The OAA legislates a wide-ranging scope of advocacy functions for the Office of the State LTC Ombudsman to perform both at the individual resident level and at the broader systems level. In performing these functions, the LTC ombudsmen must maintain relationships that are inherently full of tension. On the one hand, ombudsmen must often be highly critical of the facilities and agencies under their review; on the other hand, they must be able to work cooperatively with these parties to ensure that the resident is well served. Ombudsmen must also interact with an extensive array of program administrators and policymakers regarding extremely complex and often contradictory sets of laws, regulations, and policy and program instructions.

Resident-Level Advocacy

When working with individual residents, ombudsmen’s responsibilities include: ensuring residents have regular and timely access to the program, investigating and resolving complaints, working cooperatively with other agencies, and providing technical assistance and training to representatives of the program.

Ensuring that Residents Have Regular and Timely Access to the Program

The regular presence of persons from outside of facilities has been identified as an important factor in improving quality of care and quality of life in facilities (IOM, 1986; Barney, 1987; Feder et al., 1988; Glass, 1988; Cherry, 1991, 1993; Nelson, 1993; Arcus, 1994). Many LTC ombudsmen and other LTC professionals think that proactive, routine on-site presence is essential. They argue that it builds awareness of the program, establishes resident confidence, detects concerns about residents’ conditions before these become serious, and creates and maintains positive working relationships with the facility administration and staff. Such factors as increased percentage of residents with mental incapacities, isolation of residents from families, and difficult access to telephones strengthen the claim for continuous, predictable visitation by LTC ombudsmen.

States often set standards for how often a facility should be visited by an ombudsman or volunteer (Table 2.5). Kautz (1994) found that, of the 36 states he studied, 29 had instituted visitation standards, but only 18 of these states generally met their standard across all facilities. None of the states that had

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