Ombudsman Program Process Evaluation: Progress and Initial Data

The National Consumer Voice for Quality Long-Term Care Conference, Arlington, VA

November 6, 2017

Kim Nguyen, PhD, NORC

Louise Ryan, MPA, ACL/AoA

Susan Jenkins, PhD, ACL/AoA

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Evaluation Team 

Process Evaluation and Special Studies Related to the LTCOP

NORC at the University of Chicago (NORC)

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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Research Questions

Process Evaluation and Special Studies Related to the LTCOP

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 governmental (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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Data Collection 

Process Evaluation and Special Studies Related to the LTCOP

Round 1 Data Collection

Telephone Interviews

Federal Staff (5)

Stakeholders (19)

State Ombudsmen (53)

Round 2 Data Collection 

Online Surveys

State Ombudsmen (census)

Local Ombudsmen (sample)

Volunteers (sample)

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Preliminary Findings

Round 1 Data Collection: Stakeholders

Uniqueness of Program

Mission

OAA  

Federally mandated to advocate for individuals living in facilities

Role of the Ombudsman

Structure

Requirement for independence

Funding

Volunteers

Heavy reliance on volunteers in delivering services

Attracts individuals with professional backgrounds 

Work characterized by a high level of responsibility

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Preliminary Findings

Round 1 Data Collection: Stakeholders

Strengths of Program 

Mission

Serves as the voice of long-term care residents

Structure

Access to residents and greater flexibility in addressing issues than other entities (such as licensing and certification)

Degree of independence afforded to the Ombudsman 

Program Staff and Volunteers

Passionate, knowledgeable, committed

Direct, face-to-face interactions with individuals

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Preliminary Findings

Round 1 Data Collection: Stakeholders

Program Visibility/Awareness

Stakeholders

High visibility within aging and disabilities network

Factors facilitating visibility of program

Efforts of Kathy Greenlee and Becky Kurtz

Participation in coalitions, taskforces, etc.

Implementation of Final Rule

Consumers

Awareness is low at the consumer level

Among current residents, awareness is on an as-needed basis.

Among prospective residents, visibility is lower. 

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Preliminary Findings

Round 1 Data Collection: Stakeholders

Program Effectiveness

Overall, the LTCOP is perceived to be effective.

Effectiveness also understood to vary across and within states.

Basis of Assessment (Metrics Used)

Observations and Anecdotes

Direct experience with complaint handling process   

Stories shared by State Ombudsmen or other stakeholders regarding activities 

Interactions with State Ombudsmen at trainings and conferences

NORS data

Frequency of visits, description of resident concerns and how they were addressed 

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Preliminary Findings

Round 1 Data Collection: State Ombudsmen

Program Structure

Types of state LTCOP structures:

State-level: Most often in an SUA, but can be in another state government agency or a nonprofit

Local level: Centralized or decentralized (local Ombudsman entities in AAAs or other host agencies)

Trade-offs with each type of organizational placement:

Location in an SUA or related government agency allows access to a variety of resources and facilitates relationships to coordinating entities

Location in an independent state agency or nonprofit facilitates autonomy

SUA support is valuable regardless of structure

Final Rule helped clarify LTCOP role and need for autonomy within program structure 

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Preliminary Findings

Round 1 Data Collection: State Ombudsmen

Resources and Program Capacity

Insufficient funding commonly reported as a challenge and source of frustration to provide desired level of service, or in many cases, service to meet federal mandates 

Funds were perceived to be insufficient with respect to  staffing, salaries, travel, and data systems 

However, some Ombudsmen reported that their program has sufficient funding to carry out responsibilities 

Ombudsmen noted the need to identify and advocate for resources to supplement federal funding to ensure program success

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Preliminary Findings

Round 1 Data Collection: State Ombudsmen

Resources and Program Capacity

Many programs struggle to visit all long-term care facilities quarterly and to conduct non-complaint-related visits 

Barriers to regular visits include staffing, distance of facilities from local Ombudsman entities 

Some reported difficulty taking on fiscal management responsibilities (OAA and Final Rule requirement) due to lack of expertise and sufficient access to budget information

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Preliminary Findings

Round 1 Data Collection: State Ombudsmen

Prioritizing Resources

Funding challenges compel State Ombudsmen to prioritize resources and program activities 

Programs may prioritize: 

Facility visits and individual case work over systems advocacy 

Case/complaint work over non-complaint visits

Cases where a resident’s health or safety is at risk

Visits to some facility types (such as nursing homes) over other facility types

Handling cases over the phone when possible (to reduce travel costs)

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Preliminary Findings

Round 1 Data Collection: State Ombudsmen

Volunteers

Successful recruitment strategies included the following:

Working with an educational institution to recruit students with community service requirements

Human interest stories in the media that highlight the LTCOP and the difference it has made in the lives of those served

Media stories about volunteers

Advertising through radio, television, and newspapers

Outreach in community settings such as churches, health fairs, and senior centers

Working with AARP to educate members about the program

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Preliminary Findings

Round 1 Data Collection: State Ombudsmen

Volunteers

Successful management strategies included the following:

Hiring a volunteer coordinator to help recruit, train, and supervise volunteers Potential benefits: 

Increase volunteers 

Improve training 

Support volunteers in addressing challenging issues, may reduce stress and help with retention

Interested volunteers required to shadow another volunteer before they undergo training 

Allows the prospective volunteer to better understand the role and confirm their interest 

Ensures commitment before investing valuable staff time in onboarding process

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Preliminary Findings

Round 1 Data Collection: State Ombudsmen

Coordinating entities

Benefits. Many ombudsmen described relationships with coordinating entities as positive and critical to carrying out their work. State agencies and other stakeholder organizations assist the program with: 

Providing services and resources to residents 

Supporting systems advocacy work to improve quality of care for residents 

Providing the “teeth” to compel nursing homes and facilities to improve care

Education on how to meet the needs of special populations

Barriers. Developing relationships can be challenging due to:

Lack of understanding of the LTCOP’s role and responsibilities

Different perspectives or priorities

Time constraints for staff at both LTCOP and coordinating entities

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Preliminary Findings

Round 1 Data Collection: State Ombudsmen

Program support

National Ombudsman Resource Center  

Ombudsmen uniformly appreciated the Resource Center’s assistance, particularly: website resources (such as webinars, issue briefs, training modules); individualized technical assistance; queries to all State Ombudsmen to address state-specific requests

Some found the navigation tool difficult to find resources on the website

ACL 

Helpful support includes one-on-one consultation and technical assistance, conference presentations, and website materials

Limited ACL guidance or involvement in State Office goal setting aside from the Final Rule

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Looking Ahead

Pending Data Collection

Process Evaluation – Round 2 

Online Surveys

State Ombudsmen (53)

Local Ombudsmen (27 states)

Volunteers (26 states)

Outcomes Evaluation  

Longitudinal Study

Interviews

Focus Groups

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Thank You!

Kim Nguyen, PhD

301-634-9495

nguyen-kim@norc.org

Thank You!

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