B&C residents is one of the chief reasons that an enhanced role for ombudsmen in B&C homes is so important.

In most states, ombudsmen play little or no part in inspections; and, like state licensing agencies, they may face difficulties in gaining access to unlicensed B&C homes, even if they wish to visit such homes. Given the limited understanding about the appropriate way to assure quality of care and life in B&C homes (Reschovsky and Ruchlin, 1993; Hawes et al., 1994), the role ombudsmen should play, in order to be most useful, is still in question (Phillips et al., 1994).

In addition to these structural complexities, the B&C environment itself presents other challenges. B&C homes are extraordinarily diverse, defying easy classification and uniform approaches. Their residents, too, are diverse and may actually demand a more complex and potentially expansive approach for individual and systemic advocacy than nursing facility residents.

Chaitovitz (1994b) reported several factors that ombudsmen identified as obstacles to their providing more intense coverage of B&C facilities:

  • Ombudsman need specific training concerning B&C issues.

  • Many volunteers find that they have difficulty building relationships with chronically mentally ill residents of B&C homes.

  • Visits by ombudsman to small personal care homes may seem like an intrusion to provider, resident, and volunteer alike; access therefore is often difficult.

  • Many volunteer ombudsman rely on positive feedback from volunteer coordinators, social workers, and other staff more likely found in nursing facilities, and they do not find this interaction in the relatively isolated atmosphere of B&C homes.

  • In metropolitan areas, B&C homes are frequently located in high crime areas and safety concerns discourage ombudsmen.


Although elements of the ombudsman programs have been vigorously implemented, in certain states and locales, overall the ombudsman program has not been fully implemented, especially with regard to the OAA provisions that call for ombudsman services to be available and accessible to residents of LTC facilities. The committee finds the following:

  • Not all residents of LTC facilities in need of advocacy assistance have meaningful access to the services of an ombudsman.

  • Many residents of LTC facilities are unaware of, and thus would probably not be able to use, ombudsman services. This lack of awareness

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