Findings from the National Evaluation of the Long-Term Care Ombudsman Program

2019 SLTCO Training Conference                      Orlando, FL

May 22, 2019

Kim Nguyen, PhD, NORC  at the University of Chicago

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1

Research on the LTCOP

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Research on the Ombudsman Program (1978-2019)

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3

National Evaluation of the LTCOP

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Overview of LTCOP

As authorized by the Older Americans Act (OAA), the Long-Term Care Ombudsman Program (LTCOP) has the following responsibilities nationally:

Identify, investigate, and resolve complaints made by or on behalf of residents of long-term care facilities 

Provide information to residents, families, staff

Advocate for systemic changes to improve residents’ care and quality of life

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Overview of LTCOP

The LTCOP is administered by the Administration on Aging

Each state has an Office of the Long-Term Care Ombudsman. 

53 programs, including Guam, Puerto Rico, and Washington DC. Each Office is led by a State Long-Term Care Ombudsman.

Ombudsmen/Representatives of the Office are advocates for residents of long-term care facilities. 

1,319 paid program staff (FTE) in 2017

523 designated local Ombudsman entities in 2017

A large volunteer workforce supports the program to maintain a presence in facilities.

6,625 certified volunteers in 2017

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6

Evaluation Team 

Process Evaluation and Special Studies Related to the LTCOP

NORC at the University of Chicago (NORC Chicago)

National Consumer Voice for Quality Long-Term Care (Consumer Voice)

Brooke Hollister, PhD, University of California, San Francisco

Helaine Resnick, PhD, Resnick, Chodorow & Associates

William Benson, Health Benefits ABCs

Human Services Research Institute (HSRI)

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7

Process Evaluation and Special Studies Related to the LTCOP

Research Questions

How is the LTCOP structured and how does it operate at the local, State, and Federal levels?

How do LTCOPs use existing resources to resolve problems of individual residents and to bring about changes at the facility and local, State, and Federal levels that will improve the quality of services available/ provided?

With whom do LTCOPs partner, and how do LTCOPs work with partner programs?

How does the LTCOP provide feedback on successful practices and areas for improvement?

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8

Data Collection 

Process Evaluation and Special Studies Related to the LTCOP

Round 1 Data Collection (2017)

Telephone Interviews

Federal Staff (5) 

Stakeholders (19) 

State Ombudsmen (53) 

Round 2 Data Collection (2018)

Online Surveys

State Ombudsmen (52) 

Local Ombudsmen (497 in 27 states) 

Volunteers (711 volunteers in 26 states) 

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9

Process Evaluation and Special Studies Related to the LTCOP

Data Collection

Round 2 Local Data Collection (27 States) 

ACL/AoA Region
| 1  | 2  | 3  | 4  | 5  | 6  | 7  | 8  | 9  | 10 |
|----|----|----|----|----|----|----|----|----|----|
| ME | NJ | DE | FL | IL | LA | IA | ND | AZ | AK |
| RI | NY | VA | KY | IN | NM | NE | SD | CA | WA |
| -  | -  | -  | TN | OH | -  | -  | -  | HI | -  |
| -  | -  | -  | SC | MN | -  | -  | -  | NV | -  |
| -  | -  | -  | -  | WI | -  | -  | -  | -  | -  |

Reporting

Findings will be disseminated through a Final Report, research briefs, and conference presentations.

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10

Individual Advocacy

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Individual Advocacy

Overview

According to the OAA, individual advocacy involves the following:

Identifying, investigating, and resolving complaints made on behalf of residents 

Identifying, investigating, and resolving complaints that relate to the action, inaction, or decisions that may have adverse affects on resident rights

Referring residents to agencies which can provide additional services

Ensuring residents have timely and unimpeded access to the services provided by the LTCOP

SLTCOs oversee individual advocacy activities and set goals for facility visits

Facility visits and complaint handling are two components of individual advocacy

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12

Program Goals for Visiting Facilities

Data: SLTCO Survey 
| What are your statewide program’s visiting goals?   | Nursing Homes | Board and Care Homes |
|-----------------------------------------------------|---------------|----------------------|
| None                                                | 12%           | 18%                  |
| At least weekly                                     | 4%            | 2%                   |
| At least monthly                                    | 15%           | 6%                   |
| At least quarterly                                  | 60%           | 53%                  |
| At least twice a year                               | 2%            | 4%                   |
| At least annually                                   | 6%            | 10%                  |
| Other                                               | 2%            | 8%                   |

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13

Facility Visit Decisions – Local Ombudsman Entities

Data: Local Ombudsman Survey
| How are decisions made about facility visits?                                                                                                                                                               | Local Ombudsman Entities |
|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------|
| Ombudsmen are assigned to a specific facility or group of facilities to visit, based on geographic region.                                                                                                  | 93%                      |
| Ombudsmen are assigned to a specific facility or group of facilities to visit, based on facility characteristics (for example, size, and ownership, level of services provided).                            | 27%                      |
| Ombudsmen visit facilities in response to information about facility problems and resident complaints.                                                                                                      | 71%                      |
| Ombudsmen are assigned to cases (regardless of facility) based on their expertise in the type of complaint that has been reported (for example, complaints related to involuntary discharges or transfers). | 20%                      |
| Ombudsmen prioritize facilities that have not recently received complaint-related visits.                                                                                                                   | 17%                      |
| Ombudsmen are not assigned to specific facilities or groups of facilities.                                                                                                                                  | 4%                       |
| Other                                                                                                                                                                                                       | 13%                      |

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14

Nursing Home Visits

Data: SLTCO Survey, Local Ombudsman Survey, Volunteer Ombudsman Survey
| Respondents                                                    | SLTCO | Local Ombudsmen | Volunteer Ombudsmen |
|----------------------------------------------------------------|-------|-----------------|---------------------|
| Personally visits nursing homes                                | 81%   | 89%             | 80%                 |
| Visit on a routine basis (not complaint driven)                | 45%   | 80%             | 95%                 |
| Visit in response to facility problems and resident complaints | 71%   | 87%             | 59%                 |
| Mean - # of facilities assigned                                | -     | 20              | 2                   |
| Median - # of facilities assigned                              | -     | 12              | 1                   |
| Range - # of facilities assigned                               | -     | 0-300           | 0-30                |

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15

Board and Care Home Visits

Data: SLTCO Survey, Local Ombudsman Survey, Volunteer Ombudsman Survey
| Respondents                                                    | SLTCO | Local Ombudsmen | Volunteer Ombudsmen |
|----------------------------------------------------------------|-------|-----------------|---------------------|
| Personally visits board and care homes                         | 69%   | 76%             | 51%                 |
| Visit on a routine basis (not complaint driven)                | 36%   | 78%             | 93%                 |
| Visit in response to facility problems and resident complaints | 64%   | 79%             | 52%                 |
| Mean - # of facilities assigned                                | -     | 45              | 5                   |
| Median - # of facilities assigned                              | -     | 15              | 2                   |
| Range - # of facilities assigned                               | -     | 0-1652          | 0-40                |

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Frequency of Facility Visits  

 Data: SLTCO Survey
| How frequently does your statewide program visit most or all facilities on average? | Nursing Homes | Board and Care Homes |
|-------------------------------------------------------------------------------------|---------------|----------------------|
| Weekly                                                                              | 8%            | 0%                   |
| Monthly                                                                             | 33%           | 17%                  |
| Quarterly                                                                           | 38%           | 38%                  |
| Twice a year                                                                        | 6%            | 8%                   |
| Annually                                                                            | 2%            | 12%                  |
| Other                                                                               | 13%           | 25%                  |

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17

Frequency of Facility Visits

Data: Local Ombudsman Survey, Volunteer Ombudsman Survey
| How often do you typically visit each facility? | Nursing Homes - Local Ombudsmen | Nursing Homes - Volunteer Ombudsmen | Board and Care Homes - Local Ombudsmen | Board and Care Homes - Volunteer Ombudsmen |
|-------------------------------------------------|---------------------------------|-------------------------------------|----------------------------------------|--------------------------------------------|
| Weekly                                          | 11%                             | 53%                                 | 2%                                     | 22%                                        |
| Less than weekly but at least once a month      | 28%                             | 26%                                 | 16%                                    | 40%                                        |
| Less than monthly but at least once a quarter   | 33%                             | 14%                                 | 48%                                    | 31%                                        |
| Twice a year                                    | 4%                              | 1%                                  | 7%                                     | 2%                                         |
| Once a year                                     | 1%                              | 0%                                  | 7%                                     | 1%                                         |
| As needed                                       | 14%                             | 3%                                  | 13%                                    | 3%                                         |
| Other (please specify)                          | 9%                              | 3%                                  | 7%                                     | 1%                                         |

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18

Time Spent at Facility

Data: Local Ombudsman Survey, Volunteer Ombudsman Survey
| Average time spent at facility per visit | Nursing Homes - Local Ombudsmen | Nursing Homes - Volunteer Ombudsmen | Board and Care Homes - Local Ombudsmen | Board and Care Homes - Volunteer Ombudsmen |
|------------------------------------------|---------------------------------|-------------------------------------|----------------------------------------|--------------------------------------------|
| Less than 1 hour                         | 13%                             | 9%                                  | 43%                                    | 41%                                        |
| 1 – 2 hours                              | 65%                             | 56%                                 | 49%                                    | 46%                                        |
| 2 – 3 hours                              | 19%                             | 28%                                 | 7%                                     | 10%                                        |
| More than 3 hours                        | 3%                              | 7%                                  | 1%                                     | 3%                                         |

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Complaint Handling

Data: Local Ombudsman Survey, Volunteer Ombudsman Survey
| How do you handle complaints?                                                | Local Ombudsmen | Volunteer Ombudsmen |
|------------------------------------------------------------------------------|-----------------|---------------------|
| I handle complaints on my own                                                | 83%             | 71%                 |
| I support other program staff/volunteers as they handle complaints           | 76%             | 32%                 |
| I consult with other program staff or volunteers, as needed                  | 79%             | 77%                 |
| I refer the complaint to other program staff or volunteers                   | N/A             | 32%                 |
| I refer the complaint to the appropriate entity when I have resident consent | 76%             | 72%                 |
| Other                                                                        | 4%              | 6%                  |

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20

Effective Relationships with Facilities – Nursing Homes
| Effectiveness of relationship                 | State Office | Local Ombudsmen | Volunteer Ombudsmen |
|-----------------------------------------------|--------------|-----------------|---------------------|
| A majority of the relationships are effective | 51%          | 66%             | 78%                 |
| Some of the relationships are effective       | 47%          | 28%             | 18%                 |
| A few of the relationships are effective      | 2%           | 5%              | 3%                  |
| None of the relationships are effective       | 0%           | 0%              | <1%              |

Data: SLTCO Survey, Local Ombudsman Survey, Volunteer Ombudsman Survey

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Effective Relationships with Facilities – Board and Care Homes
| Effectiveness of relationship                 | State Office | Local Ombudsmen | Volunteer Ombudsmen |
|-----------------------------------------------|--------------|-----------------|---------------------|
| A majority of the relationships are effective | 39%          | 59%             | 78%                 |
| Some of the relationships are effective       | 49%          | 36%             | 17%                 |
| A few of the relationships are effective      | 12%          | 4%              | 4%                  |
| None of the relationships are effective       | 0%           | 1%              | 0%                  |

Data: SLTCO Survey, Local Ombudsman Survey, Volunteer Ombudsman Survey

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22

Problems Accessing Residents in Facilities – Nursing Homes

Data: Local Ombudsman Survey
| Frequency of Access issues | Local Ombudsman Entities | Local Ombudsmen | Volunteer Ombudsmen |
|----------------------------|--------------------------|-----------------|---------------------|
| Often                      | 2%                       | 13%             | 1%                  |
| Sometimes                  | 10%                      | 19%             | 9%                  |
| Rarely                     | 48%                      | 47%             | 33%                 |
| Never                      | 41%                      | 22%             | 57%                 |

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23

Problems Accessing Residents in Facilities – Board and Care Homes

Data: Local Ombudsman Survey
| Frequency of Access issues | Local Ombudsman Entities | Local Ombudsmen | Volunteer Ombudsmen |
|----------------------------|--------------------------|-----------------|---------------------|
| Often                      | 2%                       | 4%              | 1%                  |
| Sometimes                  | 18%                      | 21%             | 9%                  |
| Rarely                     | 46%                      | 48%             | 32%                 |
| Never                      | 34%                      | 27%             | 58%                 |

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24

Program Resources

Data: SLTCO Survey, Local Ombudsman Survey
| Types of individual advocacy activities not fully carried out due to a lack of resources | SLTCO | Local Ombudsmen |
|------------------------------------------------------------------------------------------|-------|-----------------|
| Complaint investigation and resolution activities                                        | 23%   | 32%             |
| Regular nursing home visits, not in response to a complaint                              | 50%   | 45%             |
| Regular board and care home visits, not in response to a complaint                       | 67%   | 44%             |
| Consultations to facilities                                                              | 15%   | 19%             |
| Legal assistance for residents                                                           | 52%   | 42%             |

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25

Program Resources 

Data: SLTCO Interviews, SLTCO Survey, Local Ombudsman Surveys

Prioritizing Resources

Majority of State and local Ombudsmen agree that funding and staffing are insufficient to meet federal mandates

Legal assistance can be difficult to access given limited resources for both the LTCOP (e.g., costs for requesting assistance) and for legal aid (e.g., not enough funding to sufficiently staff)

Training

More training is needed on specific issues facing long term care residents (e.g., involuntary discharges)

Opportunities to shadow peers in facilities

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26

Systems Advocacy

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What is Systems Advocacy?

Advocacy is defined as:

“The act of pleading for, supporting, or recommending.”

Systems are defined as:

“A combination of things or parts forming a complex or unitary whole” or “a coordinated body of methods or a scheme or plan of procedure.”

According to the OAA, systems advocacy involves the following:

Representing interests of residents

Seeking administrative, legal, or other remedies

Analyzing, commenting on, and recommending changes to a system to benefit long-term care residents

Facilitating public comment on laws, regulations, policies, and actions

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Who Performs Systems Advocacy?

Data: SLTCO Survey, Local Ombudsman Surveys, Volunteer Survey

SLTCO

46% report that their statewide program has expertise in systems advocacy. 

Local Ombudsmen

68% report that the Office of the State LTCO coordinates with local Ombudsman entities to carry out systems advocacy.

88% report that the Office of the State LTCO encourages their local Ombudsman entities to carry out systems advocacy.

Volunteer Ombudsmen

13% monitor and work on laws, regulations, government policies and actions.

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Who Performs Systems Advocacy?

Data: Local Ombudsman Survey
| Responsible for systems advocacy work | Local Ombudsmen |
|---------------------------------------|-----------------|
| Yes                                   | 57%             |
| No                                    | 26%             |
| I don’t know                          | 17%             |

Among local Ombudsmen with systems advocacy responsibilities:

30% report that they are unable to perform this task for various reasons (e.g. lack of time, resources, training)

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Systems Advocacy Activities – Local Ombudsmen
| Which of the following activities do you perform?            | “Yes”N=277*     | “No”N=121**     | “I don’t know”N=80***       | All Local OmbudsmenN=485**** |
|--------------------------------------------------------------|-----------------|-----------------|-----------------------------|------------------------------|
| Advocacy for changes to laws, regulations, or policies       | 45%             | 7%              | 10%                         | 29%                          |
| Engagement in policy making                                  | 20%             | 5%              | 2%                          | 13%                          |
| Grassroots organizing                                        | 12%             | 5%              | 1%                          | 8%                           |
| Communication with the media                                 | 18%             | 2%              | 6%                          | 13%                          |
| Involvement in committees such as work groups or task forces | 55%             | 18%             | 30%                         | 41%                          |
| Providing information to a public or private agency          | 52%             | 31%             | 38%                         | 45%                          |
| None of the above                                            | 4%              | 30%             | 23%                         | 14%                          |

Data: Local Ombudsman Survey

*Missing=2; **Missing=4; ***Missing=4; ****Missing=12

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Systems Advocacy Activities - Volunteers

Data: Volunteer Ombudsman Survey
| Which of the following activities do you perform?                          | Volunteer Ombudsmen |
|----------------------------------------------------------------------------|---------------------|
| Provide information, resources, and support to resident councils           | 68%                 |
| Provide information, resources, and support to family councils             | 28%                 |
| Monitor/work on laws, regulations, government policies and actions         | 13%                 |
| Work with media on issues impacting residents of long-term care facilities | 3%                  |

Average number of systems advocacy activities performed:

Local staff: 2 activities (range = 0-6).

Volunteers: 1 activity (range = 0-4).

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32

Program Resources

Data: SLTCO Survey
| Types of systems advocacy activities not fully carried out due to a lack of resources                          | SLTCO |
|----------------------------------------------------------------------------------------------------------------|-------|
| Resident and family council development and support                                                            | 60%   |
| Facilitating public comment on proposed legislation, laws, regulations, policies, and actions                  | 48%   |
| Research and policy analysis to inform systems advocacy work                                                   | 42%   |
| Analyzing and monitoring federal, state, and local law, regulations, and other government policies and actions | 38%   |

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Program Resources 

Data: SLTCO Interviews, SLTCO Survey, Local Ombudsman Survey

Prioritizing Resources

Funding challenges may cause programs to prioritize facility visits and individual case work over systems advocacy

Majority of State and local Ombudsmen agree that funding and staffing are insufficient to meet federal mandates

Training

Fewer than half of local Ombudsmen surveyed reported receiving training on systems advocacy in the past year

Some State Ombudsmen report a need for additional assistance in training staff to work with legislators

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34

Program Structure & Placement

Data: SLTCO Survey, Local Ombudsman Survey

“My program’s organizational structure enables my local Ombudsman entity to carry out systems advocacy activities.”

75% of local Ombudsmen in decentralized programs agree, compared to 49% of those in centralized programs.

80% of local Ombudsmen whose State Offices are housed outside of the SUA agree, compared to 66% of those housed in the SUA.

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35

Systems Advocacy and Program Autonomy  

Data: SLTCO Survey
| ----                                                                                  | Agree / Strongly Agree | Disagree /      Strongly Disagree | Don’t Know   |
|---------------------------------------------------------------------------------------|------------------------|-----------------------------------|--------------|
| Unable to fulfill some program duties due to legislative or regulatory restrictions   | 17%                    | 75%                               | 6%           |
| Autonomy to carry out systems advocacy                                                | 90%                    | 8%                                | 2%           |
| Free to speak to the media                                                            | 80%                    | 15%                               | 4%           |
| Able to represent residents’ interests to state agencies w/o political interference   | 83%                    | 12%                               | 6%           |

Majority of SLTCO feel they have autonomy to carry out systems advocacy, although some report a lack of support from their host agency or the state government.

Program resources may be the most significant barrier to carrying out systems advocacy.

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36

Training & Support

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Orientation, Training, and Support

Data: SLTCO Survey, Local Ombudsman Survey, Volunteer Ombudsman Survey
| Orientation, training, or support received when first began in role                  | SLTCO | Local Ombudsmen | Volunteer Ombudsmen |
|--------------------------------------------------------------------------------------|-------|-----------------|---------------------|
| Self-study (on-line training or reviewing materials provided by the State Office)    | 40%   | 59%             | 29%                 |
| Self-study (on-line training or reviewing materials provided by the Resource Center) | 75%   | 39%             | 15%                 |
| In-person training/In-services                                                       | 21%   | 90%             | 96%                 |
| Resource Center in-person training for new SLTCOs                                    | 67%   | N/A             | N/A                 |
| Resource Center webinar for new SLTCOs                                               | 56%   | N/A             | N/A                 |
| Mentoring/shadowing with State Ombudsman                                             | 44%   | N/A             | N/A                 |
| Mentoring/shadowing with experienced staff                                           | 40%   | 82%             | 74%                 |
| A more experienced staff member or volunteer observed me                             | N/A   | N/A             | 36%                 |
| Training in a nursing home setting or board and care home setting                    | 15%   | N/A             | N/A                 |
| Training in a long-term care facility                                                | N/A   | 45%             | 21%                 |
| Attending a resident or family council meeting                                       | 12%   | 45%             | 32%                 |
| Introduction to key stakeholders in my state                                         | 38%   | 17%             | 5%                  |
| Outreach by Federal or Regional ACL/AoA staff                                        | 42%   | 5%              | N/A                 |
| Outreach by State Ombudsmen from NASOP                                               | 60%   | N/A             | N/A                 |
| Outreach by individuals from NALLTCO                                                 | N/A   | 10%             | N/A                 |
| Training by legal counsel                                                            | 12%   | 11%             | 10%                 |
| Other                                                                                | 25%   | 3%              | 7%                  |
| None                                                                                 | 2%    | 1%              | <1%              |

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38

Effectiveness of Orientation Training

Data: SLTCO Survey, Local Ombudsman Survey, Volunteer Ombudsman Survey
| Effectiveness of Orientation Training | SLTCO | Local Ombudsmen | Volunteer Ombudsmen |
|---------------------------------------|-------|-----------------|---------------------|
| Very effective                        | 20%   | 46%             | 69%                 |
| Somewhat effective                    | 50%   | 37%             | 26%                 |
| Neutral                               | 16%   | 11%             | 3%                  |
| Somewhat ineffective                  | 6%    | 5%              | 1%                  |
| Very ineffective                      | 6%    | 2%              | 1%                  |
| Don’t know                            | 2%    | <1%          | <1%              |

Local Ombudsmen were able to identify the types of training most relevant to their role. 

Mentoring or shadowing with experienced program staff and on-site or field training at facilities

Classroom training and self-study

Training on laws and regulations for long-term care facilities and resident rights, program policies and guidelines, and mediation and advocacy generally

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39

Effectiveness of Orientation Training

Data: SLTCO Survey, Local Ombudsman Survey, Volunteer Ombudsman Survey
| Other training would have been helpful during orientation | SLTCO | Local Ombudsmen | Volunteer Ombudsmen |
|-----------------------------------------------------------|-------|-----------------|---------------------|
| Yes                                                       | 51%   | 39%             | 26%                 |
| No                                                        | 49%   | 61%             | 74%                 |

Training that would have been helpful during orientation:

SLTCO – NORS data entry, providing services to for residents in home and community based settings and residents with behavioral health issues, and working with legislatures.

Local Ombudsmen – Communication skills (e.g., writing memos and interacting with residents and their families/guardians), and conflict resolution and mediation skills.

Volunteer Ombudsmen – More hands-on training (e.g., internships and site visits), communication skills (e.g., improving interactions with residents with dementia), and complaint documentation and reporting.

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40

Additional Training and Support Needs

Data: Local Ombudsman Survey, Volunteer Ombudsman Survey
| Additional support desired                                    | Local Ombudsmen | Volunteer Ombudsmen |
|---------------------------------------------------------------|-----------------|---------------------|
| More information from State Ombudsman/program staff           | 17%             | 14%                 |
| More opportunities to discuss challenges with supervisor      | 21%             | 19%                 |
| More opportunities to discuss challenges with other Ombudsmen | 36%             | 32%                 |
| More professional development opportunities                   | 44%             | N/A                 |
| More formal training                                          | N/A             | 18%                 |
| More feedback on my performance and effectiveness             | 20%             | 18%                 |
| Did not select any of the above                               | 29%             | 37%                 |

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41

Ratings of National, State, and Local Entities

Data: SLTCO Survey

State Ombudsmen: How helpful have the following entities been to you?
| Entities                                           | Very helpful | Somewhat helpful | Not helpful | Total N | NA |
|----------------------------------------------------|--------------|------------------|-------------|---------|----|
| SUA                                                | 37%          | 49%              | 14%         | 51      | 1  |
| NASOP                                              | 73%          | 27%              | 0%          | 52      | 0  |
| Resource Center                                    | 87%          | 13%              | 0%          | 52      | 0  |
| National Consumer Voice for Quality Long-Term Care | 82%          | 18%              | 0%          | 50      | 0  |
| NASUAD                                             | 10%          | 63%              | 27%         | 49      | 2  |
| ACL/AoA                                            | 32%          | 62%              | 6%          | 50      | 1  |
| ACL/AoA - Regional Office                          | 38%          | 48%              | 14%         | 50      | 1  |
| Justice in Aging                                   | 52%          | 41%              | 7%          | 44      | 7  |
| Support from other state agencies                  | 35%          | 52%              | 13%         | 46      | 4  |

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42

Ratings of National, State, and Local Entities

Data: Local Ombudsman Survey

Local Ombudsmen: How helpful have the following entities been to you?
| Entities                                   | Very helpful | Somewhat helpful | Not helpful | Not familiar with resource/Not applicable |
|--------------------------------------------|--------------|------------------|-------------|-------------------------------------------|
| AAA                                        | 34%          | 35%              | 13%         | 18%                                       |
| SUA                                        | 15%          | 33%              | 24%         | 80%                                       |
| Office of the State LTCO                   | 58%          | 31%              | 6%          | 4%                                        |
| NALLTCO                                    | 25%          | 40%              | 14%         | 58%                                       |
| Resource Center                            | 48%          | 39%              | 4%          | 13%                                       |
| Resource Center website (ltcombudsman.org) | 47%          | 37%              | 4%          | 16%                                       |

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43

Ratings of National, State, and Local Entities

Data: Volunteer Ombudsman Survey

Volunteer Ombudsmen: How helpful have the following entities been to you?
| Entities                                   | Very helpful | Somewhat helpful | Not helpful | Not familiar with resource/Not applicable |
|--------------------------------------------|--------------|------------------|-------------|-------------------------------------------|
| AAA                                        | 28%          | 20%              | 4%          | 47%                                       |
| Local Ombudsman entity                     | 61%          | 20%              | 1%          | 17%                                       |
| Office of the State LTCO                   | 32%          | 35%              | 6%          | 27%                                       |
| NALLTCO                                    | 8%           | 14%              | 5%          | 72%                                       |
| Resource Center                            | 12%          | 18%              | 5%          | 65%                                       |
| Resource Center website (ltcombudsman.org) | 11%          | 18%              | 6%          | 66%                                       |

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44

Sufficiency of Resource Center Resources

Data: SLTCO Survey, Local Ombudsman Survey, Volunteer Ombudsman Survey
| Sufficiency of Resources Provided by the Resource Center for Carrying Out Statewide or Local Ombudsman Entity Responsibilities | Statewide Ombudsman Program | Local Ombudsman Programs |
|--------------------------------------------------------------------------------------------------------------------------------|-----------------------------|--------------------------|
| Yes                                                                                                                            | 76%                         | 71%                      |
| Somewhat                                                                                                                       | 20%                         | NA                       |
| No                                                                                                                             | 0%                          | 15%                      |
| Don't know                                                                                                                     | 4%                          | 14%                      |

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45

Sufficiency of Resource Center Resources

Data: SLTCO Survey, Local Ombudsman Survey, Volunteer Ombudsman Survey
| Sufficiency of Resources Provided by the Resource Center for Carrying Out Individual Ombudsman Work | Local Ombudsmen | Volunteer Ombudsmen |
|-----------------------------------------------------------------------------------------------------|-----------------|---------------------|
| Yes                                                                                                 | 59%             | 34%                 |
| No                                                                                                  | 7%              | 4%                  |
| Don't know                                                                                          | 34%             | 61%                 |

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46

Volunteers

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Volunteer Ombudsmen Profile

Data: Volunteer Ombudsman Survey
| Characteristics             | Mean    | Median  | Range                      |
|-----------------------------|---------|---------|----------------------------|
| Age                         | 70      | 77      | 27-90                      |
| Length of time as volunteer | 6 years | 4 years | Less than 1 month-32 years |
| Hours per month             | 14      | 10      | 1-160                      |

76% of volunteers are female and 88% are white (97% are non-Hispanic/Latino).

70% of volunteers have a bachelor’s degree or an advanced degree.

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48

Volunteer Ombudsmen 

Data: Volunteer Ombudsman Survey
| Race                                      | Volunteer Ombudsmen |
|-------------------------------------------|---------------------|
| American Indian or Alaska Native          | 1%                  |
| Asian                                     | 4%                  |
| Black or African American                 | 4%                  |
| Native Hawaiian or Other Pacific Islander | 0%                  |
| White                                     | 88%                 |

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49

Volunteer Ombudsmen 

Data: Volunteer Ombudsman Survey
| Education                                                                    | Volunteer Ombudsmen |
|------------------------------------------------------------------------------|---------------------|
| Less than high school or GED                                                 | 0%                  |
| High school or GED                                                           | 5%                  |
| College coursework but not degree (may include community college coursework) | 17%                 |
| Associate's degree                                                           | 9%                  |
| Bachelor's degree                                                            | 20%                 |
| Some graduate work                                                           | 9%                  |
| Master's degree                                                              | 32%                 |
| Juris Doctorate                                                              | 3%                  |
| Doctor of Philosophy                                                         | 5%                  |
| Medical Degree                                                               | 1%                  |

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50

Volunteer Ombudsmen 

Data: Volunteer Ombudsman Survey
| Employment status                                                     | Volunteer Ombudsmen |
|-----------------------------------------------------------------------|---------------------|
| Retired                                                               | 77%                 |
| Employed full-time                                                    | 9%                  |
| Employed part-time                                                    | 11%                 |
| Out of work and looking for paid work (either part-time or full-time) | 2%                  |
| A homemaker                                                           | 7%                  |
| A student                                                             | 2%                  |

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51

Volunteer Ombudsmen 

Data: Volunteer Ombudsman Survey
| How volunteers learned about the LTCOP                                              | Volunteer Ombudsmen |
|-------------------------------------------------------------------------------------|---------------------|
| LTCOP website                                                                       | 7%                  |
| LTCOP program materials (for example, poster, brochure)                             | 8%                  |
| In-person conversation with program staff or volunteers                             | 26%                 |
| LTCOP article or advertisement in a newspaper or other publication or on television | 34%                 |
| Social media (for example, Facebook, Twitter)                                       | 2%                  |
| Family/friends received long-term services and supports                             | 8%                  |
| Presentation by program staff or volunteers                                         | 10%                 |

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52

Volunteer Ombudsmen 

Data: Volunteer Ombudsman Survey
| Motivation to work for LTCOP                            | Volunteer Ombudsmen |
|---------------------------------------------------------|---------------------|
| Personal fulfillment (e.g. enjoyment in helping others) | 67%                 |
| Career development                                      | 6%                  |
| Interest in the program's mission                       | 54%                 |
| Family/friends received long-term services and supports | 27%                 |
| Personal experience with the program                    | 8%                  |

20% of volunteer Ombudsmen reported that they previously held a position with the LTCOP. 

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53

Volunteer Ombudsmen 

Data: Volunteer Ombudsman Survey
| How volunteers feel about their work in the LTCOP                            | Strongly disagree | Disagree | Neutral | Agree | Strongly agree |
|------------------------------------------------------------------------------|-------------------|----------|---------|-------|----------------|
| I feel burned out from my work                                               | 45%               | 33%      | 14%     | 6%    | 2%             |
| I feel I'm positively influencing other people's lives through my work.      | 6%                | 1%       | 6%      | 46%   | 42%            |
| I have the support of supervisory and managerial staff to carry out my work. | 6%                | 2%       | 7%      | 29%   | 55%            |

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54

Volunteer Ombudsmen 

Data: Volunteer Ombudsman Survey
| Job satisfaction as an Ombudsman | Volunteer Ombudsmen |
|----------------------------------|---------------------|
| Very satisfied                   | 66%                 |
| Somewhat satisfied               | 26%                 |
| Neutral                          | 4%                  |
| Somewhat dissatisfied            | 3%                  |
| Very dissatisfied                | 1%                  |

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55

Outcome Evaluation

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Looking Ahead

Upcoming Evaluation Activities

Outcome Evaluation

National Post-Acute and Long-Term Care Study (NPALS)

NORC at the University if Chicago developed two survey items to be included in the 2020 NPALS.

Surveys 

SUA Directors

Former Ombudsmen 

Facility Administrators 

Focus Groups

Facility Staff 

Stakeholders 

Residents 

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57

Thank you

Kim Nguyen, PhD	

301-634-9495

nguyen-kim@norc.org 

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58

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