Ombudsman Program

What is an Ombudsman?

The word ombudsman (om-budz-man) is of Swedish origin, and means one who speaks on behalf of another. The Missouri Long-Term Care (LTC) Ombudsman Program is a statewide network of individuals who help residents in long-term care facilities maintain and improve their quality of life by helping ensure their rights are preserved and respected.

Through the ombudsman’s regular visits, residents have an easy and available means to solving any issues they encounter.

Ombudsmen seek to reduce the sense of isolation some residents feel, especially those who do not have close family or friends. Ombudsmen can help the resident rediscover a sense of self determination and exercise their rights.

Although all facilities are required to have a formal grievance procedure, residents can be hesitant to speak up about their concerns for any number of reasons. Sometimes, the resident has a real fear of retaliation from a staff member, for example.

For residents who hesitate to speak even to the ombudsman about a problem, ombudsmen have the advantage of being able to build a relationship over time. In these cases, the ombudsman, who is not tied to the facility by employment or other relationship, can become a trusted confidant and may be viewed as more objective.

In addition, ombudsmen learn the importance of maintaining strict confidentiality when it comes to the identity of any resident who has a complaint. This makes a trust relationship possible between ombudsman and resident.

At no time will ombudsmen take action on a complaint, begin an investigation, or discuss the complaint if the resident has not expressly given consent.

When the ombudsman does take action, his/her aim is always to first provide support and encouragement so residents can solve the problem by themselves. It is much better to empower them to solve their own concerns than to “take over” the situation!

In any case, the ombudsman always moves (or chooses not to take action) at the resident’s direction, unless extraordinary circumstances demand otherwise.

Ombudsman volunteers are special. They make a significant, personal commitment to the program, through not only their ongoing learning but also their regular contacts with residents, reporting, and travel.

Ombudsman Roles

Ombudsmen have many different roles in their work:

1. Facilitator: Helping residents engage in self-directed and self-empowered advocacy..
2. Educator: Providing materials and resources to residents, facility staff, families, and the community at large that encourage and support self-help and problem solving.
3. Broker: Making referrals and following through until the problem is solved.
4. Intermediary: Promoting communication among those involved in a problem.
5. Collaborator: Working with residents and staff to resolve problems to the satisfaction of the resident.
6. Mediator: Bringing together residents of equal standing and cognitive ability to arrive at an agreement or a compromise.
7. Advocate: Acting on behalf of someone else.
8. Investigator: Gathering pertinent information from many sources in order to engage in a well-defined problem-solving process.
9. Problem solver: Resolving problems and complaints from residents.
10. Activist: Engaging in systems advocacy on behalf of residents in long-term care settings.

Ombudsman Program Description

Missouri's ombudsman program is a network of ombudsmen volunteers serving residents of nursing homes and residential care facilities to provide support and assistance with their problems or complaints. Individual ombudsman volunteers are recruited by regional ombudsman coordinators in their local ombudsman programs, operated by the Area Agencies on Aging (AAAs) or their service providers. The volunteer becomes familiar with the facility and its procedures and then begins regular visits with the residents.

As residents get to know the ombudsman volunteer, they are able to discuss complaints and concerns with the volunteer. The volunteer helps the residents to work through their issues, and helps them become empowered to resolve complaints.

History of the Ombudsman Program

The long-term care industry grew fast during the 1960s with little regulation. After well-publicized reports of abuse, neglect and substandard conditions in nursing homes, several congressional committees were convened to hear testimony and propose regulations for the nursing home industry. The following timeline offers a brief history of the program.

• 1965 - Medicare and Medicaid programs begin to provide public funding for long-term care.
• 1970 - Publicity about poor care, abuse, neglect, and substandard living conditions in nursing homes lead to Congressional Hearings which identify a breakdown in licensing and certification systems meant to protect vulnerable individuals.
• 1971 - President Nixon established the Office of Nursing Home Affairs. This agency would coordinate the efforts of other department agencies to establish nationwide standards for nursing home construction, care, and operation.
• 1972 - The Long-Term Care Ombudsman Program was formed to help states establish an investigative unit which would respond to complaints in long-term care facilities.
• 1975 - Missouri took advantage of these grants that were established by the AoA to start the long-term care ombudsman program.
• 1978 - The amendments to the Older Americans Act elevated the Nursing Home Ombudsman Program to a statutory level. The statute and subsequent regulations required all state agencies on aging to establish an ombudsman program.
• 1981 - The program name was changed to Long-Term Care Ombudsman to reflect these added responsibilities.
• 1987 - Amendments to the Older Americans Act significantly strengthened the program's ability to advocate on behalf of residents in long-term care facilities.
• 2016 - Federal Ombudsman Final Rule implemented

Over time, amendments to the Older Americans Act changed the Long-Term Care Ombudsman Program. However, those changes always strengthened the program by clarifying the role of the Ombudsman as an independent advocate for vulnerable adults living in long-term care settings. As long as residents experience substandard care as a result of poor regulation, enforcement, and care delivery, Ombudsman will continue to have a role to play in long-term care facilities.

