Conflicts of interest may arise from the structure in which the ombudsman program exists, from situations faced by the ombudsman, and from individual ombudsman relationships or conduct. The OAA charges the state agency and the state ombudsman with responsibility to establish mechanisms to identify and remove conflicts of interest pertinent to the ombudsmen (both state and local), their immediate family members, and the entities that host the program.
Implementation of this policy is very difficult to actualize. It is almost impossible to eliminate all potential conflicts of interest because of how the LTC ombudsman programs operate and where they are located. This is especially true if the definition of situations where conflicts of interest arise is understood to include more than those noted in the OAA [see (f)(3) subparagraphs (A) through (D) in Appendix B]. Nevertheless, the importance of addressing certain situations where conflicts of interest may be expected to arise with some frequency is not to be understated. In some cases, measures can be taken to prevent the occurrence of conflicts of interest or reduce or eliminate them once identified, but other desirable aspects of program management or operation may also be eliminated by such actions.
The duties of the LTC ombudsman program, if properly carried out, present multiple situations in which conflict of interest can occur. In the early years of development of the program, major concerns were twofold: (1) SUAs were prohibited from contracting for the operation of the ombudsman program with agencies that license or certify LTC facilities, and (2) conflicts of interest arose from relationships, such as employment arrangements, with LTC facilities. Concern over conflicts of interest or potential conflicts of interest are justifiable given the multiple forces and incentives that influence the behavior and decision making of the ombudsman, those with whom the ombudsman must work, and those who provide funding.
Since the list of duties for SUAs, area agencies on aging (AAAs), and ombudsmen has grown in length and specificity during the last two reauthorizations of the OAA (see, for example, Generations, 1991, and Appendix A), an even greater potential for conflict of interest exists between LTC ombudsman programs and the public agencies that typically house them. This growth in responsibility has occurred at the same time that state governments have faced increased fiscal constraints. The OAA has clearly designated the LTC ombudsman program as the voice representing the LTC resident to government, yet in most cases the program continues to be housed within state and local governments that are increasingly responsible for service provision to older persons (Buford, 1984; Rango, 1984; Coleman, 1991; Holstein, 1994; Hornbostel, 1994).