## LongTerm Care Ombudsman Annual Report: Fiscal Year 1995

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## Part II. FY1995 Program Highlights 

A number of important Ombudsman Program milestones occurred inFY 1995. 

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### **The WhiteHouse Conference on Aging**

Elder Rights and the Ombudsman Program under the OAA receiveda strong endorsement from delegates to the FY 1995 White HouseConference on Aging. As part of the second major resolutionregarding reauthorizing and preserving the integrity of the OAA,the delegates resolved to support policies that: 

- Preserve and strengthen the existing aging network...to        ensure a seamless continuum of quality services which        includes . . . advocacy and elder rights protection. 
- As part of the seventh resolution concerning preserving        advocacy functions under the OAA, delegates declared that        "older persons critically need protection against        abuse, neglect and exploitation" and made five        specific resolutions, including: 
- Preserve the OAA's focus on protecting the rights of        vulnerable older people; 
- Expand the elder rights portions of the OAA's Title VII        (i.e., ombudsman program, legal assistance, elder abuse        prevention, and insurance and benefits assistance) with        adequate funding; and 
- Reinforce the responsibility of the aging network,        including the Administration on Aging, state and area        agencies on aging, and service providers, to advocate on        behalf of older persons on all issues which impact older        persons and their families. 

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### **OperationRestore Trust (ORT)**

President Clinton announced this major initiative to combatMedicare and Medicaid fraud at the White House Conference onAging. State ombudsmen in the five states where the largestMedicare expenditures occur — California, New York,Illinois, Florida and Texas — were designated part of thecore team for ORT, a two year U.S. Department of Health and HumanServices demonstration project involving coordinated efforts bythe Health Care Financing Administration, Office of InspectorGeneral, and AoA. Under ORT, ombudsmen in the five stateslaunched ambitious statewide training programs to educateombudsmen and others about what constitutes fraud, waste andabuse and what to do when one encounters it. 

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### **TheInstitute of Medicine Study**

In January 1995, a Committee of the Institute of Medicine(IOM), National Academy of Sciences chaired by Dr. Carroll L.Estes, Professor and Director of the Institute for Health andAging, University of California at San Francisco, issued theresults of a year-long evaluation of the effectiveness of theOmbudsman Program. The study was required in the FY 1992Amendments to the OAA and funded by AoA. 

The Committee concluded that the Ombudsman Program serves avital public purpose and recommended that Congress continue theprogram as set forth in the Act. [ 1 Institute of Medicine, RealPeople, Real Problems: An Evaluation of the Long-Term CareOmbudsman Program of the Older Americans Act , page 153.] At thesame time, the Committee found that the program lacks sufficientfunding to adequately perform the functions assigned to it underthe Act. 

The report stated: 

Through systemic advocacy work and educational efforts, theState programs, individually and collaboratively, have brought tothe attention of State and Federal policy makers, regulatoryagencies and provider organizations a host of conditions that canand should be changed to improve the health, safety, rights andwelfare of LTC residents. Examples of changes advanced orpromoted by ombudsman programs (often in conjunction with otherorganizations) include: enactment of the Nursing Home Reform Lawof 1987; increased personal needs allowances; protections frominvoluntary discharge and room transfers; reduced use of physicalrestraints; improved building and safety standards; increasedstate funding for inspection and surveying of LTC facilities;reduced use of psychotropic medications; better licensingoversight of health care professionals; increased use of advancedirectives; stronger LTC staff competencies and sensitivities;and empowerment of residents through stronger resident and familygovernance structures. [ 2**Ibid .] 

The Committee made numerous specific recommendations to thestates, AoA, and Congress for ways to improve the effectivenessof all state programs. These included increasing federal andstate resources for the program to a level that would provide onefull-time equivalent (FTE) paid ombudsman for every 2000 beds. [3**Ibid, p. 193.] (The FY 1995 ratio is 1 FTE staff personfor every 2718 beds.) 

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### **The TitleVII Elder Rights Bi-Regional Conferences**

AoA sponsored five conferences in FY 1995 to assist stateagency on aging directors; area agency representatives; otherswho manage elder rights programs; and representatives of thestate ombudsmen, legal assistance development, adult protectiveservices, information and assistance, and benefits counselingprograms to develop: 

- a shared vision of the mission of Title VII of the Act; 
- a common understanding of its mandates; and 
- strategic approaches which states could undertake to        advocate on behalf of vulnerable older persons. 

