This report from the Institute of Medicine (IOM) addresses important aspects of the LTC ombudsman program—specifically the LTC ombudsmen’s ability to deal with problems that affect the care provided to and the quality of life achieved by elderly residents of LTC facilities. The ombudsman program arose in response to the widespread perception of problems in nursing facility quality. The program began in 1972 through five state demonstration projects that were funded by the Department of Health, Education, and Welfare’s Health Services and Mental Health Administration. The Administration on Aging (AoA) received responsibility for the program during a departmental reorganization in 1973 and has retained that responsibility over the past two decades.

Recently, policymakers—at the urging of ombudsmen themselves— concluded that a more in-depth examination of the program is warranted, with the aim of clarifying present strengths and weaknesses and assessing the program’s potential for future contributions. To this end, the Congress of the United States directed, in the 1992 reauthorization of the Older Americans Act (OAA), that the Assistant Secretary for Aging conduct a study of the state LTC ombudsman programs. Through a contractual arrangement, the IOM carried out the study.

This report is the culmination of that work, which commenced in October 1993. To conduct the study, the IOM appointed a 16-member expert committee comprising individuals recognized for their expertise in LTC, medicine, medical sociology, health care policy and research, clinical research, health law, health care administration, state government policy and program administration, consumer advocacy, public health, voluntarism, and the LTC ombudsman program (for details of committee members’ backgrounds and specialties, see Appendix D).

The committee’s report examines four key issues:

  1. the extent of compliance with the program’s federal mandates, including conflict of interest issues;

  2. the availability of, unmet need for, and effectiveness of the ombudsman program for residents of LTC facilities;

  3. the adequacy of federal and other resources available to operate the programs; and

  4. the need for and feasibility of providing ombudsman services to older individuals who are not residing in LTC facilities.

To inform itself on issues pertaining to this charge, the committee engaged in a variety of factfinding activities. These included site visits, seven commissioned papers, numerous contacts with a wide array of ombudsmen and

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