## LongTerm Care Ombudsman Annual Report: Fiscal Year 1995

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## Part IV:Program Structure and Operations 

### **OrganizationalLocation of State Ombudsman Programs**

State agencies on aging are required under the Act [1 Sections307(a)(12) and 712] to establish and operate an office of thestate long-term care ombudsman to carry out specific functionsdesigned to assist and advocate on behalf of older people whoreside in long term care facilities. Most state agencies operatetheir ombudsman programs directly, but, as permitted by the Act,eleven states contract operation of the program to the non-profitorganizations listed below. 

| **Table 9****:        Ombudsman Programs Operated by Outside Non-Profit        Organizations** |
|------------------------------------------------------------------------------------------------|
| **Colorado**                                                                                   | The Legal Center | Agency which runs the        protection and advocacy program for people with        disabilities |
| **District of Columbia**                                                                       | AARP, Legal Counsel for the        Elderly | Legal Assistance        Organization |
| **Florida**                                                                                    | State Long-Term Care        Ombudsman Council | Free-Standing Ombudsman        Program |
| **Maine**                                                                                      | Long Term Care Ombudsman        Program | Free-Standing Ombudsman        Program |
| **Michigan**                                                                                   | Citizens for Better Care | Advocacy Organization |
| **Oregon**                                                                                     | Office of the Long-Term Care        Ombudsman | Free-Standing Ombudsman        Program |
| **Virginia**                                                                                   | Association of Area Agencies        on Aging | AAA Association |
| **Vermont**                                                                                    | Senior Citizens Law Project | Legal Assistance        Organization |
| **Washington**                                                                                 | State Long Term Care        Ombudsman Program | Free-Standing Ombudsman        Program |
| **Wisconsin**                                                                                  | Board on Aging & Long        Term Care | Free-Standing Ombudsman        Program |
| **Wyoming**                                                                                    | Senior Citizens, Inc. | Legal Assistance        Organization |

### **Facilitiesand Beds**

Ombudsman programs are charged under the Older Americans Actwith investigating complaints of older residents of nursing andboard and care facilities and "any other adult carehome" similar to nursing and board and care facilities. [1Older Americans Act, As Amended, Section 102(34)] For theirreports, states were asked to provide the number of licensednursing facilities and licensed board and care or similarfacilities and number of beds in those facilities covered bytheir program. [2 There are significant variations among thestates in the types of board and care/similar facilities whichare both licensed and covered by the ombudsman programs. AppendixE gives state definitions of the facilities included in the statetotal.] Ombudsmen also cover unlicensed board and care homes, butthe report did not request numbers of such facilities, as stateswould not be able to provide an accurate count — or even ameaningful estimate — of these types of homes. 

The response indicated a total of almost 2.5 million beds inover 55,000 facilities serving the older population. Of thesefacilities, almost 19,000 were nursing facilities and almost37,000 were board and care facilities. According to thisombudsman data, the number of individuals 65 years or older perlong term care bed is 13.5. The national mean of nursing facilitybeds to board and care and similar facility beds for older peopleis 2.74. 

Table1 on page provides national information on facilities andbeds. A state-by-state breakdown of these totals is in TablesA-7A through C. 

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### **StatewideCoverage**

States were asked to describe how their programs providestatewide ombudsman coverage for the facilities within theirpurview and barriers to providing statewide coverage. 

Methods of coverage included: 

- local programs; 
- coverage by state programs where no local programs exist;    
- toll-free telephone lines; 
- regular presence in facilities provided by volunteer        ombudsmen; 
- ombudsman posters and brochures in all facilities; and 
- pervasive program publicity. 

Barriers to full coverage included: 

- no local ombudsman programs; 
- insufficient funding/paid staff; 
- lack of regulations for program structure and guidance;        and 
- lack of certified volunteers. 

The state responses are summarized in two tables (for nursingfacility and board and care/similar facility) and provided infull in Appendix F. 

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### **LocalOmbudsman Entities**

The Act specifies that "in carrying out the duties of theOffice, the Ombudsman may designate an entity as a localOmbudsman entity, and may designate an employee or volunteer torepresent the entity" [1 Section 712(a)(5)(A)k] , outlineseligibility criteria for designation of local entities, and setsforth policies and procedures relative to local entities. 

For FY 1995, states reported a total of 565 designated localombudsman entities, 374 of which were located in area agencies onaging. Table 10 below provides national percentages for types ofhost organizations. Table A-8 (p. A-36) gives a state-by-statebreakdown of numbers of local programs by type of hostorganizations. 

| **Table 10****: Designated Local        Ombudsman Entities—FY 1995** |
|---------------------------------------------------------------------------|
| **Total**                                                                 | **Area Agency        on Aging** | **Other        Local Government Entity** | **Legal        Services Provider** | **Social        Services Non-profit Agency** | **Free-standing        Ombudsman Program** | **Regional        Office of State Ombudsman Program** | **Other** |
| 565                                                                       | 66.2% | 1.6% | 5.0% | 14.3% | 2.3% | 7.8% | 2.7% |

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### **Staff andVolunteers**

State staffing and volunteer data aresummarized below. A state-by-state breakdown is in Table A-9, p.A-37. 

| **Table 11****:        National Staff and Volunteers Totals         FY 1995**  |
|--------------------------------------------------------------------------------|
| **Paid        program staff (FTE's)**                                          |  | **913** |
| **working        at state level**                                              | 179 |   |
| **working        at local level**                                              | 734 |   |
| **Paid        individuals working full-time on program**                       |  | **598** |
| **at        state level**                                                      | 155 |   |
| **at        local level**                                                      | 443 |   |
| **Volunteer        ombudsmen trained and certified to investigate complaints** |  | **6,421** |
| **working        at state level**                                              | 380 |   |
| **working        at local level**                                              | 6,041 |   |
| **Other        Volunteers (not involved in complaint work)**                   |  | **5,159** |
| **working        at state level**                                              | 157 |   |
| **working        at local level**                                              | 5,002 |   |

