Ombudsman What is an Ombudsman?

An ombudsman is a person who advocates on behalf of others. In this context, a long-term care ombudsman advocates for residents in an assisted living facility or health care institution. This person receives, investigates, and resolves complaints against the residential facility or health care institution involving the safety, health, welfare, and rights of residents and patients. There are many types of ombudsman across the globe. However, the one that will be focused on in this paper is the ombudsman for the elderly.

The History of Ombudsman The first public sector ombudsman started in Sweden in 1809. According to the United States Ombudsman Association (2012) The Swedish Constitution divided and balanced power between the king and Parliament with the king having executive powers and Parliament retaining legislative power. The ombudsman, who was appointed by and responsible to Parliament, was to protect individual rights against the excesses of the bureaucracy. This first ombudsman's office, since its creation, has been the model for the public sector ombudsman, and set the definition that is still accepted today: a public official appointed by the legislature to receive and investigate citizen complaints against administrative acts of government. These acts may or may not include the administrative acts of the judiciary or the legislature, depending upon the statute. The ombudsman idea spread through Europe and to the US with the first offices being recognized in the United States in the mid 1960's. This was a time in the United States when

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exposure of government secrecy and scandal, and when movements such as civil rights and good government created a political atmosphere more favorable to openness, and to establishing recourse for the aggrieved. Hawaii established the first public sector office in 1967. Since then a number of states, counties and municipalities have followed suit by establishing offices of universal influence. The ombudsman movement in the United States has also been characterized by offices that represent a departure from the Swedish model. These differences would include offices with general jurisdiction but appointment by a governor or mayor, legislative offices with special jurisdiction such as corrections, and single agency ombudsman with legal power.

Types of Ombudsman There are different types of ombudsmen. The ombudsmen that work with long term care elderly patients are considered advocate ombudsmen. This is a list and description of the types of ombudsmen that are available. Classical Ombudsmen These Ombudsmen receive and investigate complaints and concerns regarding governmental policies and processes. The authority and mandate of Classical Ombudsmen are typically provided by statutory language. These Ombudsmen may be elected by constituents or appointed by a legislature or organization to monitor citizens treatment under the law. Classical

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Ombudsmen generally have authority to conduct investigations and make recommendations for appropriate redress or policy change. Advocate Ombudsmen An Advocate Ombudsman may be located in either the public or private sector. He or she evaluates claims objectively but is authorized or required to advocate on behalf of individuals or groups found to be aggrieved. Advocate Ombudsmen are often found in organizations such as long-term care facilities or agencies, and organizations that work with juvenile offenders. Hybrid Ombudsmen Hybrid Ombudsmen are usually established by policy or terms of reference by both private and public sector organizations. They primarily use informal methods to resolve complaints but also have the power to investigate and the authority to publish annual and special reports. Executive Ombudsmen An Executive Ombudsman may be located in either the public or private sector and receives complaints concerning actions and failures to act of the organization, its officials, employees and contractors. An Executive Ombudsman may either work to hold the organization or one of its programs accountable or work with the organizations officials to improve the performance of a program. Legislative Ombudsmen A Legislative Ombudsman is a part of the legislative branch of a government entity and addresses issues raised by the general public or internally, usually concerning the actions or

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policies of government entities, individuals or contractors with respect to holding agencies accountable to the public. Media Ombudsmen The Media, or News, Ombudsman is familiar to many people. The News Ombudsmans primary objective is to promote transparency within his or her news organization. This Ombudsman can receive and investigate complaints about news reporting on behalf of members of the public and then recommend the most suitable course of action to resolve issues raised in the complaints. The News Ombudsman is an independent officer acting in the best interests of news consumers. He or she explains the roles and obligations of journalism to the public and acts as a mediator between the expectations of the public and the responsibilities of journalists.

