What Is a Healthcare Ombudsman? Illinois Guide for Facilities

An ombudsman is an independent, impartial official who investigates complaints made by individuals or groups about an organization. Ombudsmen are often appointed by government agencies and aim to facilitate communication, mediate negotiations, and make recommendations for improvement. When it comes to healthcare, ombudsmen often support patients or residents in advocating for better quality of care or living conditions.

You likely have questions if your facility or residence is navigating an investigation with a state ombudsman. Illinois, in particular, has developed an ombudsman program to provide oversight into skilled nursing facilities (SNFs), at-home care, and assisted living facilities (ALFs). We’ll provide an overview of what an ombudsman in Illinois does, who they work with, and some tips for navigating the ombudsman process effectively.

What Is the Illinois Ombudsman Program?

Some states have identified a need for improved regulations of long-term care (LTC) facilities and have used the services of an ombudsman. Illinois is one such state. It has developed the Illinois Long-Term Care Ombudsman Program, which is an advocacy initiative that enables patients to request improvements to their care and report complaints by reaching out to an ombudsman representative.

This program is supported by federal and state laws, such as the Older Americans Act and the Illinois Act on the Aging. In addition to patient-initiated advocacy, Illinois ombudsmen perform regularly scheduled visits to care facilities to monitor conditions and identify potential areas of need. These visits allow the ombudsman to represent and empower residents who have limited family support or diagnoses that inhibit their ability to speak out on their own.

What Does an Illinois State Ombudsman Do?

The Long-Term Care Ombudsman Program outlines a wide range of responsibilities that fall on the ombudsman. Illinois is divided into regions as part of the program, so ombudsmen carry out the tasks and respond to requests in their assigned areas. The following list outlines an ombudsman’s key roles:

• Provide an avenue for seniors and adults with disabilities to speak up about their concerns.
• Investigate resident concerns and work to resolve issues with the facility.
• Educate residents about their rights, any support available within the facility, other long-term care options, and community resources.
• Advocate for advancements in the quality of care for residents in Illinois LTC facilities.
• Hold themselves to high standards of confidentiality and discretion with patient information.

Who Does a Healthcare Ombudsman Work With?

Ombudsmen in Illinois can receive requests from any individual who has insight into the condition of residents in any of the long-term care facilities or home care services in the state. Complaints and concerns can come from a number of parties, including:

• Individuals over 18 years old who are current, former, or prospective residents of an LTC facility
• Relatives and friends of those living in an LTC facility
• Staff and administrators who have concerns about resident care at their LTC facility
• Families or individuals exploring the option of an LTC facility
• Community groups concerned about resident wellbeing

Once an ombudsman receives a complaint from one of these individuals — or identifies an issue during a site visit — they’ll conduct an investigation to uncover additional information and work with your facility to reach a resolution. It’s important to note that ombudsmen aren’t authorized to issue fines or pursue legal action, but can offer recommendations to residents or relevant government agencies about next steps.

Tips for Facilities Working With a State Ombudsman

Illinois isn’t the only state with ombudsman programs, so no matter what state you’re in, you might be searching for some advice about the process. Here are some tips to help navigate ombudsman complaints and investigations as the leader of a healthcare facility.

• Cooperate: Comply fully with the ombudsman’s requests for information or facility access as they carry out an investigation. They may ask to interview staff and residents or review documents like incident reports and medical records, so be forthright in sharing what they need.
• Respect: Maintain clear and respectful communication throughout the process. All parties in the process should have the best interest of residents in mind, so keep patient care at the forefront of your interactions to help the process go smoothly.
• Act: If the ombudsman identified areas of improvement, be sure to take appropriate action to address them. Be ready to work with the ombudsman to implement any necessary changes and submit any required plans of correction.

As a healthcare leader, your actions will influence how facility staff, patients, and other involved parties perceive the situation. Focus on the needs and wellbeing of your residents and welcome any constructive feedback about how to provide the best care possible. As you lead by example, you’ll help your organization navigate the situation with integrity and confidence.

Do You Have Other Questions for Your Facility?

We’ve helped explain how states are working to improve the quality of resident care using an ombudsman. Illinois is just one example demonstrating how the process can work. Did you know that we’re here to help answer your other pressing questions, too? Our IntelyCare newsletter is full of free nursing industry insights that can help you navigate the healthcare world and lead your facility or residence with purpose.