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### **ProgramFunding**

As discussed in Part I, for FY 1995 total ombudsman programfunding was $40,870.107. Federal funds provided 65% of thistotal, and state and local funds provided the remaining 35%. Thelargest single source of funding (47% of the total) was federalfunding to state and area agencies on aging under Title III ofthe Act. For the first time, Title III funding provided directlyby the states for ombudsman operations is distinguished fromTitle III monies provided by area agencies for ombudsman servicesfrom funding they receive through the intrastate funding formulain the OAA. Tables A-10-A through A-10-B (pp. A-38 to A-39) givestate-by-state breakdowns of sources of funding by amounts andpercentages, respectively. 

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### **OtherOmbudsman Activities**

Ombudsmen perform numerous functions in addition toinvestigating and resolving complaints. The most important ofthese are listed below; FY 1995 national totals for activitiesperformed at both the state and local level given by the 29 NORSstates which reported this information are provided for eachactivity: 

providing training and technical assistance to staff andvolunteers in the statewide ombudsman program 

- 2,783 training sessions totaling 19,189 hours to 14,990        ombudsman trainees providing training and consultation to        managers and staff of long term care facilities 
- 3,912 training sessions 
- 28,920 consultations providing information and        consultation to individuals (usually by telephone) 
- 93,325 consultations visiting residents other than in        response to complaints 
- 7,758 nursing facilities and 
- 5,772 board and care facilities visited on a regular        basis, not in response to a complaint participating in        facility surveys 
- 5,224 facility surveys working with resident and family        councils 
- attended 5,590 resident council meetings and 1,928 family        council meetings providing community education 
- 4,485 sessions working with the media 
- 1,991 interviews; 
- 702 press releases issued monitoring and working on laws,        regulations, and government policies and actions. 
- The wide range of percentage of ombudsman time spent in        this area is reflected in Table A-11. 

Table A-11 provides statistics on the extent to which thosestates which used the new reporting form (and thus reported thisdata) carried out these specific activities. 

Comparison of the number of visits to facilities(unduplicated) on a regular basis, not in response to acomplaint, reported by the states to the number of licensedfacilities in the state shows: 

- visitation of 77% of nursing facilities and 49% of board        and care facilities on a regular basis. 
- "Regular basis" is defined as weekly,        bi-weekly, monthly or quarterly; but it also includes        Florida's annual ombudsman inspection of all facilities. 

The states were asked to identify, as provided by state andlocal staff, the three most frequent: 

- topics of facility training; 
- areas of consultation to facilities; and 
- requests/needs from individual callers. 

These responses are listed in Table 12, below. 

| **Table 12****:        Most Frequent Subject Areas of Facility Staff Training,        Facility Consultation, and Assistance to Individuals        (i.e., consumers)**
**(**Numbers        indicate number of states which listed the subject area        among their "top three" for each training or        consultation activity.) |
|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| **Issue        Area**                                                                                                                                                                                                                                                                                                                          | **Facility        Staff Training** | **Facility        Consultation** | **Provided        to Individuals** |
| **State**                                                                                                                                                                                                                                                                                                                                      | **Local** | **State** | **Local** | **State** | **Local** |
| **Residents rights**                                                                                                                                                                                                                                                                                                                           | 21 | 20 | 15 | 16 | 14 | 12 |
| **Placement: selecting        & paying for a nursing home & and alternatives to        nursing homes, access, bed availability**                                                                                                                                                                                                       |  |  | 1 | 1 | 22 | 21 |
| **Ombudsman program:        role, scope, volunteers**                                                                                                                                                                                                                                                                                          | 14 | 15 | 7 | 2 | 6 |  |
| **Daily care incl.        rules & regulations: staffing issues, nutrition,        pressure sores**                                                                                                                                                                                                                                         | 2 | 4 | 3 | 9 | 8 | 10 |
| **Legal issues: Living        wills, advance directives, other health care        decision-making, guardianship, and powers of attorney**                                                                                                                                                                                                      | 6 | 4 | 5 | 5 | 4 | 2 |
| **Transfer/discharge**                                                                                                                                                                                                                                                                                                                         |  |  | 13 | 6 | 2 | 5 |
| **Residents with        problems (combative/problem behaviors) altercations,        mental illness**                                                                                                                                                                                                                                           | 3 | 1 | 10 | 8 |  |  |
| **Elder abuse/adult        protection**                                                                                                                                                                                                                                                                                                        | 7 | 6 | 4 |  | 1 |  |
| **Medicaid/Medicare:        general, eligibility, spousal impoverishment**                                                                                                                                                                                                                                                                     |  | 1 | 2 | 2 | 1 | 8 |
| **Restraints**                                                                                                                                                                                                                                                                                                                                 | 2 | 3 | 2 | 4 | 1 | 1 |
| **Family issues**                                                                                                                                                                                                                                                                                                                              | 1 | 1 | 4 | 3 | 1 |  |
| **Information and        referral to other agencies**                                                                                                                                                                                                                                                                                          |  |  | 2 |  | 2 | 1 |
| **Resident        finances/financial**                                                                                                                                                                                                                                                                                                         |  |  | 2 |  | 2 |  |

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For questions about the LTC Ombudsman Program, contact Sue WheatonHypertext conversion by Saadia Greenberg,June 25, 1997