. \

. )

Deparment of Health and Human Services 

' OFFICE 

INSPECTOR GENERAL 

EFFECTIVE OMBUDSMAN PROGRAMS


Six Case Studies


UlVJCE$. 

'0 

lt"cliG 

RiChard P. Kusserow 

INSPECTOR GENERAL 

JU 1991 
, .

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 cared out thugh a nationwide network of audits, investigations, and 

inspections conducted by th DIG operating components: the Offce of Audit Services, the 

Offce of Investigations, and the Offce of Evaluation and Inspetions. The OIG also informs the 

Secreta of HHS of progr 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, and adistrative 

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 penalties. The 01 also overses State Medcaid frud 

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 Alan S. Levine, 
 Headuarters

Demetr Arapakos Thomas Puris,
 Region IX 

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 

'0 + OEI-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 

The State Long Term Car Ombudsman progr 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 

ombudsman progr. 

The ombudsman is to be an advocate of the institutionalize elderly to ensure that they have a 

vigorous voice in their own treatment and care. Some ombudsman activities include 

investigatig and resolvig complaints on behalf of elderly residents of long term care facilties 

and providing information on long term car issues to residents, public agencies, legislaturs and 

the community-at-Iarge. Most ombudsman progrs have volunteers in addition to paid sta 

who car 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 

both paid staf and an extensive volunteer progr. 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 

best overal programs and were fruently so cite by expens in the field and in the literatu 

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. 

Durg the visits, the State ombudsman, sub-State progr 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 

care, a supportve political envirnment, excellent communication and progr cohesiveness, 

effective complaint resolution, comprehensive education of residents and their famlies, 

innovative fund rasing, and a goo volunteer progr. 

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 

The purose of this inspection is to present case studies of the six State Ombudsman progrs 

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 

1972, the Admstration on Agig (AoA) awarded seven States contrcts to car out long term 

care ombudsman demonstration projects. In 1975, amendments to the OAA authorized AoA to 

make grants for al States to have ombudsma projects. Furer amendments in 1978 requir 

each State Unit on Agig to establish and operate, either dictly or under contract, an 

Ombudsman progr. In 1981 , the Ombudsman progr 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. 

Most ombudsman progrs also have volunteers who car 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 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 

both paid sta and an extensive volunteer progr 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 

practices. These case studies are examples of the ty of information ombudsmen would lie 

dissemiated. 

METHODOLOGY 

The six State ombudsman program visited are: California, Massachusetts, Michigan, Ohio, the 

Distrct of Columbia and New Jersey. Their selection was based on th 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 

outstanding progrs. Finally, a literatue review identied ceron State progrs 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 

their unique features. The New Jersey progr 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


At the State level, the Californa Ombudsman progr 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 

though the Area Agencies on Agig (AAAs). Loal progrs are locate in a varety of public 

and private agencies; some ar freestanding and independent. 

The Californa Ombudsman progr serves residents of skilled nursing facilties, intermediate 

care facilties and residential facilties for the elderly and developmentaly disabled. It oversees 

about 1 300 skiled nursing facilities, with nearly 122,00 beds, and 10, 100 board and car 

facilties, with alost 139,00 beds. 

Outstanding Features 

With more than 110 paid staf and over 700 volunters, Caifornia has one of the largest 

ombudsman progrs 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. 

Staf and volunteer trning is crucial. A madatory 36-hour trning progr prepars 

volunteers to visit facilties and deal with complaints. Some local programs offer this training at 

community colleges which offer credit for the course. At smaller rural progrs, 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. 
A few local ombudsman progrs ar experimentaly restrctug 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 

and special trning. 

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 

ensures access to facilties, the abilty to ta to the patients and the right to review patient 

records. 

The California Ombudsman progr is also well known by the public. It has hired a public 

relations fi to publicize its program. Prgram visibilty has ben enhanced thugh public 

service anouncements, commercials, posters, an 800 hotline and presentations to community 

groups and corporations. The progr 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 

early year of the progr. Providers fruently ask ombudsmen to help resolve problems and 

disputes. Ombudsmen also offer training to providers on aging issues and community resources. 

Suppon from the State Unit on Aging (SUA) strngthens the California progr. It provides the 

ombudsman progr with admnistrtive assistance, legal representation and it suppons strong 

enabling legislation. The SUA has also forged close links with the licensing and enforcement 

staf in the Deparent of Social and Health Services. The ombudsman program also has goo 

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 

pan of the Offce on Aging. In 1985 day-to-day responsibilty was trsferr 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 

interest since the Distrct owns the nursing homes. Although the LCE is the designated 

ombudsman offce, it contracts with th 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 

all lawyers. They represent approximately 5,00 residents in 287 licensed long term car 

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 

Distrct law gives the ombudsman subpoena authority to access records without a patient 

consent. 

