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By Lance Robertson, Assistant Secretary for Aging and
Administrator, ACL
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.
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