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If you, or a loved one, is a resident of, or is considering, assisted living, or a nursing home, a long-term care (LTC) ombudsman may be able to help. LTC ombudsman help resolve residents’ complaints, provide information and assistance, advocate for residents’ rights and quality of care, and advocates for system and legislative changes. The LTC ombudsman has the power, based on federal and state law, to protect residents’ rights.

Resolving Residents’ Complaints

The long-term care ombudsman can help residents of LTC facilities who have concerns and complaints about their care or services they receive. LTC ombudsmen have a standardized classification scheme for the types of cases that they handle. The seventeen major categories are listed below and are instructive of the kinds of issues that residents may face in LTC settings:

• Abuse, Gross Neglect, Exploitation
• Access to Information by Resident or Resident’s Representative
• Admission, Transfer, Discharge, Eviction
• Autonomy, Choice, Preference, Exercise of Rights, Privacy
• Financial, Property (Except for Financial Exploitation)
• Care
• Rehabilitation or Maintenance of Function
• Restraints – Chemical and Physical
• Activities and Social Services
• Dietary
• Environment/Safety
• Policies, Procedures, Attitudes, Resources
• Staffing
• Certification/Licensing Agency
• State Medicaid Agency
• System/Others
• Complaints About Services in Settings Other Than Long-Term Care Facilities or By Outside Provider

According to the Administration on Aging, for the most recent year available (2007), “Care” has the greatest number of complaints; about 27%. Care is a broad category that includes accidental or injury of unknown origin, falls, improper handling, failure to respond to requests for assistance, failure to follow plan or physician orders, improper administration of medicines, personal hygiene, and toileting/incontinent care among others.

Environment (air/temp, cleanliness, building, etc.) comes in second with about 11%, closely followed by Autonomy (et al.) at 10% and dietary at about 8%. Detailed statistics, both national and by state, are available from the Administration on Aging LTC Ombudsman National and State Data page.

Information and Assistance

Ombudsmen do more than handle complaints. If you have questions on alternatives to nursing home care, or about your rights in a LTC facility, or on alternatives in long-term care, an ombudsman may be able to help you. Some provide witnessing services for advance health care directives. An ombudsman may be able to attend a resident care plan meeting, or a resident or family council meeting.

Advocates for system and legislative changes

State and regional ombudsman programs work with other advocacy organizations to recommend legislation and regulatory changes that affect LTC residents. They routinely serve on boards and committees of other organizations and actively advocate for policies to promote quality of care.

The National Long Term Care Ombudsman Resource Center is a great place to get a start in understanding what an ombudsman can do for you. Probably the most important page is the ‘Ombudsman Locator‘  where you can find state and local help.

Related Links

• Detailed description of ombudsman complaint codes (MS Word)
• Senior Help Forum – State and Local Resources Page

What is long-term care? It’s a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods of time. Long-term care isn’t just end-of-life care in a nursing home, and it’s not exclusively for the very old. Even those under 65 may need long-term care if injured, or chronically ill. Long-term care may occur in a person’s home, assisted living facility, or nursing home.

Long-term care can be very expensive, who pays for it? About half of long-term care is paid for by Medicaid. Since Medicaid is a government program for the poor, many people have to spend down their resources before they qualify for it. Other options for paying for care include long-term care insurance, reverse mortgage and self-insurance, though the latter is usually only possible for the wealthy.

Where can you learn more about long-term care? Kiplinger.com has an great feature on their site called, Long-Term Care Center. I’d recommend starting with the excellent(Aegis Award Winner) video on the subject. The U.S. Department of Health and Human Services maintains a site on the topic at www.longtermcare.gov.

Other potentially helpful links:
Medicare on Long-Term Care
National Care Planning Council