of life of residents; and (3) protect the health, safety, welfare, and rights of residents.

The Older Americans Act (OAA) mandates that the ombudsman work toward changing government and other institutions for the betterment of the residents of LTC facilities. The OAA requires the ombudsman to: “…seek administrative, legal, and other remedies to protect the health, safety, welfare, and rights of the residents”; “recommend any changes in such laws, regulations, policies, and actions as the Office determines to be appropriate”; and “facilitate public comment on the laws, regulations, policies, and actions.” Thus, by accepting OAA monies, state governments agree to allow one of their own employees (or a contractor of the state) both to criticize openly and publicly their policies and procedures and to work toward implementing improvements. The directive to “seek administrative, legal, and other remedies” is broad enough to include the state government itself as a target of ombudsman advocacy. Conflicts of interest can easily occur in such situations.

This chapter reviews the conflict of interest arena relevant to the LTC ombudsman program. The first section reviews the pertinent statutory provisions. A discussion of definitions and related conceptual dimensions follows. Four types of conflicts of interest are then examined: organizational conflicts; individual conflicts; willful interference; and conflicts related to the provision of legal counsel. Several mechanisms that help ameliorate conflicts of interest are delineated in the context of the ombudsman program. The committee states its conclusions and offers recommendations on this topic at the end of the chapter.

OAA ombudsman program provisions have always contained prohibitions against conflict of interest. The reauthorization of the act in 1992 placed even greater emphasis on sheltering the ombudsman program and ombudsman representatives from conflicts of interest. The program can better serve residents with focused, independent advocates. The legislation includes several important provisions on the subject. They are cited and explained here in some detail to underscore their breadth and the significance that Congress attached to this issue.

On organizations that may not house the Office of the State LTC Ombudsman and people serving as the state ombudsman: