States and localities vary on the extent to which they comply with the law and spirit of operating statewide LTC ombudsman program. Similarly, states are affected in different ways and to different degrees by a range of factors that have an impact on compliance. Generally, factors that influence states’ levels of compliance fall into three groups: leadership within the organizational framework, elements of infrastructure, and institutional care context.
During the developmental stage of the LTC ombudsman programs, AoA supported model grants to explore methods for promoting and developing ombudsman services. As states began to set up ombudsman programs, regional and central AoA staff provided other support. For example, in 1976 AoA issued program instructions that helped clarify the program’s intent. In 1981 AoA funded five resource centers; these, along with national groups such as the Legal Services Corporation (LSC) and the National Citizens’ Coalition for Nursing Home Reform (NCCNHR), further assisted states in developing their ombudsman programs. Additionally, in the early 1980s, states received a series of 22 technical assistance materials from AoA on various aspects of ombudsman program development, including such items as roles and functions of volunteers, and sample job descriptions. However, during the last half of the 1980s, AoA provided little oversight and technical assistance to the states on the implementation of the ombudsman program, and most of that effort took the form of monitoring by regional offices. Since 1988, AoA has continuously supported a single national resource center for the LTC ombudsman program with a mission of training, technical assistance, and information dissemination.3
The committee found that state and local ombudsmen were willing to acknowledge openly the weaknesses of their programs. At the same time, they expressed confidence that the program is making positive changes in the lives