The committee’s approach accords with Carol Weiss’ (1972) suggestion that efforts to develop effective social policies and programs have suffered from too much summative evaluation of ill-conceived interventions and too little research into the causes of social problems and the obstacles to their solution. Consequently, the specific purpose of the IOM review is to investigate some evidence regarding the effectiveness or ineffectiveness of the ombudsman program while it is still evolving, in order to facilitate decision making and improve program management. Thus, in addition to attempting to shed some light on the larger question of what difference the program makes, the committee’s primary goal has been to encourage positive program changes and improvements that are needed in view of evidence available to date in the lives of individual residents of LTC facilities and at the system level.

Effectiveness Questions

Effectiveness, for purposes of this report, means that the objectives of the LTC ombudsman program, as specified in the Older Americans Act (OAA) and its various amendments, are met to the maximum extent possible. It means that services are provided to residents and that residents, their families, and other advocates are informed as to the availability of those services. Furthermore, the effective ombudsman represents the interests of the residents in both quality of care and quality of life—first, last, and always—before the interests of governmental agencies and seeks administrative, legal, and other remedies to protect the health, safety, welfare, and rights of the residents of LTC facilities.

Measuring effectiveness raises two fundamental questions: Does the ombudsman program resolve the problems that confront residents of nursing facilities and board and care (B&C) facilities, with respect to the quality of their lives and their rights or privileges (when they exist)? Are individual residents and their families satisfied with problem resolution and systemic changes that affect the quality of residents’ lives in these facilities?

In this context, effectiveness evaluation should obtain systematic and consistent information on the impact of the ombudsman program on public policy and provider behavior and on the extent to which changes in policy and provider behavior benefit consumers or recipients of LTC. More specifically, this effort should seek to answer the following kinds of questions: (a) Do residents have access in a timely fashion to an independent ombudsman who can help them, especially in resolving complaints they may have against LTC facilities or staffs? (b) Do residents, families, and other citizens know about the ombudsman program, and can and do they use it? (c) Do LTC providers know about and support the program? (d) Does the program assist SUAs in accomplishing their mission? (e) Are state and local LTC policy directives implemented as a result of program initiatives?

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