2020 PROGRAM 

RESULTS 

OLDER AMERICANS ACT 

Title VII | Long-Term Care Ombudsman Program
Acknowledgment 

Beverley Laubert, National Ombudsman Program 

Coordinator, in the Ofce of Long-Term Care Ombudsman 

Programs, Administration on Aging, Administration 

for Community Living (ACL) assisted with preparation 

of the module. U.S. Department of Health and Human 

Services (HHS) in partnership with New Editions Consulting, Inc., under contract number HHSP233201500113I/ 

HHSP23337002T. 

Disclaimer 

The views, opinions, and content of this publication are 

those of the authors and do not necessarily reflect the 

views, opinions, or policies of OPE, ACL, or HHS. Nothing in 

this document constitutes a direct or indirect endorsement 

by ACL of any nonfederal entity’s products, services, or 

policies, and any reference to nonfederal entity’s products, 

services, or policies should not be construed as such. 

Public Domain Notice 

All material appearing in this publication is in the public 

domain and may be reproduced or copied without permission from ACL. Citation of the source is required. However, this publication may not be reproduced or distributed 

for a fee without specifc, written authorization by ACL. 

Electronic Access 

This publication may be downloaded from https://acl. 

gov/aging-and-disability-in-america/data-and-research. 

Recommended Citation 

Administration for Community Living (2022). Overview of 

Older Americans Act Title III, VI, and VII Programs: 2020 

Summary of Highlights and Accomplishments. U.S. Department of Health and Human Services. https://acl.gov/ 

aging-and-disability-in-america/data-and-research. 
Title VII | Table of Contents 

Title VII | Program Highlights and Accomplishments 2 

List of Exhibits 4 

Abbreviations and Acronyms 4 

Impact of COVID-19 Pandemic on Title VII LTCOP Services 5 

Funding Use 5 

Title VII LTCOP Services 6 

2020 National Ombudsman Reporting System (NORS) Data Highlights 7 

Program Structure, Stafng, and Scope 7 

Case Summary 10 

Program Activities 17 

Appendix A: Title VII NORS Defnitions 18 

References 21 

Older Americans Act Title VII LTCOP | 2020 Program Results | 1 
2 | 

Title VII 

Program Highlights and Accomplishments 

The Long-Term Care Ombudsman Program (LTCOP) is designed to protect and 

promote the health, safety, welfare, and rights of long-term care residents in all 

50 states, as well as the District of Columbia, Puerto Rico, and Guam. Long-term 

care facilities include nursing homes, board and care and assisted living facilities, and other residential care communities. To achieve their mission, state 

and local long-term care ombudsman (LTCO) programs, with the help of paid 

staf and thousands of volunteers, engage in a range of activities at the 

individual, system, and community level. 

At the individual level, Ombudsmen assist residents by resolving complaints about their care, 

and help ensure that their rights are protected. 

In addition to investigating and resolving problems, Ombudsmen play a sentinel role through 

the facility and resident visits they routinely 

conduct. Serving as the “eyes and ears” of the 

program, Ombudsman representatives help 

address residents’ concerns before they rise to 

the level of complaints requiring intervention 

by preventing actions or inactions that unfavorably impact residents’ care, rights, and quality of life. At the systems level, Ombudsmen 

advocate at the local, state, and federal levels 

for improvements in the long-term care system 

that beneft residents. These activities are not 

limited to legislative advocacy, but include coalition-building, speaking to the media, and other strategies that broadly advance residents’ 

rights and well-being. To help build capacity 

for both individual and systems advocacy, the 

program also carries out education and outreach activities. These activities include providing information and consultation to facilities, 

residents and their families, collaborating with 

other agencies, supporting family and resident 

councils, developing citizen organizations, and 

empowering residents as well as their families 

and caregivers to be efective advocates.1 

Data reported by state ombudsman programs 

in 2020 demonstrate these eforts: 

