State Ombudsman Programs in Long-Term Care: Guide and FAQ

As a leader of a long-term care (LTC) facility, one of your primary responsibilities is to support the health, safety, and welfare of your residents. Your state ombudsman program for long-term care residents is a valuable resource that can help you adhere to local policies surrounding quality of care delivery. But what exactly is an ombudsman and what do they do?

This guide will summarize everything you need to know about working with an ombudsman for nursing homes and other LTC settings. We’ll provide an overview of what ombudsman programs are, why they were created, and how they relate to your facility’s operations.

What Does an Ombudsman Do? General Overview

An ombudsman, sometimes called an ombuds, is an individual who serves as an impartial party to investigate and settle complaints made by individuals against organizations. Specific roles of ombudsmen vary greatly and can entail advocating for children, students, or families of service members, for example. Many are associated with the government on a state or federal level, but some ombudsmen serve private companies, educational institutions, or non-profits.

What Is an Ombudsman in Healthcare?

Several types of ombudsmen function in the healthcare sector, including:

• Behavioral health ombudsmen
• Hospital ombudsmen
• Managed care ombudsmen
• Long-term care ombudsmen

Of these, long-term care ombudsmen are unique because they work within the most comprehensive, federally mandated ombudsman program in healthcare, serving millions of LTC residents across the country.

The Federal Long-Term Care Ombudsman Program: History and Structure

In the 1960s, several publications came to light revealing how the abuse and neglect of residents was rampant across LTC facilities. Congress began compiling testimonies of individuals affected by poor LTC conditions. One report in particular highlighted two notable events that significantly increased public concern:

• An uncontrolled fire that spread inside a northern Ohio nursing home led to 32 resident deaths due to oxygen deprivation from smoke fumes.
• A salmonella food poisoning epidemic went undetected inside a Baltimore nursing home, leading to 25 resident deaths.

In response to these events, Congress made amendments to the Older Americans Act, paving the way for the Long-Term Care Ombudsman Program. The program was officially trialed in five states in 1972, training teams of ombudsmen to enforce health and safety standards at various LTC facilities.

After the success of the trials, the ombudsman program was eventually adopted in all states, as well as the District of Columbia, Puerto Rico, and Guam, under the oversight of the Administration on Community Living.

Currently, each state-level program is directed by a full-time State Ombudsman who oversees operations of multiple offices, and may manage staff and volunteers. Some states have a single central office, while other states use a decentralized model with multiple offices serving specific geographic regions.

Protecting the Elderly: Federal Oversight of State Ombudsman Programs

While the Long-Term Care Ombudsman Program is federal, each state administers its own LTC ombudsman services. The specific structure of state programs can vary, but they all serve the purpose of protecting the rights of LTC residents. LTC ombudsmen are typically trained to:

• Educate LTC residents and families on how to exercise their rights.
• Investigate and resolve complaints made by residents or families against facilities.
• Facilitate communication between residents and facilities.
• Help facilities comply with local care regulations.
• Monitor the quality of care delivered in LTC facilities.
• Make recommendations for local policies affecting residents’ rights.

How Does an Ombudsman Work With Facilities?

LTC ombudsmen are typically assigned to a specific area, where they serve residents of nursing homes, assisted living facilities, and boarding homes. Ombudsmen regularly visit the facilities within their region, and also investigate reported complaints. In addition, a state ombudsman for nursing homes may interface with a facility related to broader, systemic failures in providing high-quality elderly care.

Facility Leaders: When to Reach Out to an Ombudsman for Guidance

While a region’s appointed LTC ombudsman primarily works to resolve complaints made against facilities, they’ll usually advise anyone who has concerns about the rights of residents, including facility leaders seeking regulatory guidance. This means you can reach out to your local ombudsman at any time, without fear, even if your facility is not undergoing an investigation.

You might want to reach out to an ombudsman if, for example:

• You’re seeking more information on visitation rights.
• You want advice on how to improve the quality of care for your residents.
• You’re not sure what local regulations apply to your facility.
• You’d like more resources on how to educate staff about upholding resident rights.

State Long-Term Care Ombudsman Programs

If you’re actively seeking guidance, you may be wondering – who is my local ombudsman? Each state provides a list of contacts based on your area of residence. States will administer their ombudsman programs in a way that best suits the needs of their local residents. You can find more information about state-specific services in our tailored guides below.

Facility Leaders: Tips for Ombudsmen Investigations

In the event that someone files a complaint and you’re subject to an investigation, remember that an ombudsman’s goal is to provide impartial resolution for both residents and facilities. By working collaboratively with your ombudsman, medical staff and patients alike can benefit from their guidance. Here are a few tips on how you can help an investigation go smoothly.

1. Communicate

Providing all necessary information requested by the ombudsman will help them complete the investigation as quickly as possible. You may want to prepare for scheduled meetings by gathering relevant data and considering potential solutions in advance. Follow up after interactions to establish a positive rapport.

2. Cooperate

While it may seem like an ombudsman is working against you during an investigation, they really want to work with you to help improve your facility, for the sake of your residents. With this in mind, it’s important to remain cooperative and respectful throughout the process.

3. Take Appropriate Action

If an ombudsman finds an issue, act accordingly by following their recommendations to implement any necessary changes to your care delivery. While investigations are typically informal and not aimed at imposing penalties, ombudsmen can potentially refer serious issues to regulatory agencies. Collaborating with the ombudsman to work toward resolutions ensures that residents’ grievances are addressed rather than escalated.

Want More Resources to Improve Care for Your Residents?

Collaborating with a state ombudsman may help you ensure that your residents feel seen, heard, and satisfied with their care. We know that meeting the complex needs of many residents entails challenges, and we’re here to support you with healthcare tips, guides, and strategies that will help you optimize your facility’s operations and boost resident satisfaction.