stems from two causes: infrequent visitation to LTC facilities by ombudsmen in many parts of the country and little use of other methods to inform the community about ombudsman services.

  • For the most part, ombudsmen provide timely responses to complaints. However, serious problems exist in some locales. For example, some state programs serve a large proportion of their LTC residents largely through one central toll-free telephone service. In such cases, it is not unusual for ombudsmen to investigate complaints through telephone inquiries only. Those residents most in need of having the ombudsman assist in protecting their health, safety, welfare, and rights may be reluctant or simply unable to initiate complaints to the ombudsman by such means as telephone calls because they are too frail or cognitively impaired.

  • Implementation of the ombudsman program for residents of nursing facilities has been uneven among and within states.

  • Implementation of the ombudsman program for residents of B&C homes has not been achieved in any significant way except in a very few states.

  • Too many states take only piecemeal, fragmented action, focusing primarily on responding to complaints by individual residents of nursing facilities. These states are not in compliance with the spirit of the program provisions as stated in the OAA; that is, the Offices of the State LTC Ombudsman program are not functioning as a statewide, unified, integrated program delivering a range of individual, systemic, and educational services.

  • AoA has not mandated any level of implementation of the legislated LTC ombudsman program, nor has the agency monitored the implementation efforts of states. Although ombudsman programs vary in the amount of staff and volunteer resources they expend to serve the residents of LTC facilities, no minimum acceptable level of effort has been agreed upon to signify that an ombudsman program has been implemented appropriately. States do not uniformly comply with the essential requirements for operating statewide ombudsman programs, and neither AoA nor any other federal agency employs mechanisms to require such compliance.

  • AoA has not developed technical guidance materials that inform states of the federal government’s operational definition of an implemented Office of the State LTC Ombudsman program.

  • Ombudsman programs need competent legal advice and backup, including the ability to help nursing facility residents pursue issues in the courts and in regulatory hearings. These capacities are extremely uneven across the country.

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