2 | 
Older Americans Act Title VII LTCOP | 2020 Program Results | 3

PAID STAFF 

1,700 

VOLUNTEER STAFF 

6,621 

CONDUCTED ALMOST 

200,000 

VISITS IN 39,894 

LONG-TERM CARE 

FACILITIES 

PROVIDED MORE THAN 

INVESTIGATED 

153,324 640,000

INSTANCES OF INFORMATION 

AND ASSISTANCE TO INDIVIDUALS 

AND FACILITY STAFF 

COMPLAINTS 

X 

X 

X 

Older Americans Act Title VII LTCOP | 2020 Program Results | 3 
 

 

4 | 

List of Exhibits 

Exhibit 1. Location of State LTCO Ofce 

Exhibit 2. Location of Local Ombudsman Entities 

Exhibit 3. Complaints by Type of Facility 

Exhibit 4. Complaints by Verifcation Status for Each Type of Facility 

Exhibit 5. Complaints by Disposition for Each Type of Setting 

Exhibit 6. Complaints by Complaint Category, Nursing Facilities 

Exhibit 7. Complaints by Complaint Category, Residential Care Communities 

Exhibit 8. Complaints by Complaint Category, Other Settings 

Exhibit 9. Perpetrator Type for Abuse Complaints 

Exhibit 10. Program Activities to Improve Quality of Life 

Abbreviations and Acronyms 

AAA Area agency on aging HHS U.S. Department of Health and 

Human Services 

ACL Administration for Community Living 

COVID-19 Coronavirus disease 2019 

LTCO Long-term care ombudsman 

FY Fiscal year 

LTCOP Long-Term Care Ombudsman Program 

OAA Older Americans Act 

4 | 
Impact of COVID-19 Pandemic on Title VII LTCOP Services 

Funding Use 

Ombudsman programs are required to expend coronavirus disease 2019 (COVID-19) funds on allowable activities as defned by the Elder Justice Act, Coronavirus 

Aid, Relief, and. Economic Security (CARES) Act, and 

American Rescue Plan Act in accordance with state and 

local policy. This funding is intended to support the 

capacity of ombudsman programs as well as enhance, 

improve, and expand the ability to investigate allegations of abuse, neglect, and exploitation in the context 

of COVID-19 (called COVID for short). For example, 

funds could be used to 

■ enhance ombudsman program complaint investigations during the COVID public health emergency to 

address complaints related to abuse, neglect, and 

poor care; 

■ resume in-person visitation at such time as visitation is permitted, such as when the COVID vaccine 

is accessible to residents, facility staf, and individuals working for the LTCO program; 

■ conduct education and outreach on abuse and 

neglect identifcation and prevention during the 

COVID public health emergency to residents, their 

families, and facility staf; 

■ enable travel for representatives of the LTCO ofce 

to ensure all residents have access to an LTCO representative; 

■ continue purchase of needed personal protective 

equipment; 

■ continue purchase of technology as needed; 

■ enable participation in state-level “strike teams” to 

address complaints related to care and neglect; and 

■ provide information and assistance on transitions 

from long-term care facilities to community-based, 

home care settings, consistent with section 712(a) 

(3) of the Older Americans Act (OAA).2 

Older Americans Act Title VII LTCOP | 2020 Program Results | 5 
6 | 

 

Title VII LTCOP Services 

In-person visits with residents are a core part of 

ombudsman program outreach and advocacy. However, during the COVID-19 pandemic, visits have been 

dramatically curtailed, signifcantly restricting LTCO 

programs in pursuing their mission. The bullets below 

provide an overview of how the pandemic impacted 

Title VII LTCOP service needs and service provision.3,4,5 

■ Suspended and modifed facility visits. On March 

13, 2020, the Centers for Medicare & Medicaid 

Services issued guidance restricting everyone but 

essential personnel from entering nursing homes. 

