls” to new State LTCO by Office of LTCOP and RSC

20. AoA Program Guidance and Interpretation
Older Americans Act provisions, especially Section 712
Regulations
Final Rule (Regulation) for LTC Ombudsman programs
OAA regulations from 1988
FAQs – Including new FAQ’s on the LTC Ombudsman Rule
Program Instructions (PIs) – Examples relative to LTC Ombudsman Program: Certification of minimum funding requirements (annually)
Appropriate use of Title VII funds
State Plan requirements
National Ombudsman Reporting System (NORS)
States report their data to AoA in accordance with reporting requirements of the Older Americans Act

21. Current ACL/AOA/OLTCOP Activities
ACL Regional Support Centers and OLTCOP
State’s implementation of LTCO Rule
On going technical assistance
Quarterly regional calls
Center for Policy and Evaluation
NORC University of Chicago – completed a LTC Ombudsman Program Evaluation Study Design (January 2013)
Developed a methodology to evaluate LTCO program:
Efficiency and Effectiveness and Outcomes
Complete process evaluation (2017) (NORC University of Chicago)
Implement outcome evaluation ( )
-- Design of a new NORS data collection and reporting software

22. Current ACL/AOA/OLTCOP Activities
Continued work with CMS on nursing home initiatives such as implementation of the revised nursing home regulation
ACL/AoA staff - HCBS regulations, PASRR, Olmstead Planning, Advanced Illness/Care Planning, to name a few
Coordination with the Department of Justice 10 Regional Elder Justice Task Forces to coordinate and enhance efforts to pursue nursing homes that provide grossly substandard care to their residents
Finalize model training standards for purposes of designation of representatives of the Office

23. Living with the inherent tensions within the long-term services & supports world
The LTC Ombudsmen experience:
The interests of elder rights advocates often conflict with the
interests of service providers;
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.
To succeed, the Aging Network (and the Ombudsman program) must be explicit about its roles and clarify its boundaries.
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.

24. Frequent State Issue examples
Historically, 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
Ability to communicate to the general public and media
Full-time position (some states have had other elder rights’ protection duties assigned) Designate individuals (and local entities, in many states) to represent the Office of the State Long-Term Care Ombudsman
Relationship with local Ombudsman entities
Access to adequate legal counsel

25. Law, Regulation, Guidance
Older Americans Act
Public Law
42 U.S. Code Chapter 35
45 CFR Parts 1321 and 1324
Titles (III & VII)
Program Instructions
Letters to states
45 CFR Part 1321 (Title III)
45 CFR Part 1326 & 1328
(Title VI)
New laws are assigned a public law (PL) number. For example: The Older Americans Act as amended In known as Public Law
The United States Code contains the general and permanent laws of the United States. For example: 42 U.S.C. Chapter 35 - PROGRAMS FOR OLDER AMERICANS (Older American Act)
Federal Regulations (sometimes a group of regulations is collectively called a “federal rule”) are issued by federal agencies, boards, or commissions. They explain how the agency intends to carry out a law. By law, federal agencies must consult the public when creating, modifying, or deleting rules in the Code of Federal Regulations (CFR).

26. 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

27. Final Rule Published on February 11, 2015 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

28. Reauthorization of the Older Americans Act

29. Need Help?
LTC Ombudsman work is challenging, can feel lonely, and is complicated!
Don’t hesitate to reach out to…
Your Peers
NORC
AoA Office of LTCOP or AoA Regional State Liaison
Expertise of seasoned local representatives
Who to call? NORC? ACL? ---“No Wrong Door”
versus phone call?
ACL communications are discloseable under the Freedom of Information Act

30. 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!

31. “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.

32. Questions or comments? (206) 615-2514
How to find the Rule:
LTC Ombudsman Frequently Asked Questions (FAQ’s)
Louise Ryan –
(206)