Date: 

To: 

From: 

RE: 

~ ACL 

Administration for Community Living 

Improving the Lives of Older Adults and People with Disabilities 

Through Services, Research, and Education 

November 27, 2019 

State Long-Term Care Ombudsmen 

Edwin 

Director

FINAL 

L. 

Long-Term 

, Office 

Walker, 

of 

Deputy 

Long-Term 

Care Ombudsman 

Assistant 

Care 

Secretary 

Ombudsman 

Program 

for 

Training 

Aging 

Programs 

Standards 

~ 

Thank you for your participation in the development of Long-Term Care Ombudsman program 

training standards. Today I am providing the final training standards, which fulfill the Older 

Americans Act requirement for the Office of Long-Term Care Ombudsman Programs (within the 

Administration for Community Living) to establish standards applicable to the training required 

for representatives of the Office of Ombudsman (representatives) in each state. I am sure you 

share my belief that training designed and delivered pursuant to these standards will support the 

on-going effectiveness of states' Ombudsman programs. 

The development of training standards was a deliberative process, which considered the findings 

from the National Ombudsman Resource Center (NORC) report Long-Term Care Ombudsman 

Program Training Standards Report of Workgroup Meetings and Proposals for Standards. 1 The 

workgroup was comprised of state Ombudsmen, Ombudsman program representatives, and other 

stakeholders. Additionally, the National Association of State LTC Ombudsman Programs 

(NASOP) and the National Association of Local LTC Ombudsmen (NALLTCO) provided 

guidance beyond the work of the NORC report. 

ACL staff also considered other information including the findings from the Ombudsman 

Program Evaluation Study conducted by NORC at the University of Chicago. Highlights from 

the survey data from paid and volunteer representatives indicate that: 

o 96% of volunteers reported receiving in-person training and had several examples of field 

training, i.e. 74% received shadowing/mentoring observed by an experienced 

Ombudsman, etc. 

o 93% of staff Ombudsmen report having in-person training. 87% report having field 

training. 

1 https://ltcombudsman.org/uploads/files/library/training-standards-report.pdf 

330 C Street SW I Washington, DC 20201 I (202) 401 -4634 I ACL.GOV 
o 40% of paid and 25% of volunteer representatives indicated that more training would 

have been helpful. Desired topics for which additional training was requested included 

mentoring and/or shadowing with experienced staff, more site visits, and additional 

hands-on, facility-based trainings. 

All of this feedback, engagement, and data were most helpful in solidifying the final standards. 

The training standards intend to support flexibility while acknowledging the importance of field 

visits, and interactive training, either in person or by technology. Recognizing the complexity of 

the work of representatives of the Office, the minimum durational requirements for training will 

provide a solid foundation, with reinforcement through continuing education to support a 

successful experience for the learner and for the residents that they will serve. 

I recognize for some programs that will need to increase their training hours, it may take time to 

adapt. Therefore, ACL's goal is for states to achieve the minimum training requirements no later 

than September 30, 2021. ACL will review states' ability to meet the training standard through 

the annual NORS report, which asks state Ombudsmen to report their training standard hours. 

The Ombudsman Resource Center will focus efforts on revising training modules and developing 

interactive training applicable to all representatives of the Office to support your efforts. 

I appreciate your assistance in sharing the training and resources created by the NORC with your 

representatives, including volunteers. 

Thank you again for your contributions to the development of the Long-Tenn Care Ombudsman 

Program Training Standards. 

cc: State Unit on Aging Directors 

Attaclm1ent: Long-Tenn Care Ombudsman Program Training Standards 
Administration for Community Living/Administration on Aging 

Office of Long-Term Care Ombudsman Programs 

Long-Term Care Ombudsman Program Training Standards 

Why do Long-Term Care Ombudsman programs need training standards? 

