President Nixon proposed initiatives in 1975 creating ombudsman units whose focus would be on individual residents, thus compensating for the limitations of quality assurance and regulation. In 1978, amendments to the Older Americans Act required each state to establish an ombudsman program. In 1981, decisions by Congress added board and care facilities to the ombudsman federal mandate. Although this legislation did not change the qualities of the ombudsman program, it greatly increased the population that required ombudsman services. The scope of the ombudsman program's responsibilities and authority are described in Title VII, Chapter 2 of the Older Americans Act.
Ombudsmen take on a variety of roles at different levels.
On a systems-level, ombudsmen attempt to solve broader or underlying causes of problems by advocating for policy change. This is done by evaluating laws and regulations, educating public and facility staff, analyzing program data, and promoting resident and family councils. On a resident-level, the ombudsmen's responsibilities include working cooperatively with outside agencies and providing assistance and training to facility staff. It is important that ombudsmen ensure residents have timely access to the ombudsman program and resolution to complaints. In pursuit of these activities, the ombudsman must maintain relationships involving tension between the individual and the system.