During its meetings, the committee conjectured about how a future LTC system might be configured and about the trends that might affect both the need for and nature of the ombudsman program. It also encouraged those who wrote background papers, those who provided oral or written testimony in various forums, and those who replied to the various canvasses to do the same. Consensus on these topics was neither desired nor sought. Based on all this input and the committee’s own deliberations, the committee concluded that rather substantial changes in the very nature of LTC are likely in the next decade; it also concluded that any ombudsman program will face challenges to adapt and be responsive to changing needs. A brief summary of some of the major considerations discussed by the committee follows.

Regarding the Configuration of Long Term Care

Functional ability, rather than age, may become the most relevant factor in the financing and organization of the LTC financing and service delivery system. If this is the case, then the utility of the continuation of an age-specific ombudsman program is in question. Nevertheless, age-prejudiced views that devalue the worth of treating older people with respect are likely to continue, and older people may still need advocates to ensure that they receive an appropriate share of the LTC resources.

Given expected demographic changes, the absolute number of individuals in need of LTC services will increase. This will strain the resources of any LTC ombudsman service and perhaps force new mechanisms to be created and used.

People who have medically complex conditions and are dependent on high technology (especially those in vegetative or comatose states with minimal ability to interact with their environment) will become a larger share of the nursing facility population than they are today. Others will be in nursing facilities for short-term rehabilitative or convalescent stays. The former situation will require that any advocate become well versed in legal and moral issues related to end-of-life treatment, surrogacy, and guardianship. The latter may necessitate a mechanism other than routine visitation to ensure that short-stay residents receive sufficient attention from an ombudsman program.

A large variety of LTC settings will emerge and, in all likelihood, receive public subsidy. These will include family homes, adult foster homes, and assisted living arrangements. The latter may blur the distinctions between home care and residential “facility” care, especially if benefits for services become portable and are provided by home health agencies or self-employed

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