According to the latest CDC statistics, there are nearly 2.1 million Americans living in our nation’s 46,200 long-term care facilities. This includes 30,600 assisted living communities with nearly 820,000 residents, and 15,600 skilled nursing facilities (also called nursing homes) with around 1.3 million residents. In many cases, these are some of the most vulnerable members of our society, which is why long-term care ombudsman programs are critical to ensuring residents’ care needs and wellbeing are protected.

An overview of long-term care ombudsman programs

The Older Americans Act (OAA), which became law in 1965 as part of President Johnson’s “Great Society” initiative, was designed to support older people’s ability to live at home and in the broader community. One of the law’s primary objectives was to create home- and community-based support programs allowing older people to maintain their independence for as long as possible and ensure their dignity throughout their later years.

The long-term care ombudsman program (LTCOP), first formed in 1972, was one of the OAA’s key initiatives. The OAA required that every state (as well as the District of Columbia, Puerto Rico, and Guam) have a full-time ombudsman to direct the program statewide, as well as staff and volunteers who help advocate for long-term care (LTC) residents.

Today, the ombudsman program, which is administered by the Administration on Aging (AoA)/Administration for Community Living (ACL), includes 53 state ombudsmen, over 1,400 full-time staff members, and more than 4,200 volunteers, who are specially trained to investigate and resolve complaints about long-term care facilities. You can find more information on your state’s long-term care ombudsman program here.

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What ombudsman programs do and don’t do

As a part of the OAA, the long-term care ombudsman program is charged with a variety of tasks, all designed to advocate for long-term care (LTC) residents and encourage improvements within the LTC industry. For instance, a state’s ombudsman office is responsible for:

  • Identifying, investigating, and resolving complaints made by or on behalf of LTC residents, which might be related to issues like:
    • Violations of residents’ rights or dignity
    • Physical, verbal, or mental abuse, deprivation of services necessary to maintain residents’ physical and mental health, or unreasonable confinement
    • Poor quality of care, including inadequate personal hygiene and slow response to requests for assistance
    • Improper transfer or discharge of patients
    • Inappropriate use of chemical or physical restraints
    • Any resident concern about quality of care or quality of life
  • Providing information to LTC residents about support services
  • Ensuring that LTC residents have regular and timely access to ombudsman services, if needed
  • Representing the interests of LTC residents before governmental agencies
  • Seeking administrative, legal, and other remedies to protect residents
  • Analyzing and recommending changes in laws and regulations pertaining to the health, safety, welfare, and rights of LTC residents

In short, a state’s LTC ombudsman program gives a voice to LTC residents. Ombudsmen address long-term care facility complaints and grievances related to a resident’s quality of care or quality of life. They also serve as advocates for improvements in the overall LTC system, which includes nursing homes, board and care homes, and assisted living facilities.

In addition, ombudsman program representatives provide valuable information to prospective residents and their loved ones about how to find a facility to meet their needs and what to do to get quality care.

It is also important to know what services a state’s LTC ombudsman program does not provide. For instance, LTC ombudsmen do not conduct licensing, nor do they perform regulatory inspections or investigations, including for adult protective services (ADS). They also do not offer any type of direct care for long-term care residents.

View a helpful FAQ (PDF) created by the National Consumer Voice for Quality Long-Term Care explaining what the ombudsman program does and does not do.

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A look at program usage

According to the National Ombudsman Resource Center (NORC), in 2021 (the most recent year for which statistics are currently available), the nation’s LTC ombudsman programs provided information and assistance to more than 377,660 people. These might be LTC prospective or current residents, or their loved ones. Ombudsmen and their staff also conducted over 151,000 site visits to more than 35,000 long-term care facilities.

The most frequent complaints about nursing homes handled by ombudsman program representatives in 2021 were regarding:

  1. Discharges or evictions
  2. Responses to requests for assistance
  3. Physical abuse

For assisted living and other residential care communities, the most frequent complaints ombudsmen addressed in 2021 were around:

  1. Discharges or evictions
  2. Medications
  3. Housekeeping, laundry, and pest abatement

The nation’s ombudsmen also provide support to LTC facility managers and staff, when needed, in an effort to create improvements across the system. For instance, in 2021, they offered information and assistance to 247,161 LTC employees and led 1,434 training sessions designed for LTC staff.

>> Related: Evaluating Care, Quality, and Access at a CCRC’s Healthcare Center

A resource for current, prospective LTC residents and loved ones

The majority of long-term care communities are well-run, with complaints being fairly rare and promptly addressed should they arise. But it is important for LTC residents and their loved ones to know that there is support available to them should an issue come to light that the facility is unable or unwilling to resolve.

When someone contacts their state’s ombudsman program with a complaint, the ombudsman or their staff will visit the resident in person to discuss their (or their loved one’s) concerns and determine if the resident wants to pursue the complaint. The ombudsman will explain the role of the program, the investigation process, and the resident’s rights, and will ask about the resident’s quality of life and care.

If the resident wants the ombudsman to act on the complaint, the ombudsman will investigate and stay in touch with the resident throughout the investigation process. If the resident is unable to provide consent — because of either cognitive or physical hindrances — the ombudsman will work with the resident’s representative or follow program policies and procedures if the resident does not have a representative.

For those who are considering a particular LTC facility for themselves or a loved one, the long-term care ombudsman program for their state also can be a valuable source of information. Find the ombudsman program in your area and inquire about any regulatory violations or complaints that have been lodged against the senior living communities you are considering.

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