individuals with whom they interact, a one-day invitational symposium, and two meetings of a technical panel.

THE LONG-TERM CARE OMBUDSMAN PROGRAM

Concerns with the quality of nursing facilities, the care provided in them, and the government’s ability to enforce regulations in them led to the creation of the LTC ombudsman program in the early 1970s. In contrast to regulators, whose role is to apply laws and regulations, ombudsmen are supposed to help identify and resolve problems on behalf of residents in order to improve their overall well-being. The ombudsman program works alongside other programs, groups, and individuals engaged also in efforts to improve the quality of care and quality of life of residents in LTC facilities.

Although the classic model of the ombudsman stresses neutrality and mediation, the role of the LTC ombudsman is considered a hybrid, since it was designed to encompass both active advocacy and representation of residents’ interests over those of other parties involved. Additionally, in the classic model the ombudsman intervenes between the government and individual citizens. In the case of the LTC ombudsman program, however, intervention usually also includes a private third party—the nursing or B&C facility.

Today the LTC ombudsman program operates in all 50 states, the District of Columbia, and Puerto Rico. No single model can accurately describe these multifaceted programs. Variability in organizational placement, program operation, funding, and utilization of human resources has given rise to at least 52 distinctive approaches to implementing the program. The Office of the State LTC Ombudsman program is most often housed within the state unit on aging (SUA); 42 states have this arrangement. The SUAs in these states themselves vary in their organizational placement: some are housed in independent, single-purpose agencies; some reside in larger, “umbrella” agencies in which several other agencies report to a head office. Others are housed in independent state-run ombudsman agencies. Some even operate completely outside state government. Recent estimates of LTC ombudsman staffing put the number of full-time equivalent (FTE) paid staff at about 865. Volunteer ombudsmen number about 6,750, excluding volunteers who serve chiefly on advisory committees.

Funding for LTC ombudsman programs is patched together from multiple sources at the federal, state, and local levels. Most federal funding comes from the OAA. Sources for other funding include state and local governments, area agencies on aging (AAAs), the United Way, and foundations.

The primary activity required of LTC ombudsmen by the OAA is the identification, investigation, and resolution of individual complaints relating to



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