Real People
Real Problems:

An Evaluation of the Long-Term Care Ombudsman Programs of the Older Americans Act (Summary)

Contents

• SUMMARY
  
  • Origins of the Study and Report
    
  • The Long-Term Care Ombudsman Program
    
  • State Compliance with Program Mandates
    
    • Findings
      
    • Recommendations on Compliance
      
  • Conflicts of Interest
    • Legislative and Conceptual Aspects
      
    • Recommendations on Conflicts of Interest
      
  • Effectiveness of the Ombudsman Program
    • Continuance of the Ombudsman Program
      
    • Exemplary Practices and Performance
      
    • Data and Information Systems
      
    • Research Imperatives
      
    • Adequate Management of Volunteers
      
  • Adequacy of Resources
    • Financial Resources and Program Performance
      
    • Formula for Allocating Federal Funds and Level of State Contributions
      
    • Management of Fiscal Resources
      
    • Unmet Need and Unfunded Responsibilities
      
  • Need for and Feasibility of Expanding the Ombudsman Program
    
  • Closing Comments

  ---

  The contents of the entire report, from which this Summary is extracted, are listed below.

• 1 ADVOCATING FOR QUALITY OF CARE AND QUALITY OF LIFE FOR RESIDENTS OF LONG-TERM CARE FACILITIES
  
  • Introduction
    
  • What Is Long Term Care?
    
  • Who Uses Long Term Care?
    
    • Nursing Facility Residents
      
    • Residents of Board and Care Homes and Other Residential Settings
      
  • Long-Term Care Expenditures and Sources of Funds: Who Pays?
    
  • Quality of Care and Quality of Life
    
    • Quality of Care
      
    • Quality of Life
      
  • Assuring, Assessing, and Improving Quality
    
  • The Institute of Medicine Study
    
  • Organization of this Report

• 2 OVERVIEW OF THE OLDER AMERICANS ACT LONG-TERM CARE OMBUDSMAN PROGRAM
  
  • Evolution of the Long-Term Care Ombudsman Program
    • Ombudsman Theory and Practice
      
