Today, ACL posted new data on the Long-Term Care Ombudsman program’s impact in fiscal year 2017. Looking through the data, I am struck by both the scope and the impact of the work that ombudsmen do every day.
As the Ombudsman program enters its 40th year as a mandatory program of the Older Americans Act, I want to take this opportunity to reflect on some of the data ACL has compiled, highlight some of the amazing work done by programs across the country, and discuss some important developments for the future of the program.
I would like to start with the story of just one of the more than 200,000 complaints Ombudsman programs resolve annually. The complaint came from a nursing home where residents had to walk along a busy road to access the surrounding neighborhood.
The absence of a sidewalk presented a daily hazard to residents and had already resulted in one resident being hit by a car. That resident reached out to the Long-Term Care Ombudsman office who worked with the resident, their local Ombudsman advisory council, and, eventually, city leaders to get a new safe sidewalk built outside the facility. Now, residents can travel with greater freedom and safety.
Ombudsman programs respond to a wide variety of problems faced by residents of long-term care facilities, including discharge and eviction, inadequate care, violation of rights, and quality of life concerns. In fiscal year 2017, Ombudsman programs provided regular visits to 60% of all nursing homes and 30% of all other residential care communities in the country. They also provided over 400,000 instances of information and assistance on resident rights, care, and community options to residents and their loved ones and over 125,000 instances of information and assistance to facility staff on issues of discharge planning, care, rights, and abuse prevention.
The most common types of complaints Ombudsman programs received involved improper eviction or inadequate discharge planning, Ombudsman programs worked to resolve over 14,000 such complaints in fiscal year 2017.
In addition to addressing individual complaints, Ombudsman programs also advocate for resident interests in public policy arenas. In fact, the OAA requires Ombudsman programs to analyze, comment on, and recommend changes in laws, regulations, and government policies and actions to benefit residents. On the issue of inappropriate discharges, Ombudsman programs have developed task forces, proposed legislation, trained both hospital social workers and long-term care facility staff on relevant requirements, and trained residents and their families on their rights regarding discharge and transitioning out of a long-term care facility.
Staffing shortages are another prominent issue many Ombudsman programs are working to address through systems advocacy. Ombudsmen are working in partnership with both the long-term care provider industry and state agencies, including workforce commissions, to identify solutions to the workforce shortage, including wage increases, expanded benefits, additional direct care worker training, and the development of public awareness campaigns to elevate the profession. Ombudsman programs are also advocating for improved state laws or regulations to support adequate staffing and training facility staff on topics such as abuse prevention, person-centered care, and dementia care.
Many state Ombudsman programs utilize volunteers, designated as representatives of the Office, to work on behalf of the Ombudsman. Thousands of volunteers across the county donated their time, talents, and energy to visit residents, listen to their concerns, and take action to resolve problems. In addition to directly helping resolve complaints, volunteers help Ombudsman programs make the most of limited resources. In fiscal year 2017, volunteers contributed 591,363 hours, the estimated equivalent of over $14 million, to Ombudsman programs.
One volunteer’s story demonstrates the impact of this service. Several residents of a facility told this volunteer Ombudsman representative that they were not receiving enough food at meal times. The volunteer visited the facility and observed small portions that may have met the dietician's recommendations but left some residents still hungry. Through advocacy and persistence, she convinced the facility administrator to increase portion sizes so residents were no longer left hungry.
ACL is proud to support this critical work going forward. Here are three areas we are prioritizing as we think about the future of the Ombudsman program:
- Implementing the Ombudsman Program Final Rule: ACL’s first-ever Final Rule on States’ LTC Ombudsman Programs took effect in July 2016. Among other things, the rule provides specific guidance related to LTC Ombudsman resolution of abuse-related complaints and abuse reporting and emphasizes the role of State Units on Aging in providing elder justice coordination and leadership. ACL continues to work with every state to ensure compliance with the rule and we have been encouraged by the progress we have seen in 2018, including changes to program policies and procedures, regulations, and even some legislative changes.
- Ombudsman Program Evaluation: ACL is currently evaluating the program to understand service delivery models. This process evaluation will help ACL lay the foundation to evaluate program impact and efficiency and represents the first comprehensive, national evaluation of the Ombudsman program since 1995. ACL anticipates completion of the process evaluation this year and we are in the beginning phase of an outcome evaluation.
- National Ombudsman Reporting System (NORS) Data Collection: All of the statistics above are from data collected through NORS. ACL is revising the data collection required of state Ombudsman programs. The new data collection will begin October 1, 2019; the changes were developed in coordination with state partners and Ombudsman programs and seek to reduce reporting burdens, improve data usability, enhance ACL’s understanding of program operations and resident experiences, and reflect developments in program operations and long-term services and supports systems.
The Ombudsman program is rooted in a simple, yet powerful, principle -- that all older adults and people with disabilities are entitled to equal rights, dignity, and a life free of abuse no matter where they live. As I reflect on the accomplishments of the last 40 years, and the important work that lies ahead, I am grateful for the service of so many Ombudsman staff and volunteers who work to make this vision a reality every day.