individuals served by P&As in FY 1992, nearly 6,000 (9 percent) were age 60 or older (NAPAS, 1992).

The OAA requires the Office of the State LTC Ombudsman to coordinate ombudsman services with these organizations since they share similar concerns and mandates regarding such matters as statutes and regulations affecting the disabled, inadequate care in LTC facilities, and resident rights issues such as improper discharges and placement of individuals in inappropriate environments (although there is no similar mandate for P&As to coordinate with ombudsmen).

The 1992 survey of 20 state ombudsman programs (AoA/OIG, 1993) revealed several methods for coordination, including joint meetings, MOUs, joint training, and referral by the ombudsman to the P&As. In Colorado, the state LTC ombudsman program resides within the same agency that houses the P&As. The Louisiana ombudsman has developed a unique relationship with its P&As, the Advocacy Center for the Elderly and Disabled, or ACED (Kautz, 1994). The SUA and Office of the State LTC Ombudsman contract with ACED for legal support for state and local ombudsmen and LTC residents. Local ombudsmen have access to an attorney who is a full-time employee of ACED and a specialist in nursing facility and elder law. Not only has ACED pursued various remedies on behalf of residents and assisted the program in legislative and administrative systemic advocacy, but the relationship has also facilitated coordination activities between ombudsmen and ACED staff attorneys working on behalf of mentally ill or disabled nursing facility residents.

Coordination and cooperation are not universal, however. Several ombudsmen report that the P&As in their states give priority to those who live in the community or to school-age children (Chaitovitz, 1994b). These P&As maintain little, if any, involvement with residents of institutions. In addition, differences in philosophy and strategies may make coordination less desirable, as some state P&As take a more adversarial and litigious approach to advocacy than do ombudsmen.

To fulfill their responsibilities, ombudsmen must have a thorough and up-to-date knowledge of many topics—the laws and regulations governing nursing facilities and B&C homes, investigation and mediation techniques, geriatrics and the medical and emotional needs of persons with disabilities, and the like. Both state and local ombudsmen provide training—initial and ongoing—and technical assistance to ensure that program representatives are as well prepared as possible. Additionally, since 1988, AoA has supported a national resource center for the LTC ombudsman program (the National Ombudsman Resource Center) whose mission is to train, provide technical assistance, and disseminate information.