What Is The Long-Term Care Ombudsman Program?

(Provided by the National Long-Term Care Ombudsman Resource Center)

Q: Who does the Ombudsman program represent?

The Ombudsman program’s mandate is to represent the resident and assist at their direction. The Older Americans Act (OAA) requires the Ombudsman program to have resident consent before investigating a complaint or referring a complaint to another agency. In addition, when someone other than the resident files a complaint, the ombudsman must determine, to the extent possible, what the resident wants.

Q: What happens after I bring a concern to the Ombudsman program?

Suppose someone other than a resident contacts the Ombudsman program with a complaint. In that case, the ombudsman will visit the resident to see if the resident has similar concerns and wants to pursue the complaint. The ombudsman will explain the role of the program, the complaint investigation process, share information about residents’ rights, ask about the resident’s quality of life and care, and seek to understand the resident’s capacity to make decisions. As a result, many residents, even residents with dementia, can express their wishes.

If the resident wants the ombudsman to act on the problem, the ombudsman will investigate the complaint and continue communicating with the resident throughout the investigation process. If the resident cannot provide consent, the ombudsman will work with the resident representative or follow program policies and procedures if the resident does not have a representative.

Q: What types of complaints does the Ombudsman program investigate?

Ombudspersons handle a variety of complaints about the quality of life and care. Not all complaints are about the care provided by a facility, and some complaints are about outside agencies, services, or individuals (e.g., Medicaid or Medicare benefits). They can also receive and respond to complaints from individuals other than the resident (e.g., family member) but still need resident permission to investigate or share information.

Q: Do ombudspersons investigate complaints involving allegations of abuse, neglect, and exploitation?

Yes. The Ombudsman program investigates and resolves complaints that “relate to action, inaction or decisions that may adversely affect the health, safety, welfare, or rights of the residents,” and that includes complaints about abuse, neglect, and exploitation.

Ombudsmen are directed by resident goals for complaint resolution and limited by federal disclosure requirements. Therefore, the Ombudsman program’s role in investigating abuse allegations is unique and differs from other entities such as adult protective services and state licensing and certification agencies.

Ombudsman programs attempt to resolve complaints to the residents’ satisfaction (including those regarding abuse) and do not gather evidence to substantiate that abuse occurred or determine if a law or regulation was violated to enforce a penalty.

If necessary, with resident consent or permission of the State Ombudsman, if the resident can’t consent and does not have a legal representative, the ombudsman will disclose resident-identifying information to the appropriate agency or agencies for regulatory oversight; protective services; access to administrative, legal, or other remedies; or law enforcement action about the alleged abuse, neglect or exploitation.

Q: Is the Ombudsman program required to report allegations of abuse?

There are strict federal requirements regarding disclosure of Ombudsman program information. For example, resident-identifying information cannot be disclosed without resident consent, the consent of the resident representative, or court order. Therefore, these disclosure requirements prohibit Ombudsman programs from being mandatory reporters of suspected abuse.

Q: How do I find more information about the Ombudsman program and contact an ombudsman?

Visit the National Long-Term Care Ombudsman Resource Center (NORC) website (www.ltcombudsman.org) to learn more about the program. Locate an Ombudsman program by clicking “Visit Our Map.”