EVOLUTION OF THE LONG-TERM CARE OMBUDSMAN PROGRAM

Ombudsman Theory and Practice

Originally conceived by the Swedish parliament in 1809, the ombudsman was a government official with high personal prestige and independence who would listen to the complaints of individual citizens about the government and try to resolve them in an impartial manner. More broadly conceptualized, an ombudsman is a “public watchdog” or “citizen defender” who intercedes between a citizen and some form of authority. In addition to offering protection against the impersonality of bureaucracy, he or she also seeks to increase government’s responsiveness and accountability, provides a complaint processing system, and suggests ways to reorganize services in response to a pattern of complaints (Ziegenfuss, 1985).

In his analysis of social criticism, political philosopher Michael Walzer (1988) suggests that the role of the critic is to distinguish between and call attention to what we really are and what we most want to be. The critic is an insider, rooted in his or her society, who has obtained some critical distance. The ombudsman, as critic but also as activist, derives his or her philosophical authority from fundamental American beliefs in human rights and dignity. No matter their political persuasion, members of our society seem to recognize “the respect for life, integrity, and well-being, even the flourishing of others” as profoundly important moral concerns (Taylor, 1989).

In 1971, when the LTC ombudsman program was first proposed, the idea of the ombudsman was gaining increasing popularity in American government. In that same year, the Department of Commerce established the first ombudsman in a federal agency, and since that time a number of federal agencies, including the Internal Revenue Service, the Social Security Administration, and the Environmental Protection Agency, have followed suit. Additionally, many states, counties, and other jurisdictions have implemented ombudsman programs. Ombudsmen can also be found in unions, newspaper offices, colleges, universities, schools, and corporations. Many private hospitals and the Department of Veterans Affairs also employ patient representatives, who act in a similar advocate role on behalf of acute-care patients.

Although the classic characterization of the “ombudsman” stresses neutrality and mediation, the role of the LTC ombudsman is considered a hybrid, since it was designed for active advocacy and representation of residents’ interests over those of other parties involved. Additionally, classic ombudsman models involve intervention 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 facility or board and care (B&C) home. The extension of this role is legitimized by the government’s substantial involvement, both as



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