The Long-Term Care Ombudsman Program (Ombudsman program) promotes and protects the health, 

safety, welfare and rights of individuals (residents) living in long-term care facilities (nursing homes, 

residential care communities, including assisted living and similar settings.) The Older Americans Act 

and corresponding regulation directs the Ombudsman and the representatives of the Office to conduct a 

variety of activities in support of residents. These activities1 include: 

► Services to assist the residents in protecting the health, safety, welfare, and rights of the 

residents, 

► Investigating Complaints, 

► Informing residents about how to obtain services, 

► Ensuring that residents have regular and timely access to the Ombudsman program, 

► Representing the interests of residents before governmental agencies, 

► Seeking administrative, legal, and other remedies to protect the health, safety, welfare, and 

rights of residents, 

► Analyzing, commenting on, and monitoring the development and implementation of Federal, 

State, and local laws, regulations. 

To fulfill this mandate the Ombudsman and the representatives of the Office must have subject matter 

knowledge of resident rights, facility regulatory standards, the resident experience, complaint 

investigation and the Ombudsman program's policies and procedures. They also need to know how to 

operationalize this knowledge; for instance, how to carry out the program polices on complaint handling 

procedures, how to access resident records and steps to disclose resident information. 2 Residents call 

on Ombudsman programs to resolve a variety of problems; often times to address basic quality of life 

concerns and complex matters of eviction or abuse and neglect, therefore a baseline competency of 

both knowledge and skills is necessary to support effective and credible Ombudsman program services. 

Statutory Background: 

The Older Americans Act requires the Director of the Office of Long-Term Care Ombudsman Programs 

(within the Administration for Community Living) to establish standards applicable to the training 

required for representatives of the Office of Ombudsman in each state3• 

1 Older Americans Act Sec. 712 (a) (3) Functions of the Ombudsman 

2 The Long-Term Core Ombudsman Program: Rethinking ond Retooling for the Future. (April, 2003) "The skills needed to be an 

ombudsman are diverse and sophisticated, ranging from the ability to communicate effectively with providers and regulators, 

family members and representatives of community organizations, and, most importantly, residents. Communication skills must 

include the ability to interview and to effectively elicit facts and then to document the facts and information obtained." 

3 (L) not later than 180 days after the date of the enactment of the Older Americans Act Reauthorization Act of 

2016, establish standards applicable to the training required by section 712(h)(S); and 

Administration for Community Living/ Administration on Aging - Long-Term Care Ombudsman Program Training Standards 
The standards are to: 

(A) specify a minimum number of hours of initial training; 

(B) specify the content of the training, including training relating to-

(i) Federal, State, and local laws, regulations, and policies, with respect to long-term 

care facilities in the State; 

(ii) investigative techniques; and 

(iii) such other matters as the State determines to be appropriate; and (C) specify an 

annual number of hours of in-service training for all designated representatives. 

§201(2)(L) and §712(h)(5). 

Section 712(h)(6) prohibit any representative of the Office (other than the Ombudsman) from carrying 

out any activity described in subparagraphs (A) through (G) of subsection (a)(3) unless the 

representative-

(A) has received the training required under paragraph (5); and 

(B) has been approved by the Ombudsman as qualified to carry out the activity on behalf of the 

Office. 

The Ombudsman program rule at 45 CFR 1324.13(c) further describe the functions and responsibilities 

of the State Long-Term Care Ombudsman concerning training. 

(2) Training requirements. The Ombudsman shall establish procedures for training for certification and 

continuing education of the representatives of the Office, based on model standards established by the 

Director of the Office of Long-Term Care Ombudsman Programs as described in section 201(d) of the 

Act, in consultation with residents, resident representatives, citizen organizations, long-term care 

providers, and the State agency, that-

(i) Specify a minimum number of hours of initial training; 

(ii) Specify the content of the training, including training relating to Federal, State, and local 

laws, regulations, and policies, with respect to long-term care facilities in the State; investigative 

and resolution techniques; and such other matters as the Office determines to be appropriate; 

and 

(iii) Specify an annual number of hours of in-service training for all representatives of the Office; 

(3) Prohibit any representative of the Office from carrying out the duties described in §1324.19 unless 

the representative-

(i) Has received the training required under paragraph (c)(2) of this section or is performing such 

duties under supervision of the Ombudsman or a designated representative of the Office as part 

of certification training requirements; and 

(ii) Has been approved by the Ombudsman as qualified to carry out the activity on behalf of the 

Office. 

