State and local ombudsmen are housed in an agency dedicated to representing the interests of LTC facility residents through an effective ombudsman program.

Resident and ombudsman interests are not secondary to other agency programs and client groups.

Ombudsman financial and human resources are expended solely on ombudsman program needs.

Local ombudsmen have no clear authority to take any administrative, advocacy, or other action related to the program without clearance by someone other than the state ombudsman.

State or local ombudsmen funds, time, or other resources are being used to subsidize or provide non-ombudsman functions.

TABLE 5.3 Qualifications of Representatives of the Office

The program maintains a reputation as one staffed by well-prepared, knowledgeable workers familiar with the latest developments and trends and generously able to help others learn its knowledge and skills. Training is conducted in a manner developed to foster and encourage the ongoing improvement and skills of every representative of the Office.

The Office has an established procedure for terminating any representative of the Office for unacceptable job performance.

Representatives have in-depth initial training prior to performing any duties, are assessed for competence prior to acting directly without direct supervision, and receive ongoing training and supervision to improve skills and to stay abreast of program and LTC developments.

The Office has an established procedure for terminating any representative of the Office for unacceptable job performance.

The Office has no established procedure for terminating any representative of the Office for unacceptable job performance or the Office fails to use the established procedure in the face of unacceptable job performance.

TABLE 5.4 Legal Authority

Ombudsman legal authority has been implemented and is appropriately and responsibly exercised so that no complaints of willful interference or reprisal have been made, despite numerous visits to a broad range of LTC facilities, a vibrant complaint resolution program, and a systemic advocacy agenda.

Ombudsman legal authority related to the conflicts of interest in provisions for representatives of the Office and entities that select or house representatives of the Office have been implemented in such a way that challenges are rare.

The state has provided for sanctions and applied them for the willful interference with a representative of the Office when performing assigned duties and for any retaliation or reprisal by any entity against any person who cooperates or works with a representative of the Office.

There are no state laws, regulations, or policies that restrict the ability of the Office or its representatives to perform a mandated service or activity.

The OAA provisions related to conflicts of interest for representatives of the Office and entities that select or house representatives of the Office have been implemented consistent with the recommendations found in Chapter 4.

The state has not provided for sanctions nor enforced established sanctions for the willful interference with a representative of the Office while performing assigned duties and for any retaliation or reprisal by any entity against any person who cooperates or works with the Office.

There are specific state laws, regulations, or policies that restrict the ability of the Office or its representatives to perform a mandated service or activity (e.g., a civil service policy that forbids any state employee from representing residents in involuntary transfer and discharge hearings).

The OAA provisions related to conflicts of interest for representatives of the Office and entities that select or house representatives of the Office have not been implemented.

TABLE 5.5a Resources: Financial

TABLE 5.5b Resources: Information Management

TABLE 5.5c Resources: Legal

TABLE 5.5d Resources: Human

TABLE 5.6 Office of the State Long-Term Care Ombudsman Program

TABLE 5.7 Individual Resident Advocacy Services

With each individual resident advocacy service, an individual resident, family member, resident council, family council, or other entity becomes better equipped to self-advocate in the next matter.

Client satisfaction studies of the individual resident advocacy services program are conducted and their recommendations for program improvement are implemented.

The functions of the ombudsman program and the various regulatory agencies are clearly delineated and mutually understood.

In order to develop an individual resident advocacy service, the program has ensured that staff and volunteers are properly trained and supervised, records of activities are maintained, appropriate referrals are made, and program standards are consistently met.

The state ombudsman has developed a systematic and participatory approach to reviewing the work of all local programs, including standard methods of resolving individual resident’s concerns; consistent documentation of findings and actions taken; and standard methods of correcting problems within the ombudsman program.

All sections of relevant state and federal agencies recognize and know about the role and services of the Office and readily cooperate with requests for information from the office and the public. Likewise, the ombudsman program responds to appropriate referrals and requests for assistance from these agencies.

The program as a whole or in part lacks the training, resources, operating practices, or authority necessary to handle individual concerns. For example, staff or volunteers do not have basic skills in complaint resolution.

The state ombudsman has not developed a systematic and participatory approach to reviewing the work of all local programs, including standard methods of resolving individual resident’s concerns, consistent documentation of findings and actions taken, and standard methods of correcting problems within the program.

Important sections of relevant state or federal agencies do not recognize or know about the role and services of the Office. Similarly, a majority of state or federal field office personnel do not recognize or know about the role and services of the Office.

TABLE 5.8 Systemic Advocacy Work

The program’s systemic advocacy is focused on a variety of LTC facilities, residents, and all aspects of residents’ lives and concerns. The work is coordinated with others, including those organizations not usually interested in LTC issues, so that broad-based coalitions, rather than the ombudsman program alone, seek systemic change.

The Office has ongoing interactions with the full range of regulatory agencies with specific agendas to discuss plans for future actions at "pre- decision points," to plan and conduct joint trainings, to coordinate efforts wherever possible, and to maximize the different strengths, roles, and talents of each agency and the Office.

federal programs; or involves and assists residents, their families, other agencies, or the public in securing changes in state or federal laws, regulations, or policies.

The program’s systemic advocacy is focused on a variety of LTC facilities, residents, and all aspects of residents’ lives and concerns. The work demonstrates a willingness to take on vested interests of all kinds and bring to bear persistence, creativity, and multiple constituencies.

The Office has regular contact with regulatory agencies as required by the HCFA Medicare and Medicaid survey protocol. The Office also has the same type of contact afforded the public. This includes: ombudsman participation in committees and work groups related to LTC; and submission of comments on all proposed administrative policies that affect LTC facility residents.

The program’s systemic advocacy does not focus on a variety of LTC facilities, residents, nor all aspects of residents’ lives and concerns. For example, the program’s work is targeted only on nursing home residents and their concerns with a particular owner, but ignores the inadequacies of the licensing or certification agencies, or the eligibility standards of Medicaid.

The Office experiences open, ongoing hostility or conflict with one or more state regulatory agencies. There is no sharing of information, strategies, or goals between any segment of the Office and the management of the regulatory agencies. Each sees their relationship to the other as limited to protecting their agency or program or the residents from the other.

TABLE 5.9 Educational Services