Long-Term Care Ombudsman: What They Do and How to Reach One

The long-term care ombudsman works for your parent, not for you: a free, confidential advocate every state provides for people in nursing homes, assisted living and board and care homes. So if something is going wrong at your mom's facility and someone told you to "call the ombudsman," that's good advice. Just know going in that the ombudsman will find out what your mom wants and follow her wishes, even when you're the one who called.1

In This Guide

• Key Takeaways
• What a Long-Term Care Ombudsman Actually Does
• Who the Ombudsman Helps
• Whose Side Is the Ombudsman On?
• What Happens if You Report Abuse or Neglect to the Ombudsman
• The Ombudsman's Right to Get In the Door
• What a Nursing Home Owes You About the Ombudsman
• Ombudsman or State Survey Agency: Which One Do You Call?
• How to Find Your State's Long-Term Care Ombudsman
• Frequently Asked Questions
• Learn More

What a Long-Term Care Ombudsman Actually Does

Think of the ombudsman as a professional problem-solver whose only client is the resident. According to the federal Administration for Community Living (ACL), the Long-Term Care Ombudsman program operates in every state under the authorization of the Older Americans Act (OAA).1

Here's how the program is set up. Each state has an Office of the State Long-Term Care Ombudsman, headed by a full-time State Long-Term Care Ombudsman who directs the program statewide, and the office works through ombudsman representatives who meet with residents.1,2 According to ACL's program page, the Older Americans Act requires every state ombudsman program to identify, investigate and resolve complaints made by or on behalf of residents, give residents information about long-term services and supports, and represent residents' interests before government agencies, including seeking administrative, legal and other remedies.1

In plain terms, ACL describes the ombudsman programs as working to resolve problems related to the health, safety, welfare and rights of people who live in long-term care facilities.1 That's the everyday stuff that wears a family down, and the ombudsman's job is to work it until it's resolved the way the resident wants it resolved. Under the federal Long-Term Care Ombudsman rule (45 CFR 1324.19), the ombudsman investigates a complaint "for the purposes of resolving the complaint to the resident's satisfaction and of protecting the health, welfare, and rights of the resident."2

Each row in that table traces to federal law or regulation, not to any one state's rules.2,3

Who the Ombudsman Helps

ACL describes the ombudsman program as working to resolve problems for people who live in long-term care facilities, "such as nursing homes, board and care and assisted living facilities, and other residential care communities."1 That covers a wider range of homes than many families expect:

• Nursing homes: licensed facilities that provide nursing care and 24-hour supervision, with services that focus more on medical care than assisted living does.4 Our guide on how to choose a nursing home walks through picking one.
• Assisted living: residential settings for people who need help with daily care, but not as much help as a nursing home provides, where exact arrangements vary by facility and by state.4 See our assisted living guides by state, and our guide on how to choose an assisted living facility walks through picking one.
• Board and care homes: small private residential homes, usually with 20 or fewer residents, that provide housing, meals and personal care.4

If your parent lives in a nursing home, assisted living or a board and care home, the Long-Term Care Ombudsman program is available to them, and anyone can contact the program with a concern.1

Whose Side Is the Ombudsman On?

The resident's. Full stop. It's worth slowing down on this before you call.

The National Long-Term Care Ombudsman Resource Center puts it plainly: the ombudsman program's mandate "is to represent the resident and assist per resident direction." When someone other than the resident files a complaint, the ombudsman program must figure out, as far as possible, what the resident wants and follow that.1 The federal ombudsman rule says the same thing in regulatory language: regardless of who files a complaint, the ombudsman and the ombudsman representatives serve the resident of the long-term care facility.2

So what does that look like when you call? Under the federal rule, the ombudsman representative discusses the complaint with your parent to find out what she wants done, including whether she wants the problem reported. If your parent can't communicate informed consent, the ombudsman representative discusses the complaint with her resident representative instead.2

That can feel frustrating if you and your mom disagree about what should happen. But it cuts both ways: if your dad is afraid of retaliation and wants to stay anonymous, the ombudsman keeps his name out of it. Under the Older Americans Act, the ombudsman program may not disclose the identity of a resident or a complainant unless that person consents in writing, gives oral consent that the ombudsman documents at the time, or a court orders the disclosure.2 According to the National Consumer Voice for Quality Long-Term Care, all services of the Long-Term Care Ombudsman program are free and confidential.1

What Happens if You Report Abuse or Neglect to the Ombudsman

Here's the part that surprises a lot of families: if you tell the ombudsman you think your mom is being abused, the ombudsman generally won't report it unless your mom, or her resident representative, agrees. Under the federal Long-Term Care Ombudsman rule (45 CFR 1324.19), the ombudsman and its representatives "shall not report suspected abuse, neglect or exploitation of a resident when a resident or resident representative has not communicated informed consent to such report," with limited exceptions, and that rule applies notwithstanding state laws to the contrary.2

