Your Front-Line Advocate: Nursing Home Ombudsman

Takeaways

• Ombudsmen serve as advocates for residents in long-term care settings, helping to resolve disputes when internal efforts fail.
• Ombudsman programs are mandated under the Older Americans Act and offer services such as complaint resolution and education on resident rights.
• Ombudsmen can also provide information about selecting long-term care facilities and community services.

Most seniors would prefer to continue living in their home for as long as possible rather than move into a nursing home or similar facility. However, data shows that roughly 70 percent of adults aged 65 and older in the United States are likely to need long-term care services at some point in their later years. According to the Centers for Medicaid and Medicare Services, more than 1 million people are currently nursing home residents across the country.

Disagreements with a nursing home can arise regarding any number of topics, including the quality of food, troublesome roommates, lack of privacy, or services not meeting what was promised. Many disputes can be resolved by speaking with a nursing home staff member, supervisor, or moving up the chain of command.

However, if you can’t resolve things internally within the nursing home, your next step should be to contact the local ombudsman assigned to the nursing home.

What Is an Ombudsman?

An ombudsman is an advocate specially trained to resolve problems for residents of nursing homes, board and care homes, and assisted living facilities. They can negotiate on a resident’s behalf, provide information about selecting long-term care (LTC) facilities and community services, and educate seniors and their families on residents’ rights.

Under the federal Older Americans Act (OAA), every state must have a long-term care ombudsman program (LTCOP) in place that addresses residents’ complaints and advocates for improvements in the long-term care system.

An ombudsman’s work may involve investigating a complaint about quality of care or staffing concerns in a nursing facility, advocating for a long-term care resident's well-being, visiting facilities to assess conditions, and working at the local, state, or national level to promote policies that support vulnerable seniors.

How Much Do Ombudsman Services Cost?

Because ombudsman services are federally funded, they are provided for free, regardless of income or insurance status, so that residents of long-term care facilities or their loved ones can access assistance.

While ombudsmen do not have direct authority to require action by a facility, they are responsible for negotiating on a resident’s behalf and working with other state agencies for effective enforcement.

Every statewide program usually comprises several regional or local ombudsman programs that operate within an Area Agency on Aging or other community organization; find the local ombudsman offices in your state.

Best Practices for Engaging a Long-Term Care Ombudsman

1. Internal Resolution First. Attempt to resolve the issue directly with the nursing home staff or administration before contacting an ombudsman.

2. Clear Communication. Clearly explain the issue or concern to the ombudsman. Provide specific details, dates, times, and names of individuals involved.

3. Documentation. Maintain detailed records of the issues you or your loved one are facing, any attempts you have made to resolve them, and any communication you have had with nursing home staff. Share relevant documents with the ombudsman.

4. Be Patient. Understand that ombudsmen work within certain limitations and may not have immediate solutions. They often will need time to investigate and negotiate.

5. Understand Limitations. Recognize that ombudsmen cannot force facilities to take specific actions but can negotiate and work with state agencies.

6. Confidentiality. Be aware that ombudsmen maintain confidentiality.

7. Follow Up. Stay in communication with the ombudsman and provide any updates or additional information as needed.

Other Support

In addition to resolving complaints, ombudsmen may provide information about how to select a nursing home and answer questions about long-term care facilities, help older adults find the services they need in the community instead of entering a nursing home, and provide education on residents’ rights. Most state ombudsman programs publish annual reports about the problems and concerns they address.

However, many ombudsman programs have limited staff resources. Most local programs seek volunteers interested in training to help visit residents, act as advocates, and monitor general facility conditions.

Whether volunteer or paid, ombudsmen must undergo training and obtain certification to ensure that they understand residents' rights, complaint processes, and confidentiality requirements.

To learn more about long-term care ombudsmen, visit the National Long Term Care Ombudsman Resource Center.

Work With an Elder Law Attorney

Elder law attorneys often have established relationships with local resources, including your state long-term care ombudsman programs. An experienced elder law attorney near you can assist you or your aging family member with the following:

• Provide contact information for the relevant ombudsman office
• Explain the role and authority of an ombudsman
• Advise you on how to effectively communicate concerns to an ombudsman
• Assist in documenting complaints and supporting evidence for ombudsman review
• Introduce you to ombudsmen they have worked with before

Elder law attorneys can provide many other key services for older adults, including those who still live on their own. You may seek their assistance with executing essential estate planning documents, financial planning, as well as navigating Medicaid, Medicare, and other government benefits programs.

In addition, they can connect you with other professionals, such as financial advisors, social workers, or health care providers.

Related Reading

• Assistance With Activities for Daily Living and the Need for Long-Term Care
• 5 Tips on Whether to Buy Long-Term Care Insurance
• The Rise of ‘Granny Cams’ in Long-Term Care Facilities
• Recognizing Elder Abuse and Retaliation in Long-Term Care