What Is a Healthcare Ombudsman? Texas Guide for Facilities

In response to the mistreatment of residents in long-term care and nursing home facilities, Congress established a national Long-Term Care (LTC) Ombudsman Program in 1972. This program aimed to protect the rights of older adults in various care settings — particularly in nursing homes and skilled nursing facilities.

After the establishment of this federal initiative, many states have since created their own programs whereby health service issues are resolved through the help of an ombudsman. Texas has implemented an expansive program to not only protect the rights of LTC residents, but also address a variety of other health-related complaints from state citizens.

If you’re a facility leader preparing for interactions with a Texas ombudsman, you may be wondering what to expect. The following overview describes what the Texas ombudsman program is, who it’s for, and how it relates to your facility.

What Is the Texas Ombudsman Program?

While healthcare ombudsmen are most commonly associated with long-term care, Texas has broadened their program to cover several different health and social service areas. The Texas Health and Human Services (HHS) department oversees the state’s Office of the Ombudsman, which houses nine different branches, each responsible for resolving a dedicated category of complaints. These ombudsman branches include:

• Medicaid Managed Office
• Behavioral Health Services
• Long-Term Care
• Foster Care
• Intellectual and Developmental Disabilities
• Health, Development, and Independence Services
• State Supported Living Centers
• Suspected Abuse of Older Person or Person with Disability
• Department of Family and Protective Services

What Does an Ombudsman in Texas Do?

An ombudsman is more generally defined as someone who serves as an impartial party to investigate and resolve complaints made by individuals against organizations. In healthcare, this typically involves the concerns that patients, residents, families, or staff have about the way facilities are delivering care.

However, there are many other roles of an ombudsman. Texas in particular has a fairly comprehensive program. While each branch within the HHS department oversees different services, ombudsmen are generally trained to:

• Educate individuals, patients, or residents about their rights.
• Empower individuals receiving services to discuss concerns with facility staff.
• Identify and fix gaps in state health or social services.
• Provide information and help individuals find specific services.
• Receive, investigate, and address complaints against healthcare centers or facilities.
• Help healthcare/service workers with any regulatory questions and concerns.

Who Can Seek Help From a Healthcare Ombudsman?

Any individuals residing in Texas who have concerns about their own rights or the rights of other patients/citizens can contact the ombudsman office for guidance. Each ombudsman branch provides its own set of expertise based on its designated services. Examples of people who may want to contact an ombudsman include:

• Individuals currently or previously receiving any care services overseen by the office.
• Individuals or families seeking out specific care centers or services.
• Healthcare leaders or staff concerned about regulatory care compliance at their facility.
• Individuals concerned about suspected abuse or mistreatment of themselves or others.

The full list of contacts for each branch can be found on the HHS Office of the Ombudsman website. When seeking guidance from a Texas ombudsman, complaints or questions can be submitted directly to the branch that oversees the particular service of concern.

For example, family members concerned that a loved one is being neglected at a nursing home would contact the Long-Term Care Ombudsman. Alternatively, an individual who needs help finding a mental health counselor would contact the Behavioral Health Ombudsman

Tips for Facilities Undergoing Investigations

If your facility has been reported to an ombudsman office, it can understandably be a stressful experience to undergo an investigation into your operations. But remember, an ombudsman is trained to provide an objective solution for both you and your patients/residents. They also serve as a valuable resource that can help you improve the way you deliver care.

But, what exactly should you do when undergoing an investigation by an ombudsman? Texas facilities can follow these tips to make the process as smooth as possible:

• Be transparent about the situation. The ombudsman will be asking you to provide information that will help them resolve complaints. Giving them all the information they need as openly as possible will ensure things are resolved as fairly as possible.

• Invite the voices of staff members. Check in with any staff who were involved with the filed complaint and invite them to share information. This will ensure that both you and the ombudsman have a comprehensive idea of how to resolve the issue at hand.

• Implement necessary changes. If the ombudsman identifies an apparent issue at your facility, seize this as an opportunity to improve the quality of your services. Listen to any advice your ombudsman has about your operations and implement changes accordingly.

Stay Up-To-Date With Regulatory Compliance

Seeking guidance beyond the services provided by a healthcare ombudsman? Texas facilities can start here. Don’t miss out on IntelyCare’s other free regulatory resources and guides that can help keep you updated with the latest policies impacting your facility.