2. the bureaucratic nature of most of the institutions within which the ombudsman program must work;

3. financial and organizational disincentives that impinge on the level and quality of medical care, nursing services, social work, physical and occupational therapy, and activity therapy provided by facilities;

4. socioeconomic or cultural conflicts among residents or between providers and residents; and

5. difficulties resulting from such physical design features of LTC facilities as limited space or unattractive or inefficient physical layout.

The ombudsmen can try to ameliorate these situations but most likely cannot eliminate them because they reflect the larger societal context.

The mission of the LTC ombudsman program as outlined in the OAA is noble but extremely demanding. It requires attention to millions of individuals across the country who live in a range of settings, from single-family homes involving one owner/caregiver to mammoth buildings with a thousand or more residents and employees. The OAA calls upon ombudsmen to address, with a friendly, informed, and competent demeanor, the concerns of millions of consumers, as well as to respond, with skillful analysis, to the dynamic public policy issue of a multibillion-dollar health care system.

The ability of the LTC ombudsman program on a national level to perform its duties and responsibilities in varied arenas depends largely on a clearly stated mission supported by commensurate funding and oversight by the Administration on Aging (AoA). The necessary financial resources to produce a program that meets the congressional mission and the elements outlined here are discussed in Chapter 6. This chapter, in effect, deals with matters central to AoA management responsibilities.

Tables found at the end of this chapter (Tables 5.2 through 5.9) present the key elements of infrastructure and function that the committee believed were central to an effective program. This formulation is a culmination of the committee’s study and discussion of how the program should be structured, organized, and operated to fulfill its mission as stated in the OAA. In developing this framework, the committee referred to OAA provisions related to duties and responsibilities of both the state and local ombudsman programs. The necessary infrastructural and functional elements of an effective ombudsman program in every state are described in the following categories: