volunteer ratios average 1:8 nationally and range from 1:1 in four states to a high of 1:100 (Oregon) (AARP, 1994a).
Funding for LTC ombudsman programs is patched together from multiple sources at the federal, state, and local levels (Figure 2.1 and Table 2.4). Most federal funding comes from Titles III and VII of the OAA: in FY 1993 this accounted for 61 percent of the total program funding of nearly $38 million. States are required to provide matching funds to their Title III allotment (at least 15 percent); no state match is required for Title VII allotments. Usually the states take this additional state funding from their own general revenues, but two states (Maine and Ohio) have instituted a nursing facility bed tax to help finance the program. The amount of funding contributed by states varies considerably: in FY 1993, for example, seven programs received no state dollars, whereas seven other programs received more than 50 percent of their budget from state funds. Overall, states’ contributions account for 21 percent of total program funding. Sources for other funding include AAAs, local governments, the United Way, and foundations. These other sources account for 15 percent of total program funding.
Several important factors govern the way that OAA monies for ombudsman activities are distributed to and within the states. Title III and VII monies are distributed to states through an interstate funding formula based primarily on the number of older individuals in the state. Within states, Title III monies are distributed to AAAs through an intrastate funding formula developed by the state that takes into account such factors as number of low-income minority older individuals, geographical distribution of older individuals, and number of older individuals with the greatest economic or social need. Title VII monies, however, are distributed at the discretion of the SUA through a different intrastate formula from Title III monies. Some states use formulas that rely on factors such as location and size of nursing facilities.
At the present time, SUAs and AAAs are required to expend, at a minimum, the same amount they spent on the LTC ombudsman program from all sources in FY 1991 (primarily Title III monies). Additional monies earmarked specifically for the ombudsman program became available in FY 1992 through an appropriation for Title VII, but states are prohibited from using these new monies to supplant funds that the program had before FY 1992 (when most funding for the ombudsman program came from Title III). Therefore, most states find the primary source of funding for the program in Title III monies. (See Chapter 6 for a discussion of the adequacy of program funding.)