. \-  . )

Deparment of 
Health and Human 
Services 
' OFFICE 
INSPECTOR GENERAL 
EFFECTIVE OMBUDSMAN PROGRAMS

Six Case Studies

UlVJCE$. 
RiChard P. Kusserow 
INSPECTOR GENERAL 
JU 
'0 
1991 
lt"cliG  , .
OFFICE OF INSPECTOR GENERAL

The mission of the Offce of Inspetor Genera (DIG), as madate by Public Law 95-452, as 
amended, is to protect the integrty of the Deparent of Health and Huma Servces' (HS)
progrs as well as the health and welfare of beneficiares served by those progrs. This 
statutory mission is caredt ohut  thugh a nationwide network of audits, investigations, and 
inspections conducted by  DIG operating components: the Offce of Audit Services, the 
Offce of Investigations, and the Offce of Evaluation and Inspetions. The OIG also informs the 
progr 
Secreta of HHS of  and management problems, and reommends courses to corrct 
them. 
OFFICE OF AUDIT SERVICES 
The DIG' s Offce of Audit Servces  (OAS)  provides al auditig servces for llS, either by 
conducting audits with its own audit resoures or by overseeing audit work done by others. 
Audits examne the performance of HHS program and/or its grtes and contractors in 
carng 
out their respective responsibilties, and ar intende to provide independent 
assessments of HHS program and operations in ordr to reuce waste, abuse and 
mismanagement and to promote economy and effciency thughout the Deparent 
OFFICE OF INVESTIGATIONS 
The DIG' s Offce of Investigations (01) conducts crmial, civi adistrative 
, and 
investigations of allegations of wrngdoing in HHS progrs or to HHS beneficiares and of 
unjust enrchment by providers. The investigative effons of 01 lead to crminal 
convictions, 
admnistrative sanctions, or civil money  frud 
penalties. The 01 also overses State Medcaid 
contrl units which investigate and prosecute frud and patient abuse in the Medcaid program. 
OFFICE OF EVALUATION AND INSPECTIONS 
The DIG' s Offce of Evaluation and Inspetions (DEI) conducts shott-term management and 
progr 
evaluations (called inspections) that focus on issues of concern to the Deparent, 
the 
Congress, and the public. The fmdings and reommndations contaned in the inspections 
repons generate rapid, accurte, and up-to-dte information on the effciency, vulnerabilty, and 
effectiveness of deparenta programs. 
This repott was prepard under the diction of Thoma F. Tully, the Regional Inspector General 
for the Offce of Evaluation and Inspections, and Alan S. Meyer, Deputy Regional Inspector 
General, Offce of Evaluation and Inspections, Region II. Pancipating in this project were the 
following people:

Renee Schlesinger Project Leader  Headuarters
Alan S. Levine, 

Demetr Arapakos  Region IX 
Thomas Puris,

Nancy Harson 
Raul Marnek  Deparment of Health and Human Services

OFFICE 
INSPECTOR GENERAL

EFFECTIVE OMBUDSMAN PROGRAMS

Six Case Studies

~ SUlVJCE$' 
RiChard P. Kusserow 
INSPECTOR GENERAL 
+ OEI-
'0  02-90-02122 
~lt"dIa  EXECUTIVE SUMMARY

