These councils must receive support from facility staff, if asked, but should operate independently and feel free to voice concerns to facility staff and owners.

Many LTC ombudsmen report that resident and family councils help in solving many problems within a particular facility. For instance, the LTC ombudsman in one program stated that she had spent a great deal of time in one facility resolving complaints about cold food. She helped organize a residents’ council that now routinely deals with those complaints. Thus, she is free to work on other issues.


The creation of the LTC ombudsman program occurred in the early 1970s in response to ongoing scandals regarding the care provided in nursing facilities. The ombudsmen’s mission was to help identify and resolve problems on behalf of residents to improve their overall well-being. Unlike most other ombudsmen, who typically utilize mediation and neutrality, LTC ombudsmen utilize active advocacy and representation of residents’ interests over those of the other parties involved.

Today the LTC ombudsman program operates in all 50 states, the District of Columbia, and Puerto Rico, and covers residents of both nursing facilities and B&C homes. 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 exist between these various approaches.

The Office of the State LTC Ombudsman is most often housed within the SUA; 42 states have this arrangement. The SUAs in these states themselves vary in their organizational placement: some are in independent, single-purpose agencies; some are, in larger “umbrella” agencies in which several other agencies report to a head office; and others are in independent state-run ombudsman agencies or are completely outside state government. Some states operate from one centralized office; others have developed separate and distinct local programs. Recent estimates of LTC ombudsman staffing put the number of FTE paid staff at about 865. The number of volunteer ombudsmen is about 6,750.

Funding for LTC ombudsman programs is patched together from multiple sources at the federal, state, and local levels. Most federal funding comes from the OAA. Sources for other funding include state and local governments, AAAs, the United Way, and foundations.

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 system level. When working with individual residents, ombudsmen’s responsibilities include: ensuring residents have regular and timely

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