What Is a Healthcare Ombudsman? Pennsylvania Guide for Facilities

In 1972, Congress established a national Long-Term Care (LTC) Ombudsman Program to help protect the rights of older adults residing in long-term care settings. Under federal directives, each state has since created its own program in which complaints against long-term care facilities are resolved by a healthcare ombudsman. Pennsylvania in particular has implemented a diverse network of staff, volunteers, and even residents to help fill this role.

If you’re an LTC facility leader in Pennsylvania, you may be wondering how to prepare for interactions with a state ombudsman. We’ll provide an overview of what this program is, how it can be used, and what you should expect when working with an ombudsman.

What Is the Pennsylvania Ombudsman Program?

The primary goal of the Long-Term Care Ombudsman Program is to help resolve facility-related issues for residents in long-term care settings, such as assisted living facilities, nursing homes, and personal care homes. For state-based services delivered by an ombudsman, Pennsylvania’s Department of Aging provides all regulatory oversight.

There are three types of people who can be appointed to deliver various ombudsman services in Pennsylvania:

1. Official staff who are hired by the Department of Aging
2. State citizens who can volunteer to serve as ombudsmen
3. LTC residents who are trained to advocate for rights within their own LTC facilities

A unique aspect of Pennsylvania’s program is that it allows LTC residents to serve as ombudsmen in addition to other staff and volunteers. More formally known as Pennsylvania Empowered Expert Residents (PEERs), these individuals undergo a five-part training on how to educate and empower their fellow residents to improve day-to-day living conditions.

What Does an Ombudsman in Pennsylvania Do?

In more general terms, an ombudsman is someone who investigates and settles complaints made by individuals against organizations. Within the context of the LTC ombudsman program, this more specifically involves issues that residents have with their facilities. Other specific services provided by Pennsylvania’s program include:

• Peer-to-peer education to help enhance quality of life within LTC facilities
• Local, state, and national advocacy to improve laws affecting LTC residents
• Promotion of best care standards and regulations across all LTC settings
• General support and guidance regarding LTC regulations and care

Who Does an Ombudsman Work With?

A healthcare ombudsman in Pennsylvania will generally provide guidance to anyone who has concerns about the care or rights of LTC residents. This includes:

• Residents living in LTC facilities or receiving related services
• Families and friends of residents in LTC facilities
• Staff or leaders of LTC facilities
• Government agencies

What Types of Issues Does an Ombudsman Help Resolve?

Whether you’re a general citizen, resident, or staff member of a LTC facility, your state ombudsman can serve as a valuable resource for all of your LTC-related questions. Ombudsmen are trained to help resolve a diverse range of issues impacting older adults. Here are a few examples of why you may want to speak with an ombudsman:

• You’;re concerned about treatment of a resident from a LTC service provider.
• You have questions about billing charges under Medicare or Medicaid.
• You want to appeal a discharge or discontinuation in LTC services.
• You need help adhering to state regulations impacting your LTC facility.

If you’re seeking help from a health ombudsman, Pennsylvania provides all contact information on its program homepage. The Center for Advocacy for the Rights and Interest of Elders (CARIE) provides additional resources to help Philadelphia residents get in touch with the city’s ombudsman office.

Tips for Facilities Working With an Ombudsman

If someone has filed a complaint or issue about your LTC facility, you may be preparing to undergo an investigation. While this can feel like a stressful situation, keep in mind that ombudsmen are trained to provide impartial guidance for both you and your residents. This is an opportunity to work collaboratively with the ombudsman and improve the quality of your services. Follow these tips to ensure a smoother process:

• Communicate. Your ombudsman will need to collect as much information as possible to understand the incident at hand. Remain respectful and communicate openly to help your ombudsman resolve the situation as quickly and fairly as possible.

• Listen. It’s important to invite the voices of staff, residents, and any trained PEERs who are residing at your facility. While an issue may have been identified, it’s not too late to learn from the individuals who are essential to your operations.

• Take steps to improve. If your ombudsman suggests any changes to your care delivery, apply them accordingly to ensure that similar issues don’t occur again.

• Follow-up with your ombudsman. Remember that your ombudsman is available to help you beyond investigations. If you have any lingering questions or concerns about adhering to LTC regulations, follow-up with your ombudsman for additional guidance.

Discover More Ways to Improve Care for Your Residents

Want to enhance your operations beyond the benefits you can receive from the services of an ombudsman? Pennsylvania facility leaders can start here. Don’t miss out on IntelyCare’s free regulatory tips and guides designed to help you improve quality of care at your facility.