Training to Become an Ombudsman According to the National Long Term Care Ombudsman Resource Center training for ombudsman staff and volunteers is critical for maintaining an effective long-term care ombudsman program. Training curricula and methods are constantly being revised and reevaluated to better address a states needs and provide current information. The NLTCO Resource Center has a vast collection of training exercises, videos, tests, and advice from paid and volunteer ombudsman to ensure that quality care is given and that updated information on the law is provided. What does a long-term care Ombudsmen do?

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A long term care ombudsman resolves complaints made by or for residents of long-term care facilities. They educate consumers and long-term care providers about residents' rights and good care practices. Ombudsmen also promotes community involvement through volunteer opportunities and provides information to the public on nursing homes and other long-term care facilities and services, residents rights and legislative and policy issues. They also advocate for residents' rights and quality care in nursing homes, personal care, residential care and other long-term care facilities. The concerns that long term care ombudsmen address include the violation of a residents rights or dignity and physical, verbal or mental abuse, removal of services necessary to maintain a residents' physical and mental health, or unreasonable confinement. They also address poor quality of care, including inadequate personal hygiene and slow response to requests for assistance. Long term care ombudsmen also address the concerns of the improper transfer or discharge of a patient, improper use of physical or chemical restraints, and any resident concern about their quality of care and life in an establishment. Long term care ombudsmen are also well educated on the rights of a patient.

The rights of a long term care patient.

Residents of long term care facilities still have the same rights as everyone else. To ensure that these rights are met, a long term ombudsmen ensures these rights. These rights are: 1. the right of citizenship. Nursing home residents do not lose any of their rights of citizenship, including the right to vote, to religious freedom and to associate

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with whom they choose. 2. The right to dignity. Residents of nursing homes are honored guests and have the right to be treated as such. 3. The right to privacy. Nursing home residents have the right to privacy whenever possible, including the right to privacy with their spouse, the right to have their medical and personal records treated in confidence, and the right to private, uncensored communication. 4. The right to personal property. Nursing home residents have the right to possess and use personal property and to manage their financial affairs. 5. The right to information. Nursing home residents have the right to information, including the regulations of the home and the costs for services rendered. They also have the right to participate in decisions about any treatment, including the right to refuse treatment. 6. The right of freedom. Nursing home residents have the right to be free from mental or physical abuse and from physical or chemical restraint unless ordered by their physician. 7. The right to care. Residents have the right to equal care, treatment and services provided by the facility without discrimination. 8. The right of residence. Nursing home residents have the right to live at the home unless they violate publicized regulations. They may not be discharged without timely and proper notification to both the resident and the family or guardian. And finally, 9. The right of expression. Nursing home residents have the right to exercise their rights, including the right to file complaints and grievances without fear of reprisal.

Who can request and use ombudsmen services?

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Anyone who is currently in any long term care facility can use the services of an ombudsman. Also, anyone who is a parent, child, guardian, and even a friend can request services on behalf of someone who is currently in a long term care situation. If an employee or nursing home administrator sees a need or has a concern, they can also request an ombudsman on behalf of a patient. An individual or group interested in the welfare of a patient may also request services from ombudsmen.

Limitations of an Ombudsman

Those who complain to an ombudsman have no limitations on what they can complain about. However, an ombudsman does have limitations on what they can do and say. According to the Coalition of Federal Ombudsman (2012) the limitations of an ombudsman are as follows:

Give legal advice Provide psychological counseling Provide medical advice Make decisions on legal or medical issues Represent the client in formal hearings or proceedings

Laws and Regulations

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The Older Americans Act of 2006 was enacted to ensure that the elderly are entitled to fair treatment and rights in care settings. Per the National Long Term Care Ombudsman Resource Center (NORC), the Older Americans Act of 2006 states:

1) An adequate income in retirement in accordance with the American standard of living.

(2) The best possible physical and mental health which science can make available and without regard to economic status.

(3) Obtaining and maintaining suitable housing, independently selected, designed and located with reference to special needs and available at costs which older citizens can afford.