PURPOSE 
The purose of this repon is to present case studies of the six State Ombudsman program 
visited durg the "Successful Ombudsman Progrs" inspection (02-90-02120). 
BACKGROUND 
progr 
The State Long Term Car Ombudsman  was established under the Older Americans 
Act in response to growing concern over the poor quality of care in nuring homes. The Act 
requires each State Unit on Agig to establish and operate, either diectly or under contrct, an 
progr. 
ombudsman 
The ombudsman is to be an advocate of the  ensure that they have a 
institutionalize elderly to 
vigorous voice in their own treatment and care. Some ombudsman activities include 
elderly residents of long term care facilties 
investigatig and resolvig complaints on behalf of 
and providing information on long term car issues to residents, public agencies, legislaturs and 
progrs  sta 
the community-at-Iarge. Most ombudsman  have volunteers in addition to paid 
car 
who  out many of these functions. 
In October 1988, the Admnistration on Aging funded the formation of the National Center for 
State Long Term Car Ombudsman Resoures to provide trning, technical assistance and 
inormation exchange on long term care and ombudsmen issues to ombudsmen. 
Prior Study 
The case studies in this repon result from a recent DIG study, entitled "Successful Ombudsman 
Programs" (OEI-02-90-02120), which reponed the charcteristics of successful long term car 
ombudsman progrs. The study found these programs to be highly visible though the use of 
progr. 
both paid staf and an extensive volunteer  They visit facilties frequently, tyically 
weekly. Additionally, they handle complaints expeditiously, are highly publicized, obtan 
adequate funding, and effectively recruit, train and retain volunteers. The study also found that 
. ombudsmen want additional suppon: they would like the National Resource Center to get more 
involved in traiing, as well as become more active in circulatig information about best 
practices. These case studies are examples of the type of information ombudsmen would like 
disseminated. 
METHODOLOGY 
The six State ombudsman programs visited are: California, Massachusetts, Michigan, Ohio, the 
Distrct of Columbia and New Jersey. The team chose Calfornia, Massachusetts, Michigan and  Ohio because they received the most reommendations from other ombudsmen as having the 
literatu 
best overal programs and were fruently so cite by expens in the field and in the 
review. We selected the Distrct of Columbia and New Jersey, both also well regarded, primarly 
because of their unique featus: New Jersey s independence and strong enforcement focus and 
the Distrct of Columbia s contrcts for ombudsman services with the American Association of 
Retid Persons (AARP) and strong legal suppon. 
progr 
Durg the visits, the State ombudsman, sub-State  offcials, dictors of the State Units 
on Agig, advocacy grups and/or other expens in the field provided information on how the 
progrs ar strcturd, why they are effective and what makes them unique. 
CASE STUDIES 
California  progr is notable for its size, dedcation and trning of paid and volunter sta, 
strong enabling legislation, extensive publicity, and goo relationships with the provider 
community and the State Unit on Aging. 
The District of Columbia achieves success though fruent visitation, comprehensive enabling 
legislation, extensive legal suppon, and a strng volunteer component. 
Masachustts is effective because of its adequate fundig, excellent communication and 
coordiation, close relationship with the State Unit on Aging, goo enabling legislation, strong 
volunteer program, and extensive publicity. 
Michigan attbutes its success to an intense commtment to reform, advocacy, and quality of 
progr 
care, a supportve political envirnment, excellent communication and  cohesiveness, 
effective complaint resolution, comprehensive education of residents and their famlies, 
goo volunteer progr. 
innovative fund rasing, and a 
New Jersey s outstanding featurs include its independent admnistrative location, powerfl 
legislation, and adequate funding. The law enforcement, health care, and legal backgrounds of 
its sta are alsa noteworty. 
Ohio s effectiveness results from adequate fundig, comprehensive volunteer training, strong 
influence on State legislation, effective enabling legislation, and readily available legal support  ............ .......................... .................... .......
TABLE OF CONTENTS

EXECUTIVE SUMMARY 
INTRODUCTION..................................................................................................... .

CASE STUDIES.........................................................................................................

Calfornia .............................................................................................................

Distrct of Columbia.............................................................................................

Massachusetts....................................................................................................... 7

Michigan .................................. ...........................................................................

New Jersey...... .............. .......... .......... 

Ohio................................................................................................................... .
 INTRODUCTION

