Real People Real Problems -- Copyright -- Preface -- Acknowledgments -- Contents -- Summary -- ORIGINS OF THE STUDY AND REPORT -- THE LONG-TERM CARE OMBUDSMAN PROGRAM -- STATE COMPLIANCE WITH PROGRAM MANDATES -- Findings -- Recommendations on Compliance -- CONFLICTS OF INTEREST -- Legislative and Conceptual Aspects -- Recommendations on Conflicts of Interest -- EFFECTIVENESS OF THE OMBUDSMAN PROGRAM -- Continuance of the Ombudsman Program -- Exemplary Practices and Performance -- Data and Information Systems -- Research Imperatives -- Adequate Management of Volunteers -- ADEQUACY OF RESOURCES -- Financial Resources and Program Performance -- Formula for Allocating Federal Funds and Level of State Contributions -- MANAGEMENT OF FISCAL RESOURCES -- Unmet Need and Unfunded Responsibilities -- NEED FOR AND FEASIBILITY OF EXPANDING THE OMBUDSMAN PROGRAM -- CLOSING COMMENTS -- 1 Advocating for Quality of Care and Quality of Life for Residents of Long-Term Care Facilities -- INTRODUCTION -- WHAT IS LONG TERM CARE? -- WHO USES LONG TERM CARE? -- Nursing Facility Residents -- Residents of Board and Care Homes and Other Residential Settings -- LONG-TERM CARE EXPENDITURES AND SOURCES OF FUNDS: WHO PAYS? -- QUALITY OF CARE AND QUALITY OF LIFE -- Quality of Care -- Quality of Life -- ASSURING, ASSESSING, AND IMPROVING QUALITY -- THE INSTITUTE OF MEDICINE STUDY -- ORGANIZATION OF THIS REPORT -- 2 Overview of the Older Americans Act Long-Term Care Ombudsman Program -- EVOLUTION OF THE LONG-TERM CARE OMBUDSMAN PROGRAM -- Ombudsman Theory and Practice -- History of the Long-Term Care Ombudsman Program -- STATUS OF THE CURRENT PROGRAM -- Organizational Placement -- Operation -- Target Population -- Human Resources -- Paid Staff -- Volunteers -- Funding -- FUNCTIONS OF THE LONG-TERM CARE OMBUDSMAN PROGRAM -- Resident-Level Advocacy.

Ensuring that Residents Have Regular and Timely Access to the Program -- Investigating and Resolving Complaints -- Working Cooperatively with Other Agencies -- Providing Technical Assistance and Training to Representatives of the Program -- Systems-Level Advocacy -- Evaluating Laws and Regulations -- Providing Education to the Public and Facility Staff -- Disseminating Program Data -- Promoting the Development of Citizen Organizations and Resident and Family Councils -- SUMMARY -- 3 State Compliance in Carrying Out Long-Term Care Ombudsman Programs -- INTRODUCTION -- COMPLIANCE WITH MANDATED FEDERAL PROVISIONS -- EXTENT OF COMPLIANCE -- Direct Individual Advocacy Services -- Regular and Timely Access (Accessibility) -- Timely Responses (Availability) -- Unmet Need -- Systemic Advocacy -- FACTORS THAT ENHANCE OR IMPEDE COMPLIANCE WITH THE PROGRAM'S FEDERAL MANDATES -- Leadership Within the Organizational Framework -- Leadership from the Administration on Aging -- Leadership from State and Local Program Sponsors -- Elements of Infrastructure -- General Points -- Adequate Legal Resources -- Institutional Care Context -- Nursing Facilities -- Board and Care Homes -- SUMMARY -- 4 Conflicts of Interest -- INTRODUCTION -- LEGISLATIVE AND CONCEPTUAL ASPECTS OF CONFLICT OF INTEREST -- Older Americans Act Provisions on Conflict of Interest -- Definitions and Conceptual Variations -- Professionals: Personal Interests and Public Obligations -- Conceptual Variations -- Types of Conflict of Interest for the Ombudsman Programs -- Organizational Conflicts of Interest -- Individual Conflicts of Interest -- Willful Interference, Independence, and Conflicts of Interest -- Legal Counsel and Conflicts of Interest -- Amelioration of Individual Conflict of Interest -- Prohibition -- Disclosure -- Disclosure With Alternative Options Offered -- Disclosure With Recusal.