As the Distrct progr is operated by the LCE, it has imedate access to a staf of full-tie, 

par-tie and volunteer lawyers. Accordig to one official, there ar no political or bureaucratic 

barers that other ombudsman progrs might face where legal advice and assistace must be 

obtained though another State agency, such as the Attorney Genera' s office. He crts 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 ar also recrited by word-of-mouth from other volunters. Accordig to 

ombudsman offcial, volunters recrited this way tend to work out better because they ar more 

realstic about the job.


The Distrct progr has about 60 volunteers, not including lawyers. Volunters visit facilities, 

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 

The Massachusetts progr began in 1973 as one of the fIrst six pilot ombudsman progrs 

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 

from Title il. 

Outstanding Featres 

Respondents fruently mention adequate fundig as the mai reason for their progr 

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. 

Finally, the Offce of the State ombudsman contrbutes substantially to progr coordnation 

through annual program assessments of how progr 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. 

The close relationship and daily communication between the ombudsman progr 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 

relationship between the ombudsman progr and SUA the ombudsma was instrmenta in 

gettig legislation passed that requird training for nurse s aides. 

Their enabling legislation has been a grat benefit to ombudsmen. It gives them imunity: if 

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. 

Massachusetts has develope an excellent volunteer progr. 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 

volunteers for more than 10 year because they believe trating volunteers the same as paid sta 

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. 

The ombudsman progr 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 

care issues at public gatherigs. The progr also recruits well-known people, including the 

Governor, to do public service announcements. 

Contact Person:	 Shelia Mar 

Supervisor State Operations 

Executive Office of Elder Affai 

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. 

These long term care facilties house a total of 85,00 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), 

which has appointed a special liaison to faciltate communication with the progr 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 

respondent describing the progr as "twenty-two people actig as one." Another says there is a 

spirt of trst and shared mission." This cohesiveness is a result of excellent communication 

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 

mailings and constat contact. Information is shar 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 

another State in her home for a week so she can explain how Michigan progr operates. 

The Michigan progr 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 

the sale of rae 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


The New Jersey progr 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 

enforcement and health car, all located in the State offce in Trenton. The offce is comprised of 

a Public Affai Unit, a Legal Deparent, an Investigations Deparent and an Admistrative 

Unit. These components work together to fulfill the progr s responsibilties of receiving, 

investigatig, and resolving complaints on behal of all institutionalize long term car patients, 

residents, and clients aged 60 or over. They also monitor the activities of State agencies relatig 

to the institutionalze care of the elderly. New Jersey has approximately 700 long term car 

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 

regarding a complaint, both of which are considered essential to a progr that relies so heavily 

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, all funds are expended at the State level in the Trenton offce. 

The DIE hires professionals with law enforcement, health care, or legal backgrounds because 

New Jersey, more than any other State, strsses enforcement. The DIE has performed "nighttme 

raids" with video cameras as pan of its enforcement activities. In-house attorneys and a State 

ombudsman with a law degree are progr 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 

Aging (SUA). The State ombudsman report ditly to the Dirctor of the SUA, who in tur 

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. 

The ombudsman progr 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 

Respondents cite adequate funding as one significant attbute. To enhance this funding Ohio 

imposes a the-dollar bed tax on facilities that goes to the ombudsman progr and allows for a 

large well trned sta and volunteer group. 

Volunteer traiing guidelines, set down in legislation, employ a tier approach, with trning 

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. 

The Ohio progr 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 

with the ombudsman s pancipation in the policy proess, the impact of regulations on residents 

wil be considered. They consider the ombudsma a tremendous resoure in formulating policy 

and view their relationship with the ombudsman as a cooperative interaction. The ombudsman 

can also help anculate what nees to happen to State policy to protect patient s nees and rights. 

Funer, beause of the ombudsma s effort in this ara, the progr is seen as stag 

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 

provisions in the OAA; gives the ombudsma the right for injunctive relief to protect resident's 

rights; insurs access to records; and clearly delineates the authority of the offce. Ombudsmen 

are satisfied with the legislation and do not anticipate revisions in the foreseeable futur. 

Additional strngths of the Ohio progr include: strng legal representation from the Attorney 

General' s Offce and private legal services; the presence of attorneys on the ombudsman s sta; 

and excellent support frm, and access to, the SUA. The SUA advocates for the progr at the 

State level, dissemiates information about the program and provides admnistrtive suppon. 

. Other reasons for success cited include the relative independence of the progr, community 

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 

Dept. of Agig 

50 West Broad Strt, 8th Floor 

Columbus, OH 43266-0501 

(614) 466-9927