Long-Term Care Ombudsman Program (OAA, Title VII, Chapter 2, Sections 711/712)
The Purpose of the Program and How It Works
Long-Term Care Ombudsmen are advocates for residents of nursing homes, board and care homes, assisted living facilities and similar adult care facilities. They work to resolve problems of individual residents and to bring about changes at the local, state and national levels that will improve residents’ care and quality of life.
Begun in 1972 as a demonstration program, the Ombudsman Program today exists in all states, the District of Columbia, Puerto Rico and Guam, under the authorization of the Older Americans Act. Each state has an Office of the State Long-Term Care Ombudsman, headed by a full-time state ombudsman. Thousands of local ombudsman staff and volunteers work in hundreds of communities throughout the country as part of the statewide ombudsman programs, assisting residents and their families and providing a voice for those unable to speak for themselves.
The statewide programs are federally funded under Titles III and VII of the Act and other federal, state and local sources. The AoA-funded National Long-Term Care Ombudsman Resource Center, operated by the National Consumers’ Voice for Quality Long-Term Care (or, Consumer Voice), in conjunction with the National Association of States Agencies on Aging United for Aging and Disabilities (NASUAD), provides training and technical assistance to state and local ombudsmen.
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Data Highlight Extensive Services Provided to Persons Living in Long-Term Care Facilities
Program data for FY 2011 indicate that long-term care ombudsman services to residents were provided by 1,186 full-time equivalent staff and 9065 volunteers, trained and certified to investigate and resolve complaints. These volunteers and paid ombudsmen:
- Worked to resolve 204,044 complaints, opening 134,775 new cases (a case contains one or more complaints originating from the same person(s)).
- Resolved or partially resolved 73% of all complaints to the satisfaction of the resident or complainant.
- Provided 289,668 consultations to individuals
- Visited 70% of all nursing homes and 33% of all board and care, assisted living and similar homes at least quarterly.
- Conducted 5,144 training sessions in facilities on such topics as residents” rights.
- Provided 114,033 consultations to long-term care facility managers and staff and participated in 20,958 resident council and 3,321 family council meetings.
The five most frequent nursing facility complaints in 2011 were:
- Improper eviction or inadequate discharge planning;
- Lack of respect for residents, poor staff attitudes;
- Medications—administration, organization; and
- Resident conflict, including roommate to roommate.
The five most frequent board and care and similar facilities complaints were:
- Quality, quantity, variation and choice of food;
- Medications—administration, organization;
- Inadequate or no discharge/eviction notice or planning;
- Equipment or building hazards; and
- Lack of respect for residents, poor staff attitudes.
For more information on ombudsman activities and the types of cases/complaints that they investigated, see 2011 National Ombudsman Reporting System (NORS) data.
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Webinar: Medicaid Administrative Claiming and Long-Term Care Ombudsman Programs
On June 18, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a clarification of its policy regarding Medicaid administrative claiming by State Medicaid Agencies related to the services of States” Long-Term Care Ombudsman Program. Its informational Bulletin states: “Medicaid funding may be available for certain administrative costs related to activities performed by state Long-Term Care Ombudsman (LTCO) Programs that benefit the state”s Medicaid program.”
CMS described this guidance during an ACL-sponsored webinar on July 9, 2013.
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Resource Update for State Long-Term Care Ombudsmen: Fact Sheet and Guidance for Minimum Data Set (MDS) 3.0 and Opportunities for Coordination Related to Section Q Implementation
On November 3, 2010 Assistant Secretary on Aging Kathy Greenlee and Cindy Mann, Director, Center for Medicaid, CHIP and Survey & Certification released a joint-letter informing State Medicaid Agencies (SMA) and other stakeholders, particularly Money Follows the Person Grantees, about opportunities for collaboration and coordination with State Long-Term Care Ombudsman Programs for the implementation of the SNF/NF MDS 3.0 assessment tool. The MDS is administered to all individuals in SNF/NFs nationwide that receive Medicaid and/or Medicare funding. In an effort to support individuals living in SNFs/NFs who wish to learn about available home and community based services (HCBS) options and available long-term care (LTC) supports in the community, the Centers for Medicare & Medicaid Services (CMS) has revised the Minimum Data Set (MDS) version 3.0 Section Q. The MDS 3.0 instructs facilities to contact Local Contact Agencies to provide information and options counseling to residents. In addition, AoA and CMS are encouraging States to coordinate with State Long-Term Care Ombudsman Programs and to consider requesting the use of MFP funds to support the increased demands for Long-Term Care Ombudsman Program services anticipated as a result of MDS 3.0 Section Q implementation. As an additional resource, AoA-funded National Long-Term Care Ombudsman Resource Center has developed a Fact Sheet on MDS 3.0 Section Q.
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Older Americans Act Title VII Chapter 2 (Ombudsman Program) congressional appropriations in recent years were as follows:
Total program expenditures from all sources, including Older Americans Act Title III, Title VII and other federal, state and local sources, in recent years were as follows:
Sources and amounts of funds the states expended from each source are provided in 2010 funding data – Table A-9.
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Resources and Useful Links
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For More Information
Questions relating to the Long Term Care Ombudsman Program should be directed to Becky Kurtz.