Congress or the Administration on Aging (AoA) on how to interpret these requirements. For example, is a state in compliance for ensuring regular access if it visits all its facilities on a weekly basis? Is it in compliance if it maintains a statewide hotline and visits facilities only when a complaint is lodged? Is the program in compliance if it serves a large Spanish-speaking population, but all paid and volunteer ombudsmen speak only English?

Regular and Timely Access (Accessibility)

According to the findings of a General Accounting Office (GAO) study (1992b), regular facility visitation by an ombudsman can affect a program’s impact in four ways: (1) by increasing access to the ombudsman by residents; (2) by increasing access to the ombudsman by residents at higher risk of experiencing poor care or poor quality of life; (3) by increasing knowledge about the universe of problems within a given facility among ombudsmen; and (4) by increasing awareness and knowledge of resident-care issues among facility personnel.

In order for a resident to gain access to ombudsman services, the resident or someone who acts on his or her behalf must be aware of the ombudsman’s services. Most programs operate statewide hotlines and use posters, informational brochures, and public service announcements to inform the public of their existence and describe the scope of their services. However, given the characteristics of the target population and the high turnover rate among residents and facility staff, are these indirect activities sufficient to create a program that is “available” and “accessible” to the residents of LTC facilities?

Historically, frequent, routine, visitation to residents brought public awareness and constituted a critical aspect in the design of the ombudsman program. As noted in Chapter 2, however, the frequency of visits per facility varies significantly within and across states. Half of the state ombudsman programs continue to encounter problems gaining access to LTC facilities (AoA/OIG, 1993). Two-thirds of state ombudsmen (66 percent) indicated in the Chaitovitz (1994b) canvass that the primary reason that the need for ombudsman services of residents of nursing facilities is not met is that facilities are not visited frequently enough to assure that residents are aware of the program.

An even higher percentage of state ombudsmen (74 percent) expressed concern about low visitation rates to B&C facilities (Chaitovitz, 1994b). Many local ombudsmen who sent information to the committee indicated their concern about whether they visit facilities frequently enough to assure that residents were aware of their services. Phillips and colleagues (1994) reported



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