The center is currently sponsored jointly by the National Citizen’s Coalition for Nursing Home Reform and the National Association of State Units on Aging.

To ensure that ombudsmen have a core level of knowledge to carry out their responsibilities, in the 1992 amendments to the OAA, Congress mandated AoA to establish procedures for the training of ombudsman program representatives, including unpaid volunteers. At the time of this writing, no such procedures have been established, however (see further discussion in Chapter 3).

Systems-Level Advocacy

In addition to working on individual cases and complaints, ombudsmen must address and attempt to rectify the broader or underlying causes of problems for residents of LTC facilities. When working on the systems level, ombudsmen advocate for policy change by evaluating laws and regulations, providing education to the public and facility staff, disseminating program data, and promoting the development of citizen organizations and resident and family councils.

Evaluating Laws and Regulations

The OAA directs state and local ombudsmen to analyze, comment on, recommend changes in, and monitor the development and implementation of laws affecting residents. Ombudsmen typically achieve this requirement through legislative, judicial, or administrative advocacy.

Legislative advocacy. Most ombudsmen work directly with legislators to advocate on behalf of residents. For example, the West Virginia state ombudsman lobbied successfully for a new guardianship law. The law guarantees residents and others the ability to pursue the “least restrictive alternative” by allowing for the designation of “limited” services for guardians and conservators, who are appointed by the court to handle a person’s personal affairs. Ombudsmen also lobby on the federal level through their membership association, the National Association of State LTC Ombudsman Programs (NASOP). NASOP members worked extensively on the 1992 reauthorization of the OAA that led to the creation of the new elder rights title.

Judicial advocacy. Sometimes ombudsmen make use of the judicial process to advocate on behalf of residents. The District of Columbia ombudsman program, for instance, successfully sued the city government in order to end the practice of distinguishing between skilled and intermediate levels of care and to bring local laws regulating Medicare and Medicaid facilities into compliance with



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