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OCR for page R13
Real People Real Problems: An Evaluation of the Long-Term Care Ombudsman Programs of the Older Americans Act Contents SUMMARY 1 1 ADVOCATING FOR QUALITY OF CARE AND QUALITY OF LIFE FOR RESIDENTS OF LONG-TERM CARE FACILITIES 25 Introduction, 25 What is Long Term Care?, 26 Who Uses Long Term Care?, 27 Nursing Facility Residents, 27 Residents of Board and Care Homes and Other Residential Settings, 29 Long-Term Care Expenditures and Sources of Funds: Who Pays?, 32 Quality of Care and Quality of Life, 33 Quality of Care, 33 Quality of Life, 35 Assuring, Assessing, and Improving Quality, 36 The Institute of Medicine Study, 38 Organization of this Report, 39 2 OVERVIEW OF THE OLDER AMERICANS ACT LONG-TERM CARE OMBUDSMAN PROGRAM 41 Evolution of the Long-Term Care Ombudsman Program, 42 Ombudsman Theory and Practice, 42 History of the Long-Term Care Ombudsman Program, 43 Status of the Current Program, 45 Organizational Placement, 46
OCR for page R14
Real People Real Problems: An Evaluation of the Long-Term Care Ombudsman Programs of the Older Americans Act Operation, 46 Target Population, 53 Human Resources, 53 Funding, 58 Functions of the Long-Term Care Ombudsman Program, 62 Resident-Level Advocacy, 62 Systems-Level Advocacy, 72 Summary, 76 3 STATE COMPLIANCE IN CARRYING OUT THE LONG-TERM CARE OMBUDSMAN PROGRAMS 79 Introduction, 79 Compliance with Mandated Federal Provisions, 79 Extent of Compliance, 80 Direct Individual Advocacy Services, 80 Systemic Advocacy, 86 Factors that Enhance or Impede Compliance with the Program’s Federal Mandates, 88 Leadership Within the Organizational Framework, 88 Elements of Infrastructure, 93 Institutional Care Context, 96 Summary, 98 4 CONFLICTS OF INTEREST 101 Introduction, 101 Legislative and Conceptual Aspects of Conflict of Interest, 102 Older Americans Act Provisions on Conflict of Interest, 102 Definitions and Conceptual Variations, 104 Types of Conflict of Interest for the Ombudsman Programs, 108 Amelioration of Individual Conflict of Interest, 119 Conclusions and Recommendations, 121 Summary, 126 5 EFFECTIVENESS OF THE STATE LONG-TERM CARE OMBUDSMAN PROGRAMS 129 Introduction, 129 Evaluation Context, 130 Evaluation Strategy: Formative and Summative Evaluations, 130 Effectiveness Questions, 131 Data and Information Sources, 132 Quality as a Central Issue in Effectiveness, 133 Political and Environmental Factors Relevant to Effectiveness, 134 Models of Implementation and Measures of Effectiveness, 135