these B&C facilities, the ombudsmen’s charge is the same as their charge in nursing facilities. They are to investigate and resolve complaints, monitor regulations and policies affecting facilities, and provide information to public officials concerning residents in facilities. However, no additional federal funding accompanied this expansion. (This topic is further discussed in Chapter 3.)

In 1987, two major legislative changes greatly strengthened ombudsmen’s ability to reach and serve residents. The Nursing Home Reform Act of 1987 (Omnibus Budget Reconciliation Act of 1987) mandated that nursing facility residents have “direct and immediate access to ombudspersons when protection and advocacy services become necessary.” Simultaneously, the 1987 reauthorization of the OAA charged states to guarantee ombudsmen access to facilities and patient records and provided other important legal protections. State ombudsmen were also given the official authority to designate local programs to carry out ombudsman functions. Duly authorized employees and volunteers of these programs could then be considered “representatives” of the state ombudsman with all the ombudsman’s rights and privileges accorded to them. Finally, amendments to the Act required the SUA to ensure the program had adequate legal counsel.

The 1992 OAA amendments highlighted the role of local ombudsman programs and the state ombudsman’s leadership role while reemphasizing each LTC ombudsman’s role as an advocate and agent for systemwide change. As a result, the LTC ombudsman program was incorporated into a new Title VII for “Vulnerable Elder Rights Protection Activities” of the OAA. This title (commonly referred to as “Elder Rights”) is designed to strengthen programs that assist older people in receiving the rights and privileges to which they are entitled. In addition to the ombudsman program, three other programs were authorized under Title VII: programs for the prevention of elder abuse, neglect, and exploitation; elder rights and legal assistance development programs; and benefits outreach, counseling, and assistance programs. Although each program retains its own distinctive features, the legislation also emphasizes the value of the four programs working closely to coordinate efforts.


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. Nonetheless, many commonalities do exist between these various approaches. For example, most

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