In fulfillment of Section 712(h) (5)(6), the Administration for Community Living/ Administration on Aging 

establishes the following model training standards for purposes of designating representatives of the 

Office of State Long-Term Care Ombudsman. 

2 

Administration for Community Living/Administration on Aging-Long-Term Care Ombudsman Program Training Standards 
I. Training standards for purposes of designation: 

Each State Long-Term Care Ombudsman Program is to provide a minimum of 36 hours of initial 

certification training. Ombudsman programs may choose to require more hours of training than the 

minimum. Training hours shall include: 

► Up to 7 hours (or no more than 20% for states that provide for more than 36 hours of 

training) may be independent study/homework. 

► At least 10 hours in the field, which may include structured tours and shadowing with an 

experienced representative of the Office, meeting with resident councils, etc. 

► A range of 16 to - 20 hours conducted in a classroom style setting (including remote 

classroom format such as live webinars and/or phone discussions). This classroom 

training is to incorporate adult learning techniques such as case studies, role-plays and 

other interactive activities. States may choose to utilize selective presentations by other 

relevant agencies, such as the survey and certification agency, or legal assistance as part 

of these hours. 

Recommended practices prior to training: 

✓ Programs screen prospective representatives of the Office (both paid and volunteer) in 

accordance with state policies and procedures. 

✓ Prospective representatives of the Office are aware of individual conflicts of interest and have 

had at a minimum a preliminary conflict of interest screening in accordance with state policies 

and procedures. 

Curriculum content must include but not limited to the following subject matter knowledge4 : 

1. The Ombudsman program's role, responsibility and authority, specifically; 

a. Governing statues and regulations: Older Americans Act, Ombudsman program federal 

rule at 45 CFR 1324; applicable state statutes and regulations. 

b. Ombudsman program - organizational location, and structure, key program staff. 

c. Role of the State Ombudsman - functions and responsibilities 

i. Identify, investigate, and resolve complaints, 

ii. Ensure that residents have regular and timely access to the Ombudsman program, 

iii. Represent the interests of residents before governmental agencies, etc., 

iv. Analyze, comment on, and monitor the development and implementation of 

Federal, State, and local laws, regulations, and other governmental policies 

(systems advocacy,) 

v. Statewide leader, 

vi. Designate representatives of the Office, 

vii. Sole authority to make or delegate determinations concerning the disclosure of 

the files, records, and other information maintained by the Ombudsman program. 

d. Duties of designated representatives of the Office 

4 The order and the length of time allotted for each subject is at the discretion of the State LTC Ombudsman. 

3 

Administration for Community Living/ Administration on Aging - Long-Term Care Ombudsman Program Training Standards 
i. Similarities to role of state Ombudsman, i.e. to investigate complaints, provide 

access, 

ii. Differences from role of state Ombudsman 

1. Program policies re: systems advocacy and the role of a designated 

representative of the Office, 

2. Release of program information. 

e. Ethics and conflicts of interest - both individual and organizational. 

2. The resident and the resident experience 

a. Introduction to common health issues individuals using Long-Term Services and 

Supports (LTSS) may experience. Types of disabilities that people may live with 

including physical disabilities, developmental and intellectual disabilities, Alzheimer's 

disease and related dementias, significant mental illnesses, 

b. Resident experience living in a long-term care setting, 

c. Myths and stereotypes about older adults and persons with disabilities. 

