a regulator and reimburser, with these industries. In this way, as an engaged critic of both government and private industry, the LTC ombudsman plays a unique role.

History of the Long-Term Care Ombudsman Program

Responding to growing concerns about the quality of nursing facilities, the care provided in them, and the government’s ability to regulate and enforce laws regarding these facilities, President Nixon proposed an eight-point initiative in 1971 to improve conditions in the nation’s nursing facilities. One of the eight points called for using “state investigative ombudsman units” to improve quality of care by focusing exclusively on the resident, thereby compensating for the limitations of regulations and other quality assurance strategies (Butler, 1975). In 1972, the Department of Health, Education, and Welfare (DHEW), Health Services and Mental Health Administration, awarded five contracts for states to implement nursing home ombudsman demonstration programs. The demonstrations took place in Idaho, Michigan, Pennsylvania, South Carolina, and Wisconsin.

During a DHEW reorganization in 1973, the Administration on Aging (AoA) received administrative responsibility for the demonstration programs. Assignment of the programs to AoA was consistent with AoA’s statutory responsibilities for advocacy and coordination on behalf of the elderly at the federal level. Additionally, the move placed the programs within the infrastructure of the “aging network” of state and area agencies on aging. This network of agencies is authorized, through the Older Americans Act (OAA), to foster the development and implementation of a vast array of supportive services for individuals 60 years of age or older.

The structure of the aging network consists of the AoA and 10 regional offices at the federal level; state units on aging (SUAs) in all states and territories; 670 area agencies on aging (AAAs); and thousands of direct service providers. When it first was formed in the late 1960s, few state and area agencies actually provided services directly. Today, however, SUAs and AAAs are deeply involved in the provision of community-based LTC (AoA, 1994b). (For a more complete description of the aging network, see Appendix A.)

In May 1975, then Commissioner on Aging Arthur S.Flemming invited all SUAs to submit proposals for grants “to enable the State Agencies to develop the capabilities of the Area Agencies on Aging to promote, coordinate, monitor and assess nursing facility ombudsman activities within their service areas.” The grants sought primarily to inaugurate, in as many areas as possible, community action programs dedicated to identifying and dealing with the complaints of older persons or their relatives regarding the operation of nursing facilities. All states except Nebraska and Oklahoma received grants the first year and hired nursing



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