a stronger ombudsman program than exists today and to bring more and better empirical evidence into the debate.
An individual’s need for advocacy assistance is likely to be related to two factors: (1) the individual’s vulnerability and lack of empowerment and (2) the complexity of the system of care with which the individual is having problems (see Figure 7.1). Empowerment denotes an individual’s ability to express his or her views, to feel a sense of personal control, and to influence his or her environment. To the extent that an individual lacks empowerment, he or she is more vulnerable to abuse, neglect, or exploitation. A highly complex system is characterized by a high level of bureaucracy or multiple points of accountability, fragmentation in the provision of services, and limited flexibility. Both lack of empowerment and organizational complexity result in the special necessity to ensure that an individual’s rights are adequately protected.