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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 R13
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