Everyday Ethical Behavior -- Public Accountability -- CONCLUSIONS AND RECOMMENDATIONS -- Organizational Location and Governance -- Individual Conflicts of Interest -- Legal Counsel and Conflict of Interest -- SUMMARY -- 5 Effectiveness of the State Long-Term Care Ombudsman Programs -- INTRODUCTION -- EVALUATION CONTEXT -- Evaluation Strategy: Formative and Summative Evaluations -- Effectiveness Questions -- Data and Information Sources -- Quality as a Central Issue in Effectiveness -- Political and Environmental Factors Relevant to Effectiveness -- MODELS OF IMPLEMENTATION AND MEASURES OF EFFECTIVENESS -- Infrastructure and Function -- Performance Indicators -- EFFECTIVENESS OF THE OMBUDSMAN PROGRAM: THE DATA -- Findings Related to Effectiveness -- Build Visibility and Awareness of the Program -- Investigate and Resolve Complaints -- Providers' and State Agency Directors' Perspectives -- Adequacy and Management of Volunteers -- Barriers to Effectiveness -- General Problems and Impediments -- Barriers to Effectiveness in the Local Ombudsman Program -- Committee Reflections on Data -- CONCLUSIONS AND RECOMMENDATIONS -- Continuance of the Ombudsman Program -- Exemplary Practices and Performance -- Monitoring and Evaluating Effectiveness: Data and Information Systems -- Research Imperatives -- Research Imperatives -- SUMMARY -- 6 Adequacy of Resources -- ADEQUATE PROGRAM PERFORMANCE -- FINANCIAL RESOURCES -- FINANCIAL RESOURCES AND PROGRAM PERFORMANCE -- CONCLUSIONS AND RECOMMENDATIONS -- Adequacy of Resources for the Currently Mandated Program -- Monetary Resources -- Funding Allocation Formula -- State Match of Federal Funding -- Fiscal Accountability for Ombudsman Program Budgets at the State and Local Levels -- Unmet Need and Unfunded Responsibilities -- SUMMARY -- 7 Expansion of the Long-Term Care Ombudsman Program.

NEED FOR OMBUDSMAN SERVICES BY CONSUMERS OF HEALTH CARE AND LONG-TERM CARE SERVICES -- Vulnerable Populations -- Community-dwelling Elderly -- Nonelderly Groups -- Complex Systems -- Advocates for Vulnerable Populations -- Family and Friends -- Case Management -- Adult Protective Services -- Protection and Advocacy Systems -- Other Oversight, Quality Assurance, Consumer Interest, and Advocacy Programs -- Concluding Thought -- STATE EXPERIENCE WITH AN EXPANDED OMBUDSMAN PROGRAM -- FEASIBILITY OF EXPANDING THE CURRENT LONG-TERM CARE OMBUDSMAN PROGRAM -- Conceptual Considerations -- What Conceptual Model Would Be Used in an Expanded Ombudsman Program? -- Why Would an Expanded Ombudsman Program Be Opposed? -- Why Would an Expanded Ombudsman Program Be Supported? -- Operational Considerations -- Current Program Capacity to Expand -- Target Population -- Organizational Placement -- Staffing -- Funding -- CONCLUSIONS AND RECOMMENDATIONS -- SUMMARY -- 8 Closing Comments -- THE CURRENT VIEW OF THE LONG-TERM CARE OMBUDSMAN PROGRAM -- VISIONS OF THE FUTURE: CHANGES THAT MAY AFFECT THE OMBUDSMAN PROGRAM -- Regarding the Configuration of Long Term Care -- Regarding the Role of the Ombudsman -- GOALS REVISITED -- References -- Appendixes -- A Older Americans Act: A Staff Summary (A Publication of the Select Committee on Aging) -- INTRODUCTION -- GRANTS FOR STATE AND COMMUNITY PROGRAMS ON AGING: TITLE III OF THE OLDER AMERICANS ACT -- Development of the State and Area Agency on Aging Structure: General Background -- Overview of State and Area Agency on Aging Responsibilities -- General -- Designation of State and Area Agencies on Aging and Planning and Service Areas -- State and Area Agency on Aging Responsibilities -- Service Programs Authorized Under Title III -- VULNERABLE ELDER RIGHTS PROTECTION ACTIVITIES: TITLE VII OF THE OLDER AMERICANS ACT.

B Title VII-Allotments for Vulnerable Elder Rights Protection Activities: Chapter 2 -- C Study Activities -- STUDY COMMITTEE AND TECHNICAL PANEL -- Study Committee -- Technical Panel -- DATA COLLECTION AND OTHER STUDY ACTIVITIES -- Meetings Convened by the Committee -- IOM Committee Meetings -- Symposium -- Technical Panel Meetings -- Public Hearing -- Background Information -- Commissioned Papers -- Canvasses by the IOM Committee -- Site Visits -- Other Consultations -- D Biographies of Committee Members -- Glossary and Acronyms.