(4) Full restorative services for those who require institutional care, and a comprehensive array of community-based, long-term care services adequate to appropriately sustain older people in their communities and in their homes, including support to family members and other persons providing voluntary care to older individuals needing longterm care services.

(5) Opportunity for employment with no discriminatory personnel practices because of age. (6) Retirement in health, honor, dignityafter years of contribution to the economy.

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(7) Participating in and contributing to meaningful activity within the widest range of civic, cultural, educational and training and recreational opportunities.

(8) Efficient community services, including access to low cost transportation, which provide a choice in supported living arrangements and social assistance in a coordinated manner and which are readily available when needed, with emphasis on maintaining a continuum of care for vulnerable older individuals.

(9) Immediate benefit from proven research knowledge which can sustain and improve health and happiness.

(10) Freedom, independence, and the free exercise of individual initiative in planning and managing their own lives, full participation in the planning and operation of community based services and programs provided for their benefit, and protection against abuse, neglect, and exploitation.

The Older Americans Act goes on to define the terms abuse, aging network, elder justice, and neglect in very specific details. There are also provisions for Medicaid and Medicare under this Act.

The original Older Americans Act which was enacted in 1965 was passed by congress in response to concern by policymakers about a lack of community social services for older persons. The original legislation established authority for grants to States for community planning and social services, research and development projects, and personnel training

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in the field of aging. The law also established the Administration on Aging (AoA) to administer the newly created grant programs and to serve as the Federal focal point on matters concerning older persons. Although older individuals may receive services under many other Federal programs, today the OAA is considered to be the major vehicle for the organization and delivery of social and nutrition services to this group and their caregivers. It authorizes a wide array of service programs through a national network of 56 State agencies on aging, 629 area agencies on aging, nearly 20,000 service providers, 244 Tribal organizations, and 2 Native Hawaiian organizations representing 400 Tribes. The OAA also includes community service employment for low-income older Americans; training, research, and demonstration activities in the field of aging; and vulnerable elder rights protection activities.

The OAA has been updated and revised a total of three times. The first OAA was in 1965. The second and third times were in 1988 and recently in 2006.

Ombudsmen Organizations

There are a number of Ombudsmen Advocacy groups and organizations. 1. CARIE CARIE is the Center for Advocacy for the Rights and Interests of the elderly. This nonprofit organization in Philadelphia that is devoted to improving the life of vulnerable elderly. CARIE goes on to say our programs and services include community education, professional training, and individual counseling and problem solving. CARIE was started in 1977 by a union of groups and

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individuals, including the Friends Committee on Aging, the Lutheran Council on Aging, and the Grey Panthers. In the fall of 2004, CARIE was recognized by Citizens Bank and NBC 10 as their Community Champion for the Elderly. 2. PCA - Philadelphia Corporation for Aging is a private, non-profit organization serving as Philadelphia Countys Area Agency on Aging since 1973. One of the regions largest non-profit organizations, PCA's mission is to improve the quality of life for older Philadelphians or people with disabilities and to assist them in achieving their maximum level of health, independence and productivity. Special consideration is given to those with the greatest social, economic, and health needs. 3. NORC - The National Long-Term Care Ombudsman Resource Center provides support, technical assistance and training to the 53 State Long-Term Care Ombudsman Programs and their statewide networks of almost 600 local programs. The Center's purpose are to improve the skills, knowledge, and management capacity of the State programs to enable them to handle residents' complaints and represent resident interests (individual and systemic advocacy).

In conclusion, the long term care ombudsmen across the country are an asset to the elderly population. Whether the issue is hospice care, a nursing home, Medicare or Medicaid, the ombudsman is there to assist and direct the person in the best direction possible. Without these ombudsmen, the elderly population would be left to defend themselves in a world where the wolves eat the young, old, and the weak.

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Some ombudsmen are paid, but for the majority, ombudsmen are on a volunteer basis and do the job because their heart tells them its the right thing to do. In the end, someone has to know the law and rights and relay that information to the elderly population. Being an ombudsman allows you to give out not only information but hope as well.