interviews with state ombudsmen, the OIG investigators attempted to determine the characteristics of successful programs and to identify highly successful programs; the highly successful programs were then examined in greater depth.

The OIG analysts developed a multidimensional index to serve as the basis for rating the activities of all state programs. This index comprised a series of measures grouped into three main categories—visibility, complaint resolution, and peer recommendations. Measures included frequency of visits to LTC facilities, ratio of professional staff to beds, ratio of volunteers to beds, incidence of complaints received and resolved in a timely manner, and a rating of state program reputations based on peer appraisals. The OIG staff scored these measures and then translated them into a final, global score for each state and the District of Columbia that ranged empirically from a high of 27 (out of a possible 28) to a low of 11; the modal score was 19.

Table 6.1 reproduces portions of the OIG data for three groups of states (the six highest-ranked on the aggregate OIG index [scores 23–27], the seven middle-ranked [score of 19], and the seven lowest-ranked [scores 11–13]). In addition, the table shows the total nursing home and B&C beds, dollar expenditure per LTC bed for FY 1993, and ratio of FTE paid staffing to beds.

The variation within these three groups in, for example, ratios of paid staff to volunteers (see Table 2.3) and program expenditures per LTC bed is striking. However, the differences among the groups on certain measures is also striking, particularly for the highest- and lowest-ranked states in terms of ratio of staff to volunteers, schedule of visits (see Table 2.5), number of complaints per 1,000 LTC beds,1 and, of course, program expenditures per LTC bed. Some use of these data (or group-specific calculations) will be made below in discussing overall levels of funding for the ombudsman pro


The volume of complaints received is a difficult measure to interpret, absent detailed knowledge of each state’s LTC sector and ombudsman program. High complaint rates may reflect poor nursing facility or B&C services and an “average” level of activity by the ombudsman program, or it may reflect “average” LTC services and a very active ombudsman program and clientele; conversely, low rates may suggest very good LTC facilities overall in a state or an extremely unproductive and ineffective ombudsman program. Some limited evidence suggests an impressive association between complaint volumes (on the one hand) and levels of staffing and frequency of visits (on the other) (see, for example, OIG, 1991a,b,c; Huber et al., 1993). Reports from site visits made by the committee underscored this view.

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