the state survey agency when a complaint of abuse or neglect had been filed. Similarly, about one-third of the ombudsmen (36 percent) reported that they filed a complaint only if they were unable to resolve the individual case (Hawes and Blevins, 2001).

These diverse findings suggest the need for:

  • Studies that identify different models of ombudsman programs and examine their effect on the prevalence of reports, substantiation rates, deficiency citations, and the use of enforcement sanctions.

  • An examination of the effect of various ombudsman interventions on the prevalence and nature of abuse, including an analysis of the conditions under which such interventions will be adopted, fully implemented, and maintained over time in various types of facilities. Examples include programs developed by CARIE (1991) (advocates in Philadelphia), the Atlanta Long-Term Care Ombudsman program, and the North Shore Legal Services Program.

  • An examination of the effects of different types of training for nursing facility and RCF staff, resident and family education and empowerment interventions provided by ombudsmen programs (effects on both detection and reporting as well as on prevention).

  • What is the relationship between abuse of residents and the work conditions experienced by direct care staff (e.g., management style, staff satisfaction with working conditions and management support, staff satisfaction with wages and benefits)?

  • What is the relationship between aggressive or difficult behaviors by residents and abusive behaviors by staff and whether aggressive staff responses are moderated by staff training, staffing levels, or specific interventions (e.g., use of behavior management teams for residents with challenging behaviors)?

  • What staff characteristics are associated with a greater propensity for abuse or neglect, including such factors as gender, reason for choosing work in residential long-term care, attitudes about the elderly, and others?

  • What are risk factors for individual staff members—both situational, having to do with their work environment, and intrinsic?

  • Evaluate different facility management styles (e.g., administrator, director of nursing, unit charge nurses) associated with variations in rates

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