As a result, the state ombudsman and ombudsman staf and volunteers serving as designated 

representatives of the ofce of the LTCO generally 

stopped visiting facilities in person during that 

time. When in-person visits slowly resumed, they 

would take place through windows, outdoors, or 

in a designated safe space until it was determined 

that in-room visits would resume. Since states and 

facilities had diferent protocols and policies for 

visits, ombudsmen had to spend extensive time to 

determine the requirements for visits and the most 

recent COVID-19 testing results to know if a visit 

could take place safely. 

■ Contacted facilities and residents remotely. While 

restrictions were in place, ombudsmen contacted 

facilities, families, and residents by phone, email, 

or video calls. Since restrictions were eased, ombudsmen have made contact with residents through 

a combination of phone contacts, virtual visits, and 

in-person visits. 

■ Experienced reduced number of complaints. Ombudsman programs have seen drops in the number 

of cases and number of complaints during the pandemic, which can be attributed to the lack of direct 

contact with residents by families and ombudsmen. 

■ Continued to investigate complaints. Ombudsman 

programs have continued to investigate complaints 

they receive and to provide information and assistance to residents, family members, the public, and 

long-term care staf, despite access to in-person 

visits having been restricted. Ombudsman programs have proactively reached out to residents 

and family members as well as facility staf by 

phone, email, and/or video calls to check in. 

■ Experienced an increase in information and assistance. Much of the ombudsman work this past year 

consisted of listening to stories of the impact of the 

COVID-19 pandemic and restrictions on facilities, 

staf, and residents. In addition, ombudsmen spent 

more time providing education on COVID-19 regulations and guidance. Consultations were conducted 

in person, by phone, or by email. 

■ Conducted virtual meetings. Ombudsman programs 

reported hosting virtual meetings (e.g., Facebook 

live, Zoom meeting) for family members of individuals living in long-term care facilities and the public 

to share information and respond to questions 

about COVID-19 and long-term care issues. Resident 

and family councils sometimes have used telecommunication platforms to hold their meetings rather 

than meeting in person. 
Older Americans Act Title VII LTCOP | 2020 Program Results | 7

Program Structure, Staffing, and Scope

Number of Ombudsman Entities

Reporting data in FY 2020 were 

■ 52 state LTCO offices (all 50 states, the District 

of Columbia, and Puerto Rico)† and

■ 438 local ombudsman entities.

The majority (n=31) of state LTCO offices were located within state units on aging which served as the 

contracting entity for the state. Thirteen of the 52 state 

LTCO offices were located inside state government, 

either within another agency (n=10) or as stand-alone 

agencies (n=3). Eight state LTCO offices were located 

outside state government as part of a nonprofit agency 

(n=5) or representing its own stand-alone nonprofit 

agency (n=3). 

† Guam has an ombudsman but does not report data. Guam has 

only one nursing home and an unknown number of assisted living 

facilities.

State LTCO 52 | offices

Local ombudsmen 438 | entities

2020 National Ombudsman Reporting System Data Highlights*

* Program Performance Report reporting year 2020: 

April 1, 2020–March 31, 2021

As part of Title VII Chapter 2 (LTCOP), each state is 

required to establish and operate a statewide office 

of the state LTCO, headed by a full-time state LTCO. 

These ombudsman programs currently operate in all 

50 states, the District of Columbia, Puerto Rico, and 

Guam. The state LTCO manages all aspects of the 

statewide program. Ombudsman staff and volunteers 

serving as designated representatives of the office 

of the LTCO at the local level assist in performing the 

activities and fulfilling the responsibilities of the program, including advocating on behalf of residents in 

long-term care settings. 

Funds are awarded to states based on a formula that 

takes into account the state’s population age 60 or older compared to all states. States may implement LTCOP 

activities directly or through contracts or agreements 

with public or nonprofit private agencies or organizations, such as other state agencies, area agencies 

on aging (AAAs), county governments, institutions of 

higher education, Indian tribes, or nonprofit service 

providers or volunteer organizations.6

October 1, 2019 - September 30, 2020.
8 | 

 

Exhibit 1. Location of State LTCO Ofce 

State unit on aging 

10 

3 

5 

3 

31 

Inside state government 

other agency 

Inside state government, 

stand-alone agency 

Outside state government 

within a nonprofit agency 

Outside state government in a 

stand-alone nonprofit agency 

0 5 10 15 20 25 30 35 

The majority (n=308) of local ombudsman entities were 

located within AAAs, with the local ombudsman representatives of the ofce being employed by the AAA. In 

Exhibit 2. Location of Local Ombudsman Entities 20 instances there were no local ombudsman entities. 

Area agency on aging (AAA) 308 

Nonprofit agency, 

with 501(c)(3) status 76

There are no local ombudsman 

entities 20

Legal services provider 19 

Stand-alone non-profit agency 12 

Other 3 

0 50 100 150 200 250 300 350 
Older Americans Act Title VII LTCOP | 2020 Program Results | 9 

Other volunteers 

(not ombudsmen representatives) 

 

Paid 

Staf 

Number of Staf and Volunteers 

In FY 2020, the majority of LTCO program staf were volunteers (n=6,621), with 78% of volunteers (n=5,152) serving 

as certifed ombudsman and 22% of volunteers (n=1,469) 

serving in other roles.‡ The majority of certifed volunteer 

‡ Volunteers who serve on a program advisory or governing board, 

assist with fund raising, provide other in-kind services such as 

accounting or strategic planning, etc. 

Paid staf 

1,700 

Certifed volunteer ombudsmen 

5,125 

1,469 

ombudsmen (79%, n= 4,075) and the majority of paid 

staf (75%, n= 1,283) worked at the local level. The other 

certifed volunteer ombudsmen (21%, n= 1,077) and paid 

staf (25%, n= 417) worked at the state level. 

Of 6,621 Volunteers 

78% 22% 

Served as 

certifed 

ombudsman 

Served in 

other roles 

Majority of certifed ombudsman and 

paid staf worked at the local level 

Certifed 

ombudsman 

79% 75% Local 

Level = 

21% 25% State 

= Level 
10 | 

Number of Complaints 

 

Complaint Verifcation Status 

Number of Facilities and Capacity 

In FY 2020, LTCO programs and their representatives 

served more than 75,000 nursing homes and assisted 

living and similar residential care facilities, promotFacilities 

75,795 

ing and protecting the rights of more than 

3 million residents. 

Residents 

3,192,209 

Case Summary 

In FY 2020, there were a total of 153,324 complaints which required LTCOP 

investigation and resolution on behalf of one or more residents of a longterm care facility. Of the 153,324 complaints, the majority (n=108,648; 71%) 

originated in nursing facilities. 

153,324 | 

Almost three quarters of all complaints (n=109,555; 71%) were verifed, meaning that ombudsmen confrmed that most or all facts alleged by the complainant were likely to be true. 

In nursing facilities, 72% of complaints (n=78,358) were verifed; in residential care facilities, 69% of complaints (n=28,763) were verifed; and in other settings, 77% of complaints 

(n=2,434) were verifed. 

71% | 
Older Americans Act Title VII LTCOP | 2020 Program Results | 11 

Exhibit 3. Complaints by Type of Facility 

Other 

3,165 

Nursing Facilities 

108,648 

Residential Care 

Communities 

41,511 

Exhibit 4. Complaints by Verifcation Status for Each Type of Facility 

78,358 80,000 jjjjjj

j Nursing Other n

Residential 

Facilities Care Facilities l

60,000 

40,000 

20,000 

0 

nn

jjn

731 l

n

l2,434 

j

n

28,768 30,290 

12,748 

Verified Not Verified 
12 | 

 

Complaint Dispositions 

70% |

More than two thirds of all complaints (n=107,310; 70%) were either partially or fully

resolved.§ For another 20% (n=29,976), no action was needed or the complaint was withdrawn. In about 10% of cases (n=16,038), the complaints were not resolved.¶ In nursing 

facilities, 71% of complaints (n=76,917) were partially or fully resolved; in residential care 

facilities, 67% of complaints (n=27,979) were partially or fully resolved; and in other 

settings, 77% of complaints (n=2,414) were partially or fully resolved. 

§ Verifcation and resolution were both afected by the pandemic. 

¶ Resolution is based on the satisfaction of the resident, and some problems just cannot be resolved. For example, a resident might complain about insufcient staf, which may be resolved by the ombudsman working with 

the facility on a staf assignment plan (resolved). However, other times it may be about not having enough people 

to hire (not resolved). 

Exhibit 5. Complaints by Disposition for Each Type of Setting 

76,917 80,000 jjjjjj

l2,414

nn

27,979 n

j Other 

Facilities 

Nursing n

Residential 

Care Facilities 

jj20,614 

l

60,000 

40,000 

20,000 

n

l

j

11,117 

n4,574 

347 

0

 Partially or fully resolved Withdrawn or Not resolved 

no action needed 

2,414

8,958 

404
Older Americans Act Title VII LTCOP | 2020 Program Results | 13 

 

Complaints Categories 

The largest number of complaints in nursing facilities 

(n=32,680; 30%) was related to care issues, including 

facility staf failure to provide care or providing poor 

quality care. The second most complaints (n=16,645; 

15%) were related to facility staf failure to honor and 

promote a resident’s autonomy, choice, and rights. 

There were also many complaints in nursing facilities 

(n=13,349; 12%) related to abuse, gross neglect, and 

exploitation—which involves the willful mistreatment 

of residents by facility staf, resident representative/ 

family/friend, other residents, or an outside individual—as well as many complaints against nursing facilities (n=10,935; 10%) involving admission, transfer, 

discharge, and/or eviction. 

Exhibit 6. Complaints by Complaint Category, Nursing Facilities 

Care 

Autonomy, choice, rights 

Abuse, gross neglect, 

exploitation 

Admission, transfer, 

discharge, eviction 

Environment 

Financial, property 

Dietary 

Activities and community 

integration and social services 

Facility policies, procedures, 

and practices 

Access to information 

System and others (nonfacility) 

Complaints about an outside 

agency (nonfacility) 

32,680 

0 10,000 20,000 30,000 40,000 

16,645 

13,349 

10,935 

6,585 

6,096 

5,620 

4,489 

4,305 

3,378 

3,319 

1,247
14 | 

 

20% |

Complaints in residential care communities followed a pattern similar to those in nursing 

facilities, with the largest number of complaints related to care issues (n=8,461; 20%), 

followed by complaints related to autonomy, choice, and rights (n=6,905; 17%) and abuse, 

gross neglect, and exploitation (n=5,352; 13%). 

Exhibit 7. Complaints by Complaint Category, Residential Care Communities 

Care 8,461 

Autonomy, choice, rights 

Abuse, gross neglect, 

exploitation 

Admission, transfer, 

discharge, eviction 

Environment 

Financial, property 

Facility policies, procedures, 

and practices 

Dietary 

Activities and community 

integration and social services 

System and others (nonfacility) 

Access to information 

Complaints about an outside 

agency (nonfacility) 

6,905 

5,352 

3,963 

3,686 

2,879 

0 2,000 4,000 6,000 8,000 10,000 

2,754 

2,436 

1,760 

1,716 

1,080 

519
Older Americans Act Title VII LTCOP | 2020 Program Results | 15 

 

In other settings, too, the largest number of complaints (n=590; 19%) was related to care 

issues. The second largest number (n=533; 17%) was complaints about an outside agency, 

followed by complaints related to abuse, gross neglect, and exploitation (n=500; 16%). 19% |

Exhibit 8. Complaints by Complaint Category, Other Settings 

Care 590 

Complaints about an outside 

agency (nonfacility 

Abuse, gross neglect, 

exploitation 

Admission, transfer, 

discharge, eviction 

Autonomy, choice, rights 

System and others (nonfacility) 

Facility policies, procedures, 

and practices 

Activities and community 

integration and social services 

Financial, property 

Environment 

Access to information 

Dietary 

533 

500 

394 

331 

317 

0 200 400 600 

146 

83 

82 

79 

55 

55
16 | 

Perpetrator Type** 

55% |

For complaints related to abuse (physical, sexual, psychological), more than half of the 

complaints (n=10,644; 55%) involved a facility staf member, and almost a quarter of the 

complaints (n=4,416; 23%) involved another resident. 

** Perpetrator type is reported for complaints related to abuse only. An ombudsman may select more than one 

type of perpetrator for a single abuse complaint. Thus, there are more perpetrators (n=19,303) than abuse complaints (19,201). 

Exhibit 9. Perpetrator Type for Abuse Complaints 

Other 

1,733 Family, Resident 

Representative, 

Friend 

2,511 

Another 

Resident 

4,416 

Facility Staff 

10,644 
Older Americans Act Title VII LTCOP | 2020 Program Results | 17 

 

Program Activities 

In addition to investigating complaints, LTCO programs 

engage in a range of activities to improve quality of 

life and care for residents of long-term care facilities. 

In FY 2020, the largest number of activities completed 

by LTCO programs focused on information and assistance to individuals (n=381,174 instances) or resident 

staf (n=261,989 instances). These activities may 

include providing information about issues that impact 

Exhibit 10. Program Activities to Improve Quality of Life 

residents (e.g., resident rights, care issues, services) 

and/or providing assistance to access services without 

opening a case and working to resolve a complaint. 

LTCO programs also completed almost 200,000 visits 

to 39,984 long-term care facilities, no matter the purpose of visit (complaint or noncomplaint related).†† 

†† These activities were also highly influenced by the pandemic. 

Information and 

assistance to individuals 

Information and 

assistance to staff 

Number of visits 

Facilities visited 

Facility surveys 

Resident councils 

Community education 

Training sessions for 

facility staff 

Family councils 

Routine access 

381,724 

261,989 

191,214 

39,984 

0 100,000 200,000 300,000 400,000 

12,230 

10,737 

8,323 

2,121 

1,208 

298
18 | 

 

Appendix A: Title VII National Ombudsman 

Reporting System Defnitions7 

Abuse: Physical abuse: The intentional use of physical 

force that results in acute or chronic illness, bodily injury, physical pain, functional impairment, distress, or 

death. Sexual abuse: Forced and/or unwanted sexual 

interaction (touching and nontouching acts) of any 

kind. Psychological abuse: The infliction of anguish, 

pain, or distress through verbal or nonverbal acts, 

including but not limited to verbal assaults, insults, 

threats, intimidation, humiliation, and harassment. 

Abuse, Gross Neglect, Exploitation (Code A): Serious 

complaints of willful mistreatment of residents by 

facility staf, resident representatives/ family/friends, 

other residents, or outside individuals. Indicate who 

appears to be the cause of the abuse, neglect or 

exploitation: (1) facility staf; (2) another resident; (3) 

resident representative, family, friend; or (4) other. 

Access to Information (Code B): Complaints against 

the facility regarding access to information made by or 

on behalf of the resident. Use for willful interference 

with ombudsman duties. 

Activities, Community Integration and Social Services 

(Code G): Complaint involving activities, community 

integration, or social services. 

Admission, Transfer, Discharge, Eviction (Code C): 

Complaints against the facility involving issues regarding admission, transfer, discharge, and/or eviction. 

Area Agency on Aging (AAA): Public or private nonproft 

agency designated by a state to address the needs and 

concerns of all older persons at the regional and local 

levels. The term AAA is a general one; names of local 

AAAs may vary. The AAAs coordinate and ofer services 

that help older adults remain in their homes, if that is 

their preference, aided by services such as home-delivered meals, homemaker assistance, and whatever else 

it may take to make independent living a viable option. 

Autonomy, Choice, Rights (Code D): Complaints 

involving facility staf failure to honor and promote a 

resident’s right or preferences. 

Care (Code F): Complaints involving facility staf failure 

to provide care, including poor quality care, planning, 

and delivery. 

Certifed Volunteer Ombudsmen: Volunteers designated as representatives of the LTCO ofce. 

Community Education: Community education outreach 

sessions by ombudsman program—e.g., attendance at 

health fairs, community events, general presentations, 

etc. 

Complaint: An expression of dissatisfaction or concern 

brought to, or initiated by, the ombudsman program 

which requires ombudsman program investigation and 

resolution on behalf of one or more residents of a longterm care facility. 

Complaints About an Outside Agency (Nonfacility; 

Code K): Complaints involving decisions, policies, 

actions, or inactions by programs and agencies—including private and public benefts. 

Complainant: An individual who requests ombudsman 

program complaint investigation services regarding 

one or more complaints made by, or on behalf of, 

residents. 

Complaint Disposition: Final resolution or outcome of 

the complaint. 

Complaint Verifcation: A confrmation that most or all 

facts alleged by the complainant are likely to be true. 

Dietary (Code H): Complaints regarding food service, 

assistance. 

Environment (Code I): Complaints involving the physical environment of the facility, including the resident’s 

space. 

Facilities Visited: Total number of facilities that 

received at least one visit by a representative of the 

LTCO ofce during the reporting year, regardless of the 

purpose of the visit. 
Older Americans Act Title VII LTCOP | 2020 Program Results | 19 

Facility Capacity: Number of beds for which the facility 

is licensed, certifed, or registered. 

Facility Policies, Procedures, and Practices (Code J): Acts 

of commission or omission by facility leadership/owners, 

including administrators, resident managers, etc. 

Facility Staf: Any employee or contractor of a longterm care facility who brings a complaint to the ombudsman program regarding one or more residents. 

Facility Surveys: Participation in survey activity 

conducted by regulatory agencies, including participation in both standard surveys and complaint surveys. 

Survey participation includes, but is not limited to, 

providing presurvey information to surveyors, sharing 

complaint summary reports, and participating in exit 

conferences and informal dispute resolution. 

Financial, Property (Code E): Complaints involving 

facility staf mismanagement of residents’ funds and 

property or billing problems. 

Gross Neglect: Failure to protect a resident from harm 

or the failure to meet needs for essential medical care, 

nutrition, hydration, hygiene, clothing, basic activities 

of daily living, or shelter, which results in a serious risk 

of compromised health and/or safety relative to age, 

health status, and cultural norms. 

Information and Assistance: Providing information 

about issues that impact residents (e.g., resident 

rights, care issues, services) and/or providing assistance to access services without opening a case 

and working to resolve a complaint. Information and 

assistance may be provided through various means, 

including but not limited to by telephone, by written 

correspondence such as email, or in person. 

Nursing Facility: Any skilled nursing facility, as defned in section 1819(a) of the Social Security Act (42 

U.S.C. 1395i–3(a)), or any nursing facility, as defned 

in section 1919(a) of the Social Security Act (42 U.S.C. 

1396r(a)). May also include noncertifed nursing homes 

licensed by the state. 

Ombudsman Program: The program through which the 

functions and duties of the LTCO ofce are carried out, 

consisting of the ombudsman, the ofce headed by the 

ombudsman, and the representatives of the ofce. 

Other Settings: Settings beyond those defned as longterm care facilities in the Older Americans Act (OAA). 

Other Volunteers: Other types of volunteers who are 

not representatives of the ofce. 

Perpetrator: Person who appears to have caused the 

abuse or neglect or exploitation. 

Resident: An individual who resides in a long-term care 

facility. 

Residential Care Community: A type of long-term care 

facility as described in the OAA that, regardless of setting, provides, at a minimum, room and board, aroundthe-clock on-site supervision, and help with personal 

care such as bathing and dressing or health-related 

services such as medication management. Facility 

types include, but are not limited to, assisted living; 

board and care homes; congregate care; enriched 

housing programs; homes for the aged; personal 

care homes; adult foster/ family homes; and shared 

housing establishments that are licensed, registered, 

listed, certifed, or otherwise regulated by a state. 