PURPOSE 
progrs 
The purose of this inspection is to present case studies of the six State Ombudsman 
visited onsite durng the "Successful Ombudsman Progrs" inspection (02-90-02120). 
BACKGROUND 
History 
The State Long Term Car Ombudsma program was established under the Older American 
Act (OAA) in response to growing concern over the poor quality of car in nuring homes. In 
car 
1972, the Admstration on Agig (AoA) awarded seven States contrcts to  out long term 
care ombudsman demonstration projects. In 1975, amendments to the OAA authorized AoA to 
requir 
make grants for al States to have ombudsma projects. Furer amendments in 1978 
each State Unit on Agig to establish and operate, either dictly or under contract, an 
progr.  progr 
Ombudsman  In 1981, the Ombudsman  was extended to board and care 
facilties. 
Pror to FY 1987 the OAA requird States to spend at least one percent of their supportve 
servces alotment under TItle III-B of the OAA or $20,00, whichever was grater, to suppon 
statewide ombudsman activities. Based on amendments in 1987 States must in the futue spend 
at least as much on the Ombudsman program as they did in FY 1987, as long as Federal 
alotments continue above FY 1987 levels. 
Role of the Ombudsman 
The ombudsman is an advocate for the institutionalized elderly to ensure that they have a 
vigorous voice in their own treatment and care. Some activities include investigating and 
resolving complaints on behalf of elderly residents of long term care facilties, informng 
residents of their legal rights and providing information on long term care issues to public 
agencies, legislatues and the community-at-Iarge. 
Most State ombudsman programs operate under the diect auspices of their State s Unit on Aging 
and have sub-State ombudsma programs. These ar either managed diectly by the State or are 
sponsore by a varety of organizations, including Ara Agencies on Aging, other sub-State 
governmental units, citizen advocacy comminees and private, non-profit organizations. 
progrs  car 
Most ombudsman  also have volunteers who  out a varety of functions, including 
makng frendly visits to facilities, resolving complaints and informing the comm\lnity about the 
progr.  Prior Study 
The case studies in ths repon result from a reent OIG  Successful Ombudsman 
study, entitled "
car 
Programs" (OEI-02-90-02120), which reponed the charcteristics of successful long term 
ombudsman progrs. The study found these programs to be highly visible: though the use of 
progr 
both paid sta and an extensive volunteer  they visit facilties frequently, typically 
weekly. Additionally, they handle complaints expedtiously, are highly publicize, obtain 
adequate funding, and effectively recrit, train and retan volunteers. The study also found that 
ombudsmen want additional suppon: they would like the National Resource Center to get more 
invloved in traiing, as well as become more active in cirulatig informtion about best 
ty  lie 
practices. These case studies are examples of the  of information ombudsmen would 
dissemiated. 
METHODOLOGY 
The six State ombudsman program visited are: California, Massachtushett s, Michigan, Ohio, the 
Distrct of Columbia and New Jersey. Their selection was based on  factors. First, the 52 
State ombudsmen interviewed durng the "Successful Ombudsman Progrs" inspection named 
other State program they believed to be the most successful. Second, other expens in the field, 
such as Congrssional stafers and representatives frm the National Resource Center cited 
progrs.  progrs 
outstanding  Finally, a literatue review identied ceron State  with unique 
or outstanding featues. 
The team chose to visit California, Massachusetts, Michigan and Ohio because they received the 
most votes from other ombudsmen for having the best overal programs. Also, expens in the 
field and the literatur review frequently cited these States as the most successful. The team 
selected the Distrct of Columbia and New Jersey, both also well regared, primaly because 
progr 
their unique features. The New Jersey  is one of the few located in an independent State 
agency and has a strong enforcement focus. The Distrct of Columbia contrcts out all its 
ombudsman services to the American Association of Retire Persons (AARP) and has unusually 
strong legal suppon. 
Durg the on site visits the State ombudsma, sub-State program offcials, dictors of the State 
Units on Aging, advocacy groups and/or other expens in the field provided information on how 
the six programs are strcturd, why they ar effective and what makes them unique. In al, the 
team conducted 28 interviews.  CASE STUDIES

CALIFORNI 
Key Features:

Size and dedication of paid and volunteer staff

Staff training

Strong enabling legislation

Extensive publicity

Good relationship with provider community 
Supportfrom the State Unit on Aging 
Program Strcture