3. Long-term care settings - Overview 

a. Skilled Nursing Facility- federal regulations and any relevant state statues & 

regulations 

i. Resident rights, 

ii. Assessment & care planning - person centered care, 

iii. Transfer & discharge requirements and challenges, 

iv. Survey and inspection process. 

b. Residential Care Community, as defined in the state 

i. Types of settings in the respective state, 

ii. Characteristics and level of services provided, 

iii. Resident rights, as applicable in state law, 

iv. CMS HCBS settings requirements as applicable, 

v. Licensing, survey, certification and similar process. 

c. Resident and family councils 

i. Purpose, 

ii. Facility staff role and responsibilities, 

iii. Ombudsman program role. 

4. Access to residents, facilities & records 

a. Program expectations regarding providing in-person access to residents and program 

standards regarding frequency of visits and protocols to follow during a visit. 

b. Access to facilities and residents 

i. Program access policies during regular hours and at any other time when access 

may be required by the circumstances to be investigated, 

ii. Access to the resident and to the name and contact information of the resident 

representative, if any, 

iii. Program policies on access to facility records- administrative records, policies, 

and documents, to which the residents have, or the public has access. 

Administration for Community Living/Administration on Aging- Long-Term Care Ombudsman Program Training Standards 

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c. Program procedure for access to resident records 

i. Access to review the residents' medical, social and other records 

1. Requirements and steps to obtain consent to access resident records, 

2. HIPAA rule and the Ombudsman program. 

5. Disclosure 

a. Disclosure of resident information and Ombudsman program records 

i. Program records may be disclosed only at the discretion of the Ombudsman or 

designee or pursuant to court order, 

ii. Prohibition of the disclosure of identifying information of any resident or 

complainant unless -

1. resident or the resident representative communicates informed consent 

to the disclosure (verbal or documented,) 

2. State Ombudsman has authorized disclosure, 

3. In compliance with a court order. 

iii. Program policies and procedures; steps taken to disclose information. 

6. Role of Resident Representative 

a. Resident decision-making supports and options, 

b. State laws on third party decision makers; including guardianship, communication with a 

guardian, with a resident for whom a guardian has been appointed. 

c. Program polices on communication with resident representatives with regards to 

complaint processing in particular; 

i. the Ombudsman or representative of the Office shall ascertain the extent of the 

authority that has been granted to the resident representative. 

7. Complaint Investigation 

• Reinforce access, disclosure, and role of the program as a resident advocate as part 

of complaint processing, 

• Problem solving including Interviewing, observation and complaint investigation 

techniques, 

• Verification and resolution. 

a. Common types of complaints - including the use of the states' NORS data, 

b. Abuse, neglect, exploitation, and the role of the Ombudsman program, 

c. Program policies and procedures related to complaint investigation 

i. Resident consent to take action, 

ii. Role of resident representative, 

iii. Resident consent to disclose information, 

iv. Steps to take when no representative and resident not able to consent, 

v. If witness abuse, neglect or exploitation, 

Administration for Community Living/Administration on Aging - Long-Term Care Ombudsman Program Training Standards 

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vi. Resolution strategies including referrals to outside entities, resolving at facility 

level, mediation, etc. 

8. Common resources and agencies 

a. Role of Ombudsman program legal counsel and legal assistance representation of 

residents, 

b. Natural partner agencies that assist residents which may include Older Americans Act 

programs, case management, adult protective services, protection and advocacy, 

dementia specialist, and others as identified by the State Ombudsman, 

c. Programs that pay for long-term services and supports, including an introduction to 

Medicare and Medicaid. 

9. Documentation 

a. Consent to access and consent to disclose forms, 

b. NORS documentation - case, complaints consultation, activities. 

10. Communication 

a. Communication with residents, their representatives, facility staff and others, 

b. Visit protocol and techniques to ensure that the representative of the Office provides 

consistent in-person access to residents. 

c. Types of communication -verbal, non-verbal, cultural differences, etc., 

d. Use of auxiliary aides and services in communication with residents. 

Learning Outcomes: 

After completion of training, the learner will understand, i.e. be able to describe or know how to find 

and operationalize the following information: 

1. The Ombudsman program serves a vital purpose at the individual and systems level. 

2. The representative of the Office is part of a statewide program under the direction of the Office 

of State Ombudsman and carries specific responsibilities and duties to the resident and the 

program. 

3. The program serves as a resource to resident their families and facility staff with the goal to 

promote and protect the heath safety, welfare and rights of residents. 

4. Resident rights and choice are paramount and the program promotes empowerment and is 

person-directed. 

5. Relevant laws, along with where to find information on these laws, i.e. how to use the training 

manual, links to websites, who to call for technical assistance. 

Administration for Community Living/ Administration on Aging - Long-Term Care Ombudsman Program Training Standards 

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6. Awareness of different communication styles and strategies to communicate. 

7. The importance of and responsibility to maintain confidentiality of all communications, records 

and other information with residents, complainants and others. 

8. Steps to take when investigating a complaint and purpose of resolving the complaint to the 

resident's satisfaction and of protecting the health, welfare, and rights of the resident; including: 

a. Duty to support and maximize resident participation in the process of resolving the 

complaint, 

b. Obligation to obtain consent to begin investigating a complaint, 

c. Understanding confirmed of the balance of being an impartial fact finder when 

conducting an investigation and being a person-centered advocate to support the 

resident's desired outcome. 

9. Programmatic requirements 

a. Who contact for support 

b. Access to and understanding of how to use the program policies and procedures 

c. Familiarity with routine requirements to avoid, identify and remedy individual conflicts 

of interest 

d. Affirms the importance of completing NORS and other required documentation 

II. Annual In-Service Training hours required for maintaining designation 

1. A minimum 18 hours per year is required although more hours are encouraged, especially for 

paid representatives of the Office. The Ombudsman program does not need to personally 

conduct all in-service training and shall provide or arrange training based on the needs of 

representatives of the Office. 

a) Methods - A combination of training methods is acceptable: 

i. Classroom - including role-plays and other interactive activities; presentations by 

experts of other agencies, or internal case discussions, NORS consistency training or 

reviews, etc. Classroom training includes remote classroom formats such as live 

webinars and/or phone discussions) 

ii. In-facility training such as shadowing a trained representative of the Office or 

observing a survey process. 

iii. Web-based and self-learning techniques are acceptable including training offered by 

other entities, such as the National Center for Law and Elder Rights (NCLER), the 

National Center on Elder Abuse (NCEA), etc. 

iv. Recommend utilizing training / webinars provided or sponsored by the National 

Ombudsman Resource Center. 

Administration for Community Living/Administration on Aging-Long-Term Care Ombudsman Program Training Standards 

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Definitions from 45 CFR 1324.1 that apply to this document 

Office of the State Long-Term Care Ombudsman, as used in sections 711 and 712 of the Act, means the 

organizational unit in a State or territory, which is headed by a State Long-Term Care Ombudsman. 

Representatives of the Office of the State Long-Term Care Ombudsman, as used in sections 711 and 

712 of the Act, means the employees or volunteers designated by the Ombudsman to fulfill the duties 

set forth in §1324.19(a), whether personnel supervision is provided by the Ombudsman or his or her 

designees or by an agency hosting a local Ombudsman entity designated by the Ombudsman pursuant 

to section 712(a)(S) of the Act. 

State Long-Term Care Ombudsman, or Ombudsman, as used in sections 711 and 712 of the Act, means 

the individual who heads the Office and is responsible to personally, or through representatives of the 

Office, fulfill the functions, responsibilities and duties set forth in §§1324.13 and 1324.19. 

State Long-Term Care Ombudsman program, Ombudsman program, or program, as used in sections 

711 and 712 of the Act, means the program through which the functions and duties of the Office are 

carried out, consisting of the Ombudsman, the Office headed by the Ombudsman, and the 

representatives of the Office. 

Administration for Community Living/Administration on Aging- Long-Term Care Ombudsman Program Training Standards 

8