Resident or Family Council: Organized, self-governing, 

decision-making group of long-term care residents 

(resident council) or families (family council) who meet 

regularly to voice their needs and concerns and to have 

input into the activities, policies, and issues afecting 

the facility. 

Resident Representative, Friend, Family: Resident representative, as defned in 45 CFR 1324.1, may be 

■ an individual chosen by the resident to act on behalf of the resident in order to support the resident 

in decision-making; access medical, social or other 

personal information of the resident; manage fnancial matters; or receive notifcations; 
20 | 

■ a person authorized by state or federal law (including but not limited to agents under power of attorney, representative payees, and other fduciaries) 

to act on behalf of the resident in order to support 

the resident in decision-making; access medical, 

social or other personal information of the resident; 

manage fnancial matters; or receive notifcations; 

■ a legal representative, as used in section 712 

of the Act; or 

■ the court-appointed guardian or conservator 

of a resident. 

Friend is a nonrelative with a personal relationship 

with the resident as identifed by the resident or complainant. Family is spouse, sibling, other relative, or as 

identifed by the resident or complainant. 

Routine Access: Facilities visited, not in response to a 

complaint, in all four quarters by representatives of the 

LTCO ofce. 

State Units on Aging: Designated state-level agencies 

that are responsible for the planning and policy development as well as the administration of OAA activities. 

System: Others (Nonfacility; Code L): Other complaints, including resident representative or family 

member interfering with the resident’s decision-making and preferences related to health, welfare, safety, 

or rights, but not rising to the level of abuse, gross neglect or exploitation; problems with services provided 

to a resident from an individual or entity not associated with or arranged by the facility; and barriers to 

transition to community—inadequate assistance with 

accessing housing, services, and supports not related 

to facility action or inaction. 

Training: Training sessions provided by representatives of the LTCO ofce to facility staf. Training may 

be in person or web-based and typically includes an 

agenda and learning outcome(s). 

Visits: Facility visits, no matter the purpose of visit 

(complaint or noncomplaint related), by representatives of the LTCO ofce. 
Older Americans Act Title VII LTCOP | 2020 Program Results | 21 

 

 

References 

1 NORC. (2019). Final report: Process evaluation 

of the Long-Term Care Ombudsman Program 

(LTCOP). https://acl.gov/sites/default/fles/programs/2020-10/LTCOPProcessEvaluationFinalReport_2.pdf 

2 Administration for Community Living. (2021, February 1). Long-Term Care Ombudsman Programs 

Coronavirus Response and Relief Supplemental 

Appropriations Act of 2021. https://acl.gov/sites/ 

default/fles/common/LTCOP%20Coronavirus%20 

RR%20Sup%20Aprop%20Act%202-1-21-%20Final.pdf 

3 North Dakota Department of Human Services, Aging Services Division. (2021). 2021 annual report 

of the ND Long-Term Care Ombudsman Program. 

https://www.nd.gov/dhs/info/pubs/docs/aging/ 

ombudsman-program-annual-report.pdf 

4 The National Long-Term Care Ombudsman Resource Center. (2021). NORS FAQs: COVID-19. 

https://ltcombudsman.org/uploads/fles/support/nors-faqs-covid.pdf 

5 State of Illinois, Department on Aging. (n.d.). 

Illinois Long-Term Care Ombudsman Program. 

Frequently asked questions – COVID-19. https:// 

www2.illinois.gov/aging/programs/LTCOmbudsman/Documents/LTCOP_COVID_FAQ.pdf 

6 National Academy of Sciences. (1995). Older 

Americans Act: A staf summary (a publication of 

the Select Committee on Aging). https://www.ncbi. 

nlm.nih.gov/books/NBK231086/ 

7 Administration for Community Living. (n.d.). NORS 

technical documents. https://oaaps.acl.gov/Resources/techDocs 

8 Administration on Aging. (July 2010). Aging in 

Place: Do Older Americans Act Title III Services 

Reach Those Most Likely to Enter Nursing Homes? 

Research Brief Number 1.