progr 
At the State level, the Californa Ombudsman  is located within the California 
Deparent of Aging (CDA), an independent agency within the umbrella State Health and 
Welfare Agency. At the local level, the 34 substate ombudsman offces are contrcted out 
progrs 
though the Area Agencies on Agig (AAAs). Loal  are locate in a varety of public 
and private agencies; some ar freestanding and independent. 
progr 
The Californa Ombudsman  serves residents of skilled nursing facilties, intermediate 
care facilties and residential facilties for the elderly and developmentaly disabled. It oversees 
00  car 
about 1 300 skiled nursing facilities, with nearly 122, beds, and 10, 100 board and 
00 
facilties, with alost 139, beds. 
Outstanding Features 
With more than 110 paid staf and over 700 volunters, Caifornia has one of the largest 
progrs 
ombudsman  in the countr. The dedcation of its paid staf and volunteers is 
consistently highlighted. Accordig to the State ombudsman, "the ombudsman wil hang in 
there and persevere for the patient. This is what gets cases resolved. The program attracts high 
quality people." One ombudsman coordinator agrs: "the people in the program are the biggest 
success factor - they ar involved because they car." Sta thoughout California often put in 
60-80 hour weeks and go out on late night cals when necessar. 
trning is crucial. A madatory 36-hour trning progr prepars 
Staf and volunteer 
volunteers to visit facilties and deal with complaints. Some local programs offer this training at 
progrs, 
community colleges which offer credit for the course. At smaller rural  the 
ombudsman coordinator wil provide all the trning diectly. In addition to specialized trning 
for volunteers, the State ombudsman offers semi-annual trning and statewide conferences for 
managers and professional staff to keep updated on relevant issues.  progrs ar  restrctug 
A few local ombudsman  experimentaly  volunteer duties into varous 
levels to help prevent the overload and burout crated when volunteers ar expected to cover all 
areas. By doing so, program coordnators can alow volunteers to specialze in visits, conflct 
resolution, elder abuse cases, or community speakng; duties are now based on personal interests 
trning. 
and special 
Respondents repeatey cite strong enabling legislation as an imponat factor. The California 
Imunity Law protects ombudsmen from being sued for actions they take durng offcial duty, 
unless those actions ar grssly negligent. Additionally, California s "Willful Interference Law 
ta 
ensures access to facilties, the abilty to  to the patients and the right to review patient 
records. 
progr 
The Califforin ia Ombudsman  is also well known by the public. It has hired a public 
relations  to publicize its program. Prgram visibilty has ben enhanced thugh public 
service anouncements, commercials, posters, an 800 hotline and presentations to community 
progr 
groups and corporations. The  has recently produced two television commercials, one 
with California s fIrst lady and the other, in Spanish, with a well known actor. Finally, 
information on the progr must be poste in facilties and included in long term car adssion 
agreements. 
State policy in recent year has strssed the establishment of goo relationships with facility 
owners and managers, in contrast to the confrontational pattern which allegedy existed in the 
progr. 
early year of the  Providers  ombudsmen to help resolve problems and 
fruently ask 
disputes. Ombudsmen also offer training to providers on aging issues and community resources. 
progr. It 
Suppon from the State Unit on Aging (SUA) strngthens the California  provides the 
progr 
ombudsman  with admnistrtive assistance, legal representation and it suppons strong 
enabling legislation. The SUA has also forged close links with the licensing and enforcement 
Deparent of Social and Health Services. The ombudsman program also has goo 
staf in the 
workig relationships with severa other key State agencies such as adult protective services and 
licensur. 
Contact Person:	 Sterling Boyer 
Calfornia State Ombudsman 
160 K Strt

Sacramento, CA 95814 
(916) 323-6681  DISTRICT OF COLUMBIA 
Key Featres:

Frequent visitation 
Comprehensive enabling legislation 
Extensive legal support 
Strong volunteer component 
Program Strcture

The Distrct of Columbia s Long Term Care Ombudsman program was established in 1975 as 
trsferr 
pan of the Offce on Aging. In 1985 day-to-day responsibilty was  to the Legal 
Counsel for the Elderly (LCE), a legal suppon component of the American Association of
Reti 
Persons (AARP). This change enhances legal suppon servces and avoids a confct of 
the 
interest since the Distrct owns  tnhurs ing homes. Although the LCE is the designated 
ombudsman offce, it contracts with  local social service agencies to provide "local" 
ombudsman services thoughout the city. These agencies ar members of the senior service 
network of the Offce of Agig. 
The tota funding for the Distrct s program is $257,00, from a combination of Federa, Distrct 
and AARP funds. Additionally, AARP provides a significant amount of additional in-kind and 
other support 
The Distrct s ombudsman and the thee ombudsmen who head the local contract progrs ar 
00  car 
all lawyers. They represent approximately 5, residents in 287 licensed long term 
facilties. 
Outstanding Features 
Freuent visitation is a key featu of this progr. The thee local ombudsman projects have 
performce stadads in their contrcts requirng each nursing home with over 150 beds to be 
visited weekly, while smaler ones should be visited bi-weekly. Typically the visits ar even 
more frequent. 
The Distrct s enabling legislation is comprehensive. It allows the LCE to sue nursing homes or 
board and car facilities for violations of "residents rights" and brig lawsuits on behal of 
incompetent residents. It also includes a protective trsfer provision which 
gives residents the 
right to be notified and to have a hearng before being trsferred within a facility or to another 
institution. Recently, when about 100 residents of a nuring home were being trsferrd due 
an asbestos problem, the LCE theatened to sue over the way they were being trsferrd. The 
facilty subsequently entered into an agrement which ensurd that the residents ' rights under the 
trsfer law would be upheld.  ...
Distrct ombudsmen also have statutory authority to initiate receivership for facilties that are 
operating in a "sub-standad" manner. In 1989 the LCE was involved in thee receivership 
cases. It intervened on behalf of the residents of one nursing home where mentaly il, indigent 
and frai patients were denied their $55 monthly personal nees allowance. In addition, the 
ombudsman subpoena authority to access records without a patient 
Distrct law gives the 
consent. 
progr is operated by the LCE, it has imedate access to a staf of full-tie, 
As the Distrct 
par-tie and volunteer lawyers. Accordig to one official, there ar no political or bureaucratic 
progrs 
barers that other ombudsman  might face where legal advice and assistace must be 
crts 
obtained though another State agency, such as the Attorney Genera' s office. He  the 
extent of legal resources available for allowing the ombudsman to sue to get the Distrct to issue 
a nure s aide trning regulation and licensing regulations for nursing homes and board and car 
facilties. 
Volunteers ar recruited though the AARP which has 40,00 members in the Distrct One local 
offcial indicates that the Distrct ombudsma has ben very successful in "tapping into the 
AAR ban...AARP has had lots of experience managing volunteers... 
Volunters  word-of-mouth from other volunters. Accordig to 
ar also recrited by 
ombudsman offcial, volunters recrited this way tend to work out better because they ar more 
realstic about the job.