    • History of the Long-Term Care Ombudsman Program
      
  • Status of the Current Program
    
    • Organizational Placement
      
    • Operation
      
    • Target Population
      
    • Human Resources
      
    • Funding
      
  • Functions of the Long-Term Care Ombudsman Program
    
    • Resident-Level Advocacy
      
    • Systems-Level Advocacy
      
  • Summary

• 3 STATE COMPLIANCE IN CARRYING OUT THE LONG-TERM CARE OMBUDSMAN PROGRAMS
  
  • Introduction
    
  • Compliance with Mandated Federal Provisions
    
  • Extent of Compliance
    
    • Direct Individual Advocacy Services
      
    • Systemic Advocacy
      
  • Factors that Enhance or Impede Compliance with the Program's Federal Mandates
    
    • Leadership Within the Organizational Framework
      
    • Elements of Infrastructure
      
    • Institutional Care Context
      
  • Summary
    

• 4 CONFLICTS OF INTEREST
  
  • Introduction
    
  • Legislative and Conceptual Aspects of Conflict of Interest
    
    • Older Americans Act Provisions on Conflict of Interest
      
    • Definitions and Conceptual Variations
      
    • Types of Conflict of Interest for the Ombudsman Programs
      
    • Amelioration of Individual Conflict of Interest
      
  • Conclusions and Recommendations
    
  • Summary
    

• 5 EFFECTIVENESS OF THE STATE LONG-TERM CARE OMBUDSMAN PROGRAMS
  • Introduction
    
  • Evaluation Context
    
    • Evaluation Strategy: Formative and Summative Evaluations
      
    • Effectiveness Questions
      
    • Data and Information Sources
      
    • Quality as a Central Issue in Effectiveness
      
    • Political and Environmental Factors Relevant to Effectiveness
      
  • Models of Implementation and Measures of Effectiveness
    
    • Infrastructure and Function
      
    • Performance Indicators
      
  • Effectiveness of the Ombudsman Program: The Data
    
    • Findings Related to Effectiveness
      
    • Barriers to Effectiveness
      
    • Committee Reflections on Data
      
  • Conclusions and Recommendations
    
    • Continuance of the Ombudsman Program
      
    • Exemplary Practices and Performance
      
    • Research Imperatives
      
  • Summary
    

• 6 ADEQUACY OF RESOURCES
  
  • Adequate Program Performance
    
  • Financial Resources
    
  • Financial Resources and Program Performance
    
  • Conclusions and Recommendations
    
    • Adequacy of Resources for the Currently Mandated Program
      
    • Funding Allocation Formula
      
    • State Match of Federal Funding
      
    • Fiscal Accountability for Ombudsman Program Budgets at the State and Local Levels
      
    • Unmet Need and Unfunded Responsibilities
      
  • Summary
    

• 7 EXPANSION OF THE LONG-TERM CARE OMBUDSMAN PROGRAM
  
  • Need for Ombudsmen Services by Consumers of Health Care and Long-Term Care Services
    
    • Vulnerable Populations
      
    • Complex Systems
      
    • Advocates for Vulnerable Populations
      
  • State Experience with an Expanded Ombudsman Program
    
  • Feasibility of Expanding the Current Long-Term Care Ombudsman
    Program
    
    • Conceptual Considerations
      
    • Operational Considerations
      
  • Conclusions and Recommendations
    
  • Summary
    

• 8 CLOSING COMMENTS
  
  • The Current View of the Long-Term Care Ombudsman Program
    
  • Visions of the Future: Changes that May Affect the Ombudsman Program
    
    • Regarding the Configuration of Long Term Care
      
    • Regarding the Role of the Ombudsman
      
  • Goals Revisited
    

• REFERENCES

• APPENDIXES
  
  1. Older Americans Act: A Staff Summary (A Publication of the Select Committee on Aging)
     
  2. Title VII--Allotments for Vulnerable Elder Rights Protection Activities: Chapter 2
     
  3. Study Activities
     
  4. Biographies of Committee Members

• GLOSSARY AND ACRONYMS

2.1 Organizational Placement and Operation of the Long-Term Care Ombudsman Programs, by State

2.2 - Number of Nursing Home and Board and Care Home Beds, by State, 1992

2.3 - Long-Term Care Ombudsman Human Resources, Paid Staff and Volunteers, by State

2.4 - Long-Term Care Ombudsman Programs' Amounts of Funding by Source, FY 1993, by State

2.5 - Visitation Standards, by State

2.6 - Long-Term Care Ombudsman Complaints per 1,000 Beds, by State

4.1 - Statement on Conflicts of Interest of the National Association of State Long-Term Care Ombudsman Programs

5.1 - Examples of Performance Indicators for Ombudsman Programs, Three Domains

5.2 - Structure of the Office of the State LTC Ombudsman and Elements of the Host Agency(s) for the State and Local Entities

5.3 - Qualifications of Representatives of the Office

5.4 - Legal Authority

5.5a - Resources: Financial

5.5b - Resources: Information Management

5.5c - Resources: Legal

5.5d - Resources: Human

5.6 - Office of the State Long-Term Care Ombudsman Program

5.7 - Individual Resident Advocacy Services

5.8 - Systemic Advocacy Work

5.9 - Educational Services

6.1 - Fiscal, Staffing, and Long-Term Care Bed Data, Selected States

6.2 - Summary of Total Funding for the State Long-Term Care Ombudsman Programs, by State, FY 1993

2.1 - Sources of ombudsman funding, fiscal year 1993

7.1 - Relationship of the individual's lack of empowerment and the system's complexity to the individual's need for advocacy

NAS Home Page | NAP Home Page | Reading Room | Report Home Page