SEQ CHAPTER \h \r 1

PROGRAM INSTRUCTION

AOA-PI-95-10

September 29, 1995

TO:STATE AGENCIES ADMINISTERING PLANS UNDER TITLES III AND VII OF THE OLDER AMERICANS ACT OF 1965, AS AMENDED

SUBJECT:Instructions for Annual State Long Term Care Ombudsman Report to the Administration on Aging

LEGAL AND RELATED

REFERENCES:Older Americans Act, as amended

This Program Instruction provides directions to the states for submission of their annual Long Term Care Ombudsman Report to the Assistant Secretary for Aging for FY 1995 and FY 1996, pursuant to Section 712(h)(1) of the Older Americans Act (Act).

**Background**

In 1991, the Administration on Aging (AoA) began working with state long term care ombudsmen to upgrade the data collected by the state ombudsman programs, in compliance with the reporting requirements in the Act.  This work was initiated in response to findings by the Department of Health and Human Services, Office of the Inspector General and the U.S. General Accounting Office that substantial changes should be made in the AoA ombudsman reporting requirements in order to provide useful data on complaints and conditions in facilities and the operation of the state ombudsman programs.  In early 1995, in its evaluation of the Long Term Care Ombudsman Programs, the Institute of Medicine of the National Academy of Sciences reiterated the need to improve ombudsman data available at the national level.

As the proposed ombudsman requirements were developed, they were circulated to all state ombudsmen, and later to State Directors on Aging, for comment.  Most of the specific suggestions made during these review and comment periods were incorporated into the final requirements.

The development of new national ombudsman reporting requirements coincided with development of new requirements for reporting state activities in Title III and the other components of Title VII.  The two new sets of requirements — the National Ombudsman Reporting System (NORS) and the State Performance Report (SPR) - are among several components of the National Aging Program Information System (NAPIS).  In FY 1994, AoA provided discretionary funds to the states to assist them in implementing these new reporting requirements.

Most states have already opted to convert their ombudsman complaint documentation and reporting systems to conform to requirements in the NORS, and other states are in the process of changing their systems.  A pilot test, conducted as part of AoA's request for approval of the NORS by the Office of Management and Budget, indicated that:

!states are able to convert to the NORS easily and without excessive expense; and

!once regional ombudsman staff and volunteers are trained to use the NORS complaint categories, they prefer the NORS to the documentation system they were previously using.

**Reporting Instructions**

The U.S. Office of Management and Budget has approved:

!an interim form for use by states which did not use the NORS complaint categories during FY 1995; and

!the NORS for states' voluntary use in FY 1995 and required use in FY 1996, with a six month phase-in option in FY 1996.

**FY 1995 Report**

A form for reporting FY 1995 ombudsman complaint and program data is enclosed.  It is based on requirements which were previously in Part V of the State Program Performance Report for Title III of the Act, a revised version of which was in use through FY 1994.  The following changes have been made in the form since it was last issued:

!data elements not needed at the national level, including the too-broad complaint categories, have been eliminated; and

!the following NORS elements have been included:

Poptional description of one complaint;

Pa discussion of major issues (pursuant to Section 712(h)(1) of the Act);

Pa request to provide numbers of facilities and beds, with a description of how the state provides statewide ombudsman coverage; and

Pinformation on local program sponsors and statewide staffing, including volunteers.

For their FY 1995 ombudsman reports, states may use this form, or they may use the NORS, per instructions in the NORS transmittal specifications.  A diskette with a program, the National Ombudsman Reporting Data Input Application (NORDIA), which will allow transmission of the NORS information in the required format, is being sent under separate cover to all states.  States which use the NORS for FY 1995 may use this program or any other software which will meet the required transmittal specifications (see below).  The report is due sixty days after the close of FY 1995 and should be sent to:

U.S. Department of Health and Human Services

Administration on Aging

Division of Information Resources Management

330 Independence Avenue, S.W., Room 4655

Washington, D.C.  20201

**Instructions for Reporting Ombudsman Data for FY 1996**

Pursuant to Section 712(h)(1) of the Act, beginning on

October 1, 1995, all State Agencies on Aging, except those which choose the phase-in option outlined below, shall require their State Office of the Ombudsman to collect all data and other information requested in the NORS.  This data and information shall be reported to AoA no later than sixty days after the close of the fiscal year.

A copy of the NORS form, instructions and transmittal specifications are enclosed.  States should transmit their reports according to the transmittal specifications, per instructions provided above for FY 1995 reporting.

*Phase-in Option:*

States which have not yet implemented the NORS complaint documentation system have the option of submitting information requested in Part I, *Cases, Complainants and Complaints*, based on six months of data.  States which elect the six-month phase-in option would thus report case and complaint data collected beginning April 1, 1996.  At the end of the fiscal year, they should double these figures and report the total, as instructed above.  These states must provide all other information requested in the NORS for all of FY 1996.  States which choose the phase-in option are asked to notify their AoA Regional Office by

October 30, 1995, that they will begin collecting the case and complaint data after October 1, but no later than April 1, 1996.

*Transition from previous requirements:  counting cases*

The FY 1994 report format required states to give the number of cases "still active" at the end of the reporting period.  This has been dropped in the FY 1995 interim report format.  When states change to the NORS, they should simply report the number of cases opened during the reporting period and the number closed.  Because cases continue from one fiscal year to another, numbers of cases opened and cases closed will not correspond.  States will have their own tracking systems to ensure that cases opened are closed within a reasonable amount of time.  This information is not required at the national level.  It is understood that the change in reporting may result in more cases being reported as closed than as opened during the NORS start-up period.  This discrepancy will be explained in AoA's summary report to Congress and the public.

*Further instructions*

Further instructions for submitting the report are provided with the transmittal software, NORDIA.

**Coordination of the State Performance and Long-Term Care Ombudsman Reports**

The SPR is not intended to collect any information on the Long Term Care Ombudsman Program except that under SPR Section VII, State and Area Agency Staffing Profile.  Therefore, **do not include ombudsman information in the following sections of the SPR**:

!Section I, Estimated Unduplicated Counts of Clients Served Under Title III;

!Section II, Title III Utilization Profile; or

!Section III, Service Expenditures Profile (except as requested under Part B, Title VII Expenditures).

Area agency, state and national totals for both numbers of individuals served and funds expended can be achieved by adding information from the two reports.  These numbers must not be included in the SPR report to AoA, as they will be included in the Ombudsman Report and must not be counted twice.

Local ombudsmen should be required to document their work only through the state component of the ombudsman reporting system, even if the local program is supported with Title III funds.  The number of clients served by the ombudsmen will be reflected in the number of cases opened and closed.  The number of people to whom the Ombudsman Program provides information and assistance/referral will be captured in Part III, Section F of the Ombudsman Report.  If additional client information not included in the NORS, such as age, gender and ethnicity, is required for use at the area agency on aging or state level, state and area agencies may require their ombudsman programs to add these elements to their complaint documentation systems.  This ombudsman client information is not needed at the national level because it is available from other data sets on residents of long term care facilities.

**Do include ombudsman information in the SPR Section VI, Staffing Profile.**  Ombudsman program staff who work **directly** for the state and area agency and any ombudsman volunteers who work for substate ombudsman programs located in, and/or directly sponsored by the area agency, should be included the Staffing Profile on pages 12 and 13 of the SPR, as well as in the staffing section of the Ombudsman Report.  While the data is similar, the sets of information in the two reports serve two different purposes.  

For the SPR, count ombudsman staff full-time equivalents (FTE's) under the functional responsibility category which best describes the function they perform for the ombudsman program.  Staff or volunteers who work for agencies under contract or grant by the area agency should not be included in the Staffing Profile of the SPR.

INQUIRIES:General inquiries should be addressed to AoA Regional Administrators.  Specific questions regarding the reporting content should be addressed to AoA Ombudsman Program Officer Sue Wheaton, Tel. (202)619-7585.  Specific questions regarding the transmittal software NORDIA should be addressed to AoA HELP Desk at (202) 205-6205.

Fernando M. Torres-Gil

Assistant Secretary for Aging

COPIES:State Ombudsmen