progr 
has about 60 volunteers, not including lawyers. Volunters visit facilities, 
The Distrct 
receive complaints and sample foo; they are not alowed, however, to conduct complait 
investigations. To retan them, LCE has an annual volunteer "recognition" ceremony. Also, 
each contractor holds monthly volunter meetings. 
A policy manual developed by LCE requirs that each sta member, includig volunteers, 
receive trning. The trning is conducted by the thee contrctors on an ongoing basis. A large 
trning session for any new large pool of volunteers, however, is conducted by the Distrct 
ombudsman. In a recent report the Distrct ombudsman noted that "  trning was provided 
50 ombudsman volunteers to enhance advocacy skills and suppon their activities in the nursing 
homes. "

Contact Person:	 Anne Har 
Distrct of Columbia State Ombudsman 
Legal Council for the Elderly 
1909 K Stret, 

Washington, DC 20049 
(202) 833-6720  MASSACHUSETTS 
Key Features:

Adequate funding

Excellent communication and coordination 
Close relationship with the State Unit on Aging 
Good enabling legislation 
Strong volunteer program 
Extensive publicity

Program Structure 
progr  progrs 
The Massachusetts  began in 1973 as one of the fIrst six pilot ombudsman 
the countr. It is responsible for the 732 long term care facility subject to licensure by the 
Deparent of Public Health, which includes nursing and rest homes. The Offce of the State 
Ombudsman repons to the Executive Offce of Elder Affais (MA State Unit on Agig), a 
cabinet-level agency that report dictly to the Governor. The program consists of 236 
volunteers and 94 paid staf members and has a budget of $1.8 millon, most of which comes 
il. 
from Title 
Outstanding Featres 
Respondents  adequate fundig as the mai reason for their progr 
fruently mention 
success. Compared to other States, their budget is enormous. Although they feel they could 
always use more money, they can aford to hir an adequate number of paid sta, thus giving the 
progr 
statewide coverage and a regular presence in facilties. 
Ombudsmen also cite excellent communication and coordination on all levels as contrbu  ng to 
success. Massachusetts has many mechanisms in place to assure that this occurs. For instance, 
the 27 local program dictors attend monthly meetigs to discuss their work, problems they 
have encountered, solutions and genera aging issues. They also share a procedurs manual 
which contans admnistrtive procedurs and outlines policies for staf supervision of 
volunteers. One respondent claims that this maual "keeps the group one cohesive team. 
progr 
Finally, the Offce of the State ombudsman contrbutes substantially to  coordnation 
progr 
through annual program assessments of how  diectors ar communicating with other 
agencies and how formal referrals are handled. These assessments also encourage yearly 
recruitment and training goals. Loal ombudsmen feel they can always call the Office of the 
Ombudsman for informtion, advice or emotional suppon. 
progr 
The close relationship and daily communication between the ombudsman  and the State 
Unit on Aging (SUA) suppon the program s success. The SUA considers the ombudsman 
program an integral pan of its operation and suppons the program s work in many ways. The 
SUA is commtted to increasing funding for the ombudsman progrm; works with it on public 
policy issues; and offers it technical assistance. Ombudsman staff feel that their advocacy work  is strngtened by the SUA. One respondent states, "I can t imagine another State agency that 
would provide us with the platform to do the advocacy we do. We have nothing to do with 
licensing and certfication agencies so we can tae a stad against other agencies. No one has 
told me to curl my advocacy effons." The ombudsman has access to policy and regulatory 
development meetings because the SUA is a cabinet level agency. As an example of the close 
progr 
relationship between the ombudsman  and SUA the ombudsma was instrmenta in 
gettig legislation passed that requird training for nurse s aides. 
Their enabling legislation has been a  to ombudsmen. It gives them imunity: if 
grat benefit 
ombudsman is actig in goo faith, he or she cannot be sued. By law, the ombudsmen have 
24-hour access to all facilties. While they have access to resident records without consent, this 
has never been practiced; ombudsmen feel it is appropriate to look at these records only with the 
agreement of the resident. 
progr. 
Massachusetts has develope an excellent volunteer  Recruitment is done at the State 
and local levels by paid sta, other volunteers and thugh AARP maiings. The application for 
volunteers clearly outlines program policies and the program s expectations of volunteers. After 
recritment, the new volunters attend a comprehensive five-day State certfication trning and 
each ar then assigned to a specifc facilty. Massachusett has been able to retan many 
sta 
volunteers for more than 10 year because they believe trating volunteers the same as paid 
and respecting their opinions is the key to retaning them. The paid ombudsman staf encourages 
volunteers to come up with solutions to complaints in facilties. 
progr 
The ombudsman  in Massachusetts is well publicized, using a combination of print, 
television, and radio media to reruit staf and educate residents and the community-at-Iarge. 
Program dictors conduct inservice traiing at local facilties and often speak about long term 
progr 
care issues at public gatherigs. The  also recruits well-known people, including the 
Governor, to do public service announcements. 
Mar 
Contact Person:	 Shelia 
Supervisor State Operations 
Affai 
Executive Office of Elder 
38 Chauncy Street 
Boston, MA 02111 
(617) 727-7750  MICHIGAN 
Key Featres:

Intense commitment to reform, advocacy, and quality of care 
Supportive political environment 
Excellent communication and program cohesiveness 
Effective complaint resolution 
Comprehensive education of residents and their families 
Innovative fund raising

Good volunteer program 
Program Structure 
The Michigan progr has a contrct with a Unite Way agency called Citins for Better Car 
(CBC) to provide the activities of the State Ombudsman Offce and 12 of the 14 local offces. 
The remaning two local offces work closely with the CBC. Michigan has a tota of 22 full time 
equivalents and 70 volunteers to cover 400 nuring homes and 4300 board and car homes. 
00 
These long term care facilties house a total of 85, beds. 
The budget for Fiscal Year 1990 was $805,00, a combination of Federa, State, local and United 
Way fuds. Because Unite Way money is included, the ombudsmen are empowere to serve al 
residents in long term care facilties, not just the elderly. 
Outstanding Features 
Respondents highlight the program s intense commtment to reform, advocacy and quality of 
care. This mission of the program is recognized on al levels, both inside and outside the agency. 
Although years ago CBC representatives were considered "mavericks  , tody they are accepted 
and trsted as authorities on aging issues. One respondent reflects this change when she says, 
Statewide there is no ombudsman you can t trst with a referral. Their bottom line is the client, 
and if that makes them unpopular, tough." Another agrees, "I haven t heard of a more proactive 
progr 
than Michigan. 
Ombudsmen feel that the supportve political envionment also contrbutes to the progr 
success. The ombudsman offce has a strng relationship with the State Unit on Aging (SUA), 
progr 
which has appointed a special liaison to faciltate communication with the  and provide 
technical assistance. Both sides agre that this open communication is essential. 
Cohesiveness is another major strength. Respondents feel there is a sense of famy, with one 
progr 
respondent describing the  as "twenty-two people actig as one." Another says there is a 
shared mission." This cohesiveness is a result of excellent communication 
spirt of trst and 
and a shared philosophy of empowering the client. Ombudsmen are very focused in their  purose: they serve the client as best as they possibly can. The client is consulted before any 
action is taen on a complaint and has the final word on how his or her case should proceed. 
The State and local progrs maitan excellent communication though newsletters, weekly 
shar 
mailings and constat contact. Information is  systematically and everyone is included. 
This networking expands beyond the State: the Michigan State Ombudsman is very wiling to 
share her expertse with other States: she plans to host a newly appointed ombudsman from 
progr 
another State in her home for a week so she can explain how Michigan  operates. 
progr 
The Michigan  has been effective in complaint resolution: its percentage of complaints 
resolved is relatively high (close to 80 percent). The program also enjoys a high level of client 
satisfaction. As soon as a complaint comes into the offce, the ombudsman is very responsive 
and begis planning a coure of action with the client 
The comprehensive education of residents and their famlies is another strengt. Ombudsmen 
call this "famy suppon." They speak to residents and their famlies in understandable terms 
about long term care issues to help them become sophisticated users of information needed to 
make lie decisions. The CBC also sponsors workshops and conferences concerning such topics 
as health car issues, restrnts, fmancing and Medcaid estate planning. The CBC also works 
closely with resident councils and hospital discharge planners. 
The CBC feels that it exhibits best practices in fund rasing by packaging its gratest strength: its 
knowledge about agig issues. As a United Way agency, CBC can charge hospitas, nursing 
homes, and other organizations for inservice traiing, mileage, and materials such as brochures. 
The CBC has an assistat secretar diector as a full-time fund raiser who raises money though 
rae 
the sale of  tickets, sponsors "Bowling Bowls  , and receives donations from diect mailings 
to foundations and CBC members. 
Michigan s volunteers also contrbute heavily to the progr s effectiveness. Ombudsmen 
recruit by defining the job as diffcult from the begining. They promise the volunteers staf 
suppon, supervision, and backup and supply a comprehensive reference manual and goo
tring 
materials. Michigan retains its volunteers by recognition in award ceremonies, 
conferences, holiday pares, and a monthly newsletter just for volunteers. 
Contact Person:	 Holls Turnham 
Michigan State Ombudsman 
Citizens for Better Care 
1627 East Kalamazoo 
Lansing, MI 48912-2701 
(517) 482-1297  NEW JERSEY 
Key Featres:

