position located within the SUA.4 In contrast, local ombudsmen programs rely very little on the Office of the Attorney General or other government attorneys, turning chiefly to legal services attorneys for advice, consultation, and legal representation.

In states with inadequate legal support, SUAs should work more closely with the ombudsmen program in systematically identifying gaps in legal assistance and types of assistance needed, and in jointly planning strategies to address the gaps. To that purpose, the committee proposes the following recommendation:

3.8. The committee recommends that the Assistant Secretary for Aging require that each state unit on aging include in its state plan a description of how the state has funded and ensured the provision of adequate and independent legal counsel to the ombudsman program, including how all designated representatives of the Office of the State Long-Term Care Ombudsman are afforded legal counsel so that all their mandated duties and services can be and are performed.

The committee recognizes that adequate legal resources are not an end in themselves but are an essential element of the ombudsman programs’ infrastructure. Without such resources, the program is greatly hampered in its ability to comply with other mandated provisions in the OAA such as to “identify, investigate, and resolve complaints that are made by or on behalf of residents,” to “pursue administrative, legal, and other appropriate remedies on behalf of residents,” and to “analyze, comment on, and monitor the development and implementation of federal, state, and local laws, regulations, and other government policies and actions.”

Institutional Care Context

Nursing Facilities

Many of the problems that ombudsmen confront in their work are embedded in the structure, financing, and ideology of the LTC system, features not easily changed with the tools available to the ombudsman (Greene and Monahan, 1981; Buford, 1984; Holder and Frank, 1984; IOM, 1986; Feder et al., 1988; Mason, 1994). (See also Kane and Caplan, 1990; McGinnis, 1991; NIDR, 1992.) As a society, we have no coherent, ethically sound long-term care policy especially for the very frail and vulnerable. The LTC non-system


Some states employ a paraprofessional instead of an attorney for this function.

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