That doesn't mean the ombudsman sits on abuse. The same federal rule says the ombudsman investigates complaints of abuse, neglect and exploitation. And when a resident who has given informed consent wants regulatory, protective services or law enforcement action, the Office of the State Long-Term Care Ombudsman must help the resident contact the right agency or pass along the information the resident agreed to share.2

The exceptions are narrow. In plain English, under 45 CFR 1324.19 the ombudsman can refer suspected abuse without consent only for a resident who can't speak for herself and has no one trustworthy speaking for her, and even then only with the State Ombudsman's approval or under the state office's procedures. More precisely, for an ombudsman referral without consent under the federal ombudsman rule (45 CFR 1324.19), the resident must be unable to communicate informed consent and either have no resident representative or have a representative whose own actions, the ombudsman has reasonable cause to believe, may be adversely affecting the resident.2

For a referral without consent, 45 CFR 1324.19 also requires that the ombudsman:

• has reasonable cause to believe the resident's health, safety, welfare or rights may be adversely affected,
• has no evidence the resident would not want a referral, and
• believes a referral is in the resident's best interest.2

What if the ombudsman sees it firsthand? Under the same federal rule, an ombudsman representative who personally witnesses suspected abuse, gross neglect or exploitation must first seek the resident's consent to report it, and when the resident can't consent and has no representative available, the ombudsman must refer the matter when the rule's conditions are met.2

What should you take from this? If you believe your parent is being abused, the ombudsman is a strong ally, but don't count on a call to the ombudsman to put a report on file with anyone else. The federal Long-Term Care Ombudsman rule (45 CFR 1324.11) even requires each state program's policies to prohibit requirements that the ombudsman report abuse to Adult Protective Services or any other entity, including when that report would reveal a resident's identity without consent, except as the rule itself provides.2 Our guide on how to report nursing home abuse or neglect lays out who else to contact.

The Ombudsman's Right to Get In the Door

The ombudsman also has a federal right to get in the door, and it's broader than most families expect.

Under the Older Americans Act, each state must ensure that representatives of the Office of the State Long-Term Care Ombudsman have "private and unimpeded access to long-term care facilities and residents." The federal ombudsman rule (45 CFR 1324.11) spells that out: ombudsman representatives can enter any long-term care facility during regular business or visiting hours, and at any other time the circumstances being investigated require, and they have access to all residents.2

Records are different. Under 45 CFR 1324.11, the ombudsman can review a resident's medical, social and other records with the informed consent of the resident or the resident's representative. Under the same federal rule, an ombudsman can review a resident's records without that consent in only two narrow cases, both requiring the State Ombudsman's approval: when the resident can't communicate consent and has no legal representative, and when the ombudsman needs the records to investigate a complaint, the resident's representative refuses, and the ombudsman has reasonable cause to believe that representative isn't acting in the resident's best interests.2

What a Nursing Home Owes You About the Ombudsman

Nursing homes have their own set of federal duties toward the ombudsman, in the resident rights and discharge rules at 42 CFR Part 483. You can use these as a checklist.

• Access. Under 42 CFR 483.10, a nursing home must provide immediate access to any resident by any representative of the Office of the State Long-Term Care Ombudsman, and must let ombudsman representatives examine a resident's medical, social and administrative records in accordance with state law.3
• Posted contact information. A nursing home must post, in a form residents and their representatives can access and understand, the names, addresses, email addresses and phone numbers of state agencies and advocacy groups, including the State Long-Term Care Ombudsman program and the State Survey Agency.3
• No discouraging contact. A nursing home must not prohibit or in any way discourage a resident from communicating with representatives of the Office of the State Long-Term Care Ombudsman.3
• Discharge notices. Under 42 CFR 483.15, when a nursing home transfers or discharges a resident, the nursing home must send a copy of the written notice to a representative of the Office of the State Long-Term Care Ombudsman, and the notice itself must list the Office's name, address and phone number.3

That last one matters more than it looks. If your parent gets a discharge notice, the ombudsman's contact information is printed right on it, and the nursing home is required to send the ombudsman's office a copy.3 Call the ombudsman early rather than waiting for the move-out date.

These four duties come from federal nursing home rules, so they describe what a nursing home owes its residents. For assisted living, exact arrangements vary by facility and by state, so ask your parent's facility and your state's ombudsman program what applies.4 The ombudsman program serves assisted living residents too.1

Ombudsman or State Survey Agency: Which One Do You Call?

Both, sometimes. They do different jobs.

The ombudsman is an advocate. Under the federal Long-Term Care Ombudsman rule, the ombudsman's job is to resolve a complaint the way the resident wants it resolved and to protect the resident's health, welfare and rights.2

The State Survey Agency is where federal rules point nursing home residents for regulatory complaints. The same federal posting rule that lists the ombudsman requires