Organizations. It is primarily hospital focused. The PRs represent the management of the facility, and, as employees of the VA medical centers, the PRs are inherently subject to conflicts of interest (Custis, 1994).

In many states, facility administrators within the VA facility-managed network deny LTC ombudsmen access to veterans and claim that the PR program meets their advocacy needs. Additionally, ombudsmen encounter access problems at VA facilities, because the OAA does not specifically authorize access to federal or state-owned facilities. Some state enabling legislation also fails to grant access to state-owned facilities.

To help meet the needs for ombudsman services of these two groups, the committee offers the following recommendations:

3.1. The committee recommends that Congress amend the Older Americans Act to allow state ombudsman programs to serve younger individuals who reside in long-term care facilities in which primarily elderly individuals reside. However, state ombudsman programs should strive to comply fully with their current mandates before using Older Americans Act resources to serve residents who are younger than 60 years of age. When applicable, the state long-term care ombudsman should coordinate activities and advocacy efforts with other organizations that serve as advocates for nonelderly residents.

3.2. The committee recommends that the Department of Veterans Affairs (VA) institute an agreement with the Administration on Aging (AoA) to ensure that long-term care ombudsman services are available to all veterans residing in nursing and domiciliary homes operated by the VA. The agreement should include the transfer of adequate funds from the VA to the AoA to support the provision of ombudsman services to VA-owned or VA-managed facilities.

Systemic Advocacy

Numerous questions arise in assessing whether state LTC ombudsman programs comply generally with the mandates that focus on systemic advocacy work. For example:

  • Does the program consistently comment on proposed changes in state or federal laws, regulations, or policies?

  • Does it directly seek changes, clarifications, or improvements in state or federal laws, regulations, or policies?

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