of compliance focuses on whether what should have been done was done. In this context, the committee seeks to answer the question: Have states implemented statewide LTC ombudsman programs? The committee explores whether the ombudsman programs are achieving what they are intended to achieve in Chapter 5.

The committee decided that an analysis of whether states have implemented LTC ombudsman programs to an acceptable level of operation would provide the most meaningful information about compliance. From an operational perspective, fully implemented ombudsman programs (a) make their services available to residents and (b) ensure that residents know how and are able to gain access to the ombudsman. Furthermore, the ombudsman works with or on behalf of residents to address the residents’ concerns through resolution of individual resident complaints. The ombudsman also advocates for systemic changes. Thus, in its discussion on compliance, the committee also felt it was appropriate to address the aspects of its charge pertinent to availability, accessibility, and unmet need.


A state-operated LTC ombudsman program fully in compliance with congressional mandates will fulfill several functions.1 For purposes of reviewing the extent of compliance, the committee collapsed the several statutory functions of the LTC ombudsman program into two primary services: (1) direct, individual advocacy services to residents of nursing facilities and board and care (B&C) facilities; and (2) systemic advocacy services.

Direct Individual Advocacy Services

The OAA requires ombudsmen to ensure that residents have regular and timely access to the services provided by the ombudsman and that they receive timely responses to complaints. Presumably, the services provided should be able to meet the needs of the residents. States receive no guidance from either


The mandated functions of the ombudsman program are enumerated in Title VII, Chapter 2, of the Older Americans Act (see Appendix B). Such functions include, but are not limited to, resolving complaints; empowering residents; educating residents about how to obtain services; providing administrative and technical assistance to designated local programs; monitoring and commenting on laws, regulations, and policies; and promoting the development of citizen organizations and resident and family councils.

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