The two-day meetings were held from mid-November 1994 throughmid-January 1995 in Boston, Atlanta, Chicago, Denver and SanFrancisco. Evaluations indicated that these meetings helped theparticipants identify opportunities for joint undertakings whichcould strengthen the work of all. A number of state elder rightscoalitions developed as a result of the conferences; the work ofsome of these is mentioned in the issues section (Part V andAppendix C) of this report. 

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### **The ConsumerReports Article**

The August 1995 issue of *Consumer Reports* carried anarticle on selecting a nursing home, which included thisstatement: 

"The best advice we were able to get came from state orcounty ombudsmen, officials who resolve complaints and advocateon behalf of nursing home residents." 

The article provided a list of state ombudsmen, and calls toombudsman offices throughout the country increased substantiallyover the usually heavy volume, reflecting the public's need forthe type of information and assistance long term care ombudsmenprovide. (This increased demand came as program funding forresources to meet demand was decreasing, as indicated in Table3.) 

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### **ProposedRegulations**

AoA published in the November 15, 1994 *Federal Register*proposedrules for implementing Title VII (and the Ombudsman Programprovisions, in particular), enacted in the 1992 amendments to theAct. Numerous comments were received from state and area agencypersonnel, ombudsmen, legal services developers and others; andhearings were held in conjunction with the five Bi-Regionalconferences discussed above. All comments were analyzed, butfinal regulations were not issued due to anticipated changes inthe currently pending reauthorization of the Act. 

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### **OmbudsmanOutcomes Measures Task Force**

In September 1995, in preparation for complying with therequirements of the Government Performance and Results Act(GPRA), AoA convened a small meeting of individuals withexpertise in evaluating ombudsman outputs and outcomes torecommend measures for use at both the State and national levels.The group identified a number of measures, many of which are inthe new NORS, which could be used, over time, to assess theeffects of ombudsman work. 

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### **TheOmbudsman Resource Center**

Under a four year AoA grant funded in September 1993 at$500,000 per year, the National Citizens' Coalition for NursingHome Reform (NCCNHR), in conjunction with The NationalAssociation of State Units on Aging (NASUA), provides trainingand technical assistance to state ombudsmen and carries out otherresponsibilities specified in Section 202(e)(21) of the OlderAmericans Act. During FY 1995 the Center: 

- maintained on-going communication with the State        ombudsman programs through teleconferences and a lively        newsletter  Infobulletin ; 
- responded to several hundred requests for information and        assistance from ombudsmen and others; 
- developed a sophisticated computer capability, which        permits the Center to provide more timely and complete        information to the ombudsman network; 
- provided direct training and training materials designed        to enhance ombudsman professional advocacy and management        skills, including conducting the National Training        Conference in Seattle, Washington, which was attended by        a record number of State ombudsmen (42) and many local        ombudsmen; 
- through national exhibits and dissemination of materials,        increased public awareness of the Ombudsman Program so        that it is utilized more by residents, family members and        others in need of services; 
- supported a national ombudsman volunteer recruitment        effort through close collaboration with the American        Association of Retired Persons' Legal Counsel for the        Elderly (AARP/LCE) volunteer recruitment project; 
- provided information and fostered communication between        ombudsmen on enhancing services to residents of board and        care facilities, assisted living facilities and related        long-term care facilities; 
- provided substantial information to the IOM Committee to        assist in their evaluation of the Ombudsman Program; 
- identified and analyzed issues and promoted research to        reinforce the role and function of the Ombudsman Program;        and 
- through teleconferences and sessions at training meetings        and active participation in the AoA-sponsored Bi-Regional        Title VII meetings, assisted State ombudsman programs to        begin to implement Title VII of the Act. 

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### **NORSImplementation**

As discussed in Part I, FY 1995 marked the year in which 29state ombudsman programs began to collect and report theirombudsman complaint, issues, program and activities data andinformation in a manner which permitted compilation and analysisof this material at the national level. 

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### **TheUniversity of Louisville Project: OmTrak**

Under a three year AoA grant which began in March 1994, Dr.Ruth Huber, a professor in the Kent School of Social Work of theUniversity of Louisville in Kentucky, and her associate, KevinBorders, worked with an ever-expanding number of state ombudsmanprograms to develop a system and computer software for collectingand analyzing ombudsman complaint and other data. Through theproject, scores of ombudsmen learned the basics of the new AoAreporting system. Simple forms and a system for collectingsophisticated data were designed and made available free ofcharge to all states, and software (named OmTrak) was developedand tested by the pilot states. (The software was made availableto all states in FY 1996.) 

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For questions about the LTC Ombudsman Program, contact Sue WheatonHypertext conversion by Saadia Greenberg,June 20, 1997