Administration on Aging Issues New Rules on States’ Long-Term Care Ombudsman Programs

New rules from the “Administration on Aging of the Administration for Community Living.” Honestly, is that the longest title for any unit in federal government? AoA and ACL operate under the Department of Health and Human Services (HHS) and recently issued new final rules governing Long-Term Care Ombudsman Programs.  

Ombudsmen have traditionally had important roles to play as advocates for elderly or disabled residents in facility-based care.

The new rules complete the process of approval that commenced with proposed rules in June 2013.  The effective date for the new rules — deferred to permit implementation and training — is July 1, 2016.

In a recent email to interested stakeholders, David Godfrey, senior attorney at the ABA’s Commission on Law and Aging, comments positively on the new rules:

“Exciting news! … A culmination of several years of collaborative work with our partners, this rule guides implementation of the portions of the Older Americans Act governing grants to states for operation of Long-Term Care (LTC) Ombudsman programs.

• Key issues this rule addresses include:
• Responsibilities of key figures in the system, including the Ombudsman and representatives of the Office of the Ombudsman;
• Responsibilities of the entities in which LTC Ombudsman programs are housed;
• Criteria for establishing consistent, person-centered approaches to resolving complaints on behalf of residents;
• Appropriate role of LTC Ombudsman programs in resolving abuse complaints; and
• Conflicts of interest: processes for identifying and remedying conflicts so that residents have access to effective, credible ombudsman services.”

As noted in the introduction to the new rules, a major reason for the change is to achieve better consistency across the nation, while still preserving the “independence” that has been a hallmark of the best programs. 

Long-term Care Ombudsman programs, started in 1972 in a few locations as demonstration projects, now exist in all 50 states, D.C., Puerto Rico and Guam.  They receive major federal funding under the Older Americans Act, although some states also provide key additional funds. 

During the rule-making process, a number of critiques and comments were directed to the scope of the program, noting that as benefits increasingly focus on home and community-based care, the Ombudsmen program should be expanded to serve individuals in non-facility settings.  However, because the AoA program is controlled by federal statute, the Final Rule continues to limit authority to serve “as advocates for residents of nursing homes, board and care homes, assisted living and similar adult care facilities.”

Hat top to Karen Miller, Esq., of Florida who brought the new rules to my attention, while also raising the important observation that the definition of the service area does not seem to reach all members of continuing care retirement communities (CCRCs), especially those living outside of skilled care units.  Thanks, Karen!

I also note that AoA reportedly “anticipates little or no financial impact on the State agencies or other agencies carrying out the Ombudsman program, the consumers served by the Ombudsman Program, or long-term care facilities through implementation of this rule.” Hmm. How does that happen? Is the goal improvement of service or merely “consistency?”

Here’s the link to the all 258 pages of the Final Rules on States’ Long-Term Ombudsman Programs, comments and agency implementation memo, published in the Federal Register on February 11, 2015.