According to the latest CDC statistics, nearly 2.1 million Americans live in the nation’s approximately 46,200 long-term care facilities. That total includes about 30,600 assisted living communities housing roughly 820,000 residents and 15,600 skilled nursing facilities (often called nursing homes) with about 1.3 million residents. Many of these individuals are among the most vulnerable in society, which makes long-term care ombudsman programs essential to protecting residents’ rights, health, and wellbeing.
An overview of long-term care ombudsman programs
Enacted in 1965 as part of the Great Society initiatives, the Older Americans Act (OAA) was created to support older adults’ ability to live independently and with dignity in their homes and communities. A central goal of the law was to establish home- and community-based supports that would help older adults remain as independent as possible while ensuring access to services that protect their quality of life.
One major OAA initiative was the long-term care ombudsman program (LTCOP), established in 1972. The OAA required every state, plus the District of Columbia, Puerto Rico, and Guam, to designate a full-time state ombudsman to administer the program and to provide staff and volunteers who advocate for long-term care residents.
Today the program, administered through the Administration on Aging/Administration for Community Living, includes state ombudsmen, over a thousand full-time staff, and thousands of trained volunteers who investigate and help resolve complaints about long-term care facilities. These ombudsmen serve residents in nursing homes, assisted living and board-and-care settings, ensuring complaints are heard and that systemic improvements are pursued.
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What ombudsman programs do and don’t do
The LTC ombudsman program is charged with a range of responsibilities designed to protect residents’ rights and improve care quality. Key duties typically include:
- Identifying, investigating, and working to resolve complaints filed by or on behalf of long-term care residents. These complaints can involve:
- Violations of residents’ rights or dignity
- Physical, verbal, or psychological abuse; neglect or deprivation of necessary services; or unlawful confinement
- Poor quality of care, such as inadequate hygiene or delayed responses to requests for assistance
- Improper transfers or discharges
- Inappropriate use of chemical or physical restraints
- Any concerns about quality of care or quality of life
- Providing information to residents and families about available support services
- Ensuring residents have timely access to ombudsman services when needed
- Representing residents’ interests before government agencies
- Seeking administrative, legal, and other remedies to protect residents
- Analyzing and recommending changes to laws, regulations, and policies affecting residents’ health, safety, welfare, and rights
In essence, state ombudsman programs give long-term care residents a dedicated advocate. They address complaints and grievances related to residents’ quality of care and life while promoting broader improvements across the long-term care system.
Ombudsman representatives also provide guidance to prospective residents and families about selecting facilities and advocating for quality care. However, it is important to understand what ombudsmen do not do: they do not conduct licensing or regulatory inspections, they do not perform adult protective services investigations, and they do not provide direct care to residents.
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A look at program usage
According to national ombudsman resource data for 2021, state and local ombudsman programs provided information and assistance to more than 377,660 people, including current and prospective residents and their families. Ombudsmen and staff conducted over 151,000 site visits to more than 35,000 long-term care facilities that year.
The most common complaints handled by ombudsmen in nursing homes in 2021 included:
- Discharges or evictions
- Delays or inadequate responses to requests for assistance
- Allegations of physical abuse
For assisted living and other residential care communities, the top complaints in 2021 were:
- Discharges or evictions
- Medication issues
- Housekeeping, laundry, and pest control concerns
Ombudsmen also support facility staff and management in efforts to improve care. In 2021 they provided information and assistance to hundreds of thousands of long-term care employees and offered training sessions to help improve practices across the sector.
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A resource for current, prospective LTC residents and loved ones
Most long-term care communities operate responsibly, and complaints are uncommon and typically addressed quickly. Still, residents and families should know that ombudsman support exists when a facility is unable or unwilling to resolve an issue.
When someone contacts a state ombudsman with a complaint, the ombudsman or trained staff will meet the resident in person to discuss concerns and confirm whether the resident wishes to pursue the matter. The ombudsman explains the program’s role, the investigation process, and the resident’s rights, and asks about the resident’s quality of life and care.
If the resident requests action, the ombudsman investigates and maintains contact throughout the process. When a resident cannot provide consent due to cognitive or physical limitations, the ombudsman works with the resident’s authorized representative or follows program policies for cases without a representative.
Prospective residents and their families can also contact their state’s long-term care ombudsman program to request information about complaints or regulatory violations involving facilities they are considering, helping inform the selection of a safe, appropriate care community.