Missouri Ombudsman Program Structure

The Missouri Long-Term Care Ombudsman Program is administered by the Office of the State Long-Term Care Ombudsman located in the Missouri Department of Health and Senior Services (DHSS) within the Division of Senior and Disability Services (DSDS). 

The State Office of the Long-Term Care Ombudsman (Office), with the State Ombudsman as its head, provides the management, direction and programmatic oversight of all activities related to the Office.

Missouri law requires the DSDS to contract with Area Agencies on Aging (AAA) to operate the programs and services of the Older Americans Act (OAA), including the Long-Term Care Ombudsman Program services.

Title III Older Americans Act

This chart shows the relationship of agencies responsible for implementing programs for the elderly, such as the Ombudsman program as outlined in the Older Americans Act.

Philosophy of the Long-Term Care Ombudsman

Volunteer Model

The volunteer model operates on the principle that knowledge of a particular facility enables the regular volunteer ombudsman to handle problems more effectively. And when the volunteer ombudsman has an established relationship with the residents and staff, resolution is easier. Ombudsmen assume the role of confidant to the residents, and therefore, residents are more likely to express concerns that might not otherwise surface.

Ombudsmen provide a personalized approach to their work. Regular contact with residents builds trust, visibility and clarity of purpose.

The focus of the ombudsman efforts is resident-initiated complaints. While complaints may be made on behalf of residents by other individuals, ombudsmen are careful that such complaints accurately reflect the concerns of the resident.
Complaints are received in the strictest of confidence. Investigation and resolution are not attempted without the resident's permission. An exception to this might be a problem in the nursing home that affects more than a single resident, allowing the ombudsman to begin to work on the problem without revealing which resident or residents expressed the concern. No problem is too big or too small for the ombudsman to deal with. In fact, ombudsmen can often solve a little problem before it grows serious.

A key concept in this program is the word "empower." To empower is to enable or permit some action. Ombudsmen always look for ways to empower residents to help themselves. It would be ironic if this very system, set up to ensure that residents know their rights and maintain their dignity, became a patronizing part of the problem.

Overall Program Policy

It is important to understand the Ombudsman Program does not have enforcement powers of its own and is not a regulatory agency in any sense. Trust and confidence can be maintained only so long as residents, nursing home facilities, agencies, and the public know the ombudsman has no vested interest in any given case. The ombudsman's only interest is ensuring long-term care residents are able to freely exercise their rights.

Missouri Ombudsman Program Mission Statement and Goals

The mission of Missouri's Long-term Care Ombudsman Program is: To improve the quality of life for residents of long-term care facilities through advocacy and education. The goals of the program are to:

• advocate for Resident Rights.
• educate residents on their rights as well as to provide community education on long-term care issues.
• empower residents to speak up when they feel they have no voice.

These goals will help to ensure and maintain the best quality life possible for all residents in long-term care facilities.

To achieve these goals ombudsmen should:

• Make sure all residents are informed of their rights as established by law.
• Strive to empower residents and/or help to resolve all complaints at the facility level through the involvement of all concerned parties.
• Participate in community and facility education opportunities regarding resident rights and the role ombudsman program.

The federal Older Americans Act established the long-term care ombudsman program and ombudsman mandates. Ombudsman representatives at the state and regional programs fulfill several duties. The following references from the Older Americans Act are most directed toward systems advocacy:

• Represent the interests of residents before government agencies and seek administrative, legal, and other remedies to protect the health, safety, welfare, and rights of the residents;
• Review, comment on existing and proposed laws, regulations, and other government policies and actions, pertaining to resident well-being and rights;
• Facilitate the public’s ability to comment on laws, regulations, policies, and actions;
• Support development of resident and family councils; and
• Carry out other activities the ombudsman determines to be appropriate.

To assure resident interests are represented to the public and lawmakers, ombudsmen:

• Educate advocacy groups, governmental agencies, and policy-makers regarding the impact of laws, policies, or practices on residents;
• Seek modification of laws, regulations, policies, and actions pertaining to the right and well-being of residents;
• Facilitate the ability of residents, resident and family councils, and the public to comment on laws, regulations, policies, and actions;
• Develop or participating in work groups to study an issue;
• Participate in public hearings and forums;
• Provide community education or information; and
• Educate other aging services providers, advocacy groups, and the public on long-term care issues.

Every year the Long-Term Care Ombudsman Program hosts an Advocacy Day. This is where our Regional Ombudsman Coordinators from across the state have the opportunity to speak with their respective legislators on current legislation that affects the quality of life for residents of long-term care facilities.