Independent adinistrative location

Powerfl legislation 
Adequate funding

Law enforcement, health care, and legal background of staff 
Program Strcture

progr 
The New Jersey  is one of the few located in an independent State agency, the Offce of 
the Ombudsman for the Institutionalize Elderly (DIE) and has a strong enforcement focus. It is 
entily State funded, with a fluctuating annual budget of approximately $1.1 millon. 
Most of OlE' s 26 paid full-time sta members ar professionals trained in the aras of law 
all located in the State offce in Trenton. The offce is comprised of 
enforcement and health car, 
a Public Affai Unit, a Legal Deparent, an Investigations Deparent and an Admistrative 
components work together to fulfill the progr s responsibilties of receiving, 
Unit. These 
investigatig, and resolving complaints on behal of all institutionalize long term car patients, 
relatig 
residents, and clients aged 60 or over. They also monitor the activities of State agencies 
car 
to the institutionalze care of the elderly. New Jersey has approximately 700 long term 
facilties, consistig of about 40,00 beds. These facilties include nursing homes, homes for the 
aged, residential health care facilities, rehabiltation hospitas, State veteras homes, class " 
boardig homes, State and county psychiatrc hospitals, and regional developmenta centers. 
Outstanding Featres 
New Jersey  progr is uncommon in many ways. The OlE' s independent admistrative 
location, powerfl legislation, funding and strong enforcement philosophy have set it apan from 
the traditional model of an ombudsman program. 
Although located in New Jersey  Deparent of Community Affai for logistical puroses, DIE 
is independent by statute and exempt from contrl or supervision by any executive depanment of 
State government. The Governor appoints the Office of Ombudsman s chief executive and the 
DIE report dictly to the Governor and Legislatur. Representatives from the ombudsman 
offce feel their autonomy allows them to act quickly and effectively. In fact, the offce usually 
responds within 24 hours of receiving a complaint and even within minutes in some abuse cases. 
Many consider this a key to New Jersey s success. The DIE benefits from its location in other 
ways: it mantans a high profie and a cenan amount of clout because of its close association 
with the Governor and State Legislature. 
New Jersey s strong enabling legislation gives the ombudsman broad powers. The ombudsman 
has 24-hour access to any facilty without prior notice. If he or she is denied access, the facilty 
is stifly fined. Also, the ombudsman has the abilty to grant confidentiality and immunity to all  complaiants and to issue subpoenas for documents or for individuals to testify on matters 
progr 
that relies so heavily 
regarding a complaint, both of which are considered essential to a 
on investigation. 
The DIE enjoys the benefit of relatively adequate fundig and stamg. With a curent annual 
budget of $1.1 millon, DIE is one of the best funded progrs in the countr. Yet, New Jersey 
does not use any federa funds: it relies only on State money. Since New Jersey has no local 
progrs,  offce. 
all funds are expended at the State level in the Trenton 
The DIE hires professionals with law enforcement, health care, or legal backgrounds because 
The DIE has performed "nighttme 
New Jersey, more than any other State, strsses enforcement. 
raids" with video cameras as pan of its enforcement activities. In-house attorneys and a State 
progr 
ombudsman with a law degree are  strengths. The legal deparent is consulted 
regarg serious complaints, such as abuse, and those complaints with legal ramcations. The 
deparent also monitors judicial decisions, statutes, rules and regulations which involve the 
long term car industr, and works with the State Legislatur to crate new laws. 
Contact Person:	 Harold George 
New Jersey State Ombudsman 
28 West State Street 
Room 305 CN 808 
Trenton, NJ 08625-0807 
(60) 984-1811  OHIO 
Key Features:

Adequate funding

Comprehensive volunteer training

Strong influence on State legislation

Effective enabling legislation 
Available legal support 
Program Structure 
The Offce of the Long Tenn Car Ombudsman in Ohio is housed within the Ohio State Unit on 
ditly  tur 
Aging (SUA). The State ombudsman report  to the Dirctor of the SUA, who in 
a cabinet-level offcer reportng diectly to the Governor s offce. There are 12 local 
ombudsman programs in Ohio: 7 are under the auspices of the Area Agency on Aging, while the 
remaning 5 are contracted out by the Area Agency on Aging. 
progr 
The ombudsman  has legislative authority over nursing homes and home health care, 
and wil soon be responsible for board and car homes. Ohio has 1 100 licensed nursing homes 
with 93,00 beds and 70 licensed board and car homes with 60 beds. New legislation soon to 
become effective wil give the ombudsman authority to inspect and visit board and car homes in 
the same way as it curntly does nursing homes. As of now, visits to board and care homes are 
limited to investigating complaits or at the invitation of the home owner. The ombudsman 
progr is also involved in home health car though the investigation of complaints of any 
community-based long term care service. 
The Ohio program has an annual budget of $1.8 millon from Federa, State and private sources, 
which allows for 50 full-time professional sta and over 200 volunteers at the local level. 
Outstanding Featres 
this funding Ohio 
Respondents cite adequate funding as one significant attbute. To enhance 
progr 
imposes a the-dollar bed tax on facilities that goes to the ombudsman  and allows for a 
large well trned sta and volunteer group. 
trning 
set down in legislation, employ a tier approach, with 
Volunteer traiing guidelines, 
hours linked to areas of responsibilty and continuing education requirements. For example, 10 
hours of initial training and 6 hours of additional training per year ar needed for a volunteer to 
perform outrach; 100 hours of initial training ar needed for a volunteer to handle complex 
complaits and requir 12 hours of additional trining each year. These levels of trning build a 
career ladder for the volunteers so that they wil be more inclined to stay in the program. 
progr 
The Ohio  is pancularly effective because of the influential role the ombudsman plays 
in formulating State legislation on long tenn care issues. The ombudsman panicipates in making  policy on may interagency issues, such as the reuiment for intermedate sanctions under the 
Omibus Budget Reconcilation Act. People involved in State long term care issues feel that 
regulations on residents 
with the ombudsman s pancipation in the policy proess, the impact of 
the ombudsma a tremendous resoure in formulating policy 
wil be considered. They consider 
The ombudsman 
and view their relationship with the ombudsman as a cooperative interaction. 
can also help anculate what nees to happen to State policy tpor porogterc t patient s sneteasg a nd rights. 
Funer, beause of the ombudsma s effort in this ara, the  is seen as 
develop its own agenda, above and beyond its role as an advocate for the elderly. 
Ohio benefits frm recently amended enabling legislation. It provides for a detaed trning 
progr for sta and volunteers; protects the program by providig imunity beyond the 
for injunctive relief to protect resident's 
provisions in the OAA; gives the ombudsma the right 
Ombudsmen 
rights; insurs access to records; and clearly delineates the authority of the offce. 
futur. 
are satisfied with the legislation and do not anticipate revisions in the foreseeable 
progr 
Additional strngths of the Ohio  include: strng legal representation from the Attorney 
s sta; 
General' s Offce and private legal services; the presence of attorneys on the ombudsman 
progr 
and excellent support frm, and access to, the SUA. The SUA advocates for the  at the 
State level, dissemiates information about the program and provides admnistrtive suppon. 
progr, 
community 
. Other reasons for success cited include the relative independence of the 
suppon for the program, and a perception amongst nursing home providers and residents of the 
progr 
s past effectiveness in resolving complaints, which makes them more likely to respond 
to the ombudsma s actions. 
Contact Person:  Roland Hornbostel 
Ohio State Ombudsman 
Agig 
Dept. of 
50 West Broad Strt, 8th Floor 
Columbus, OH 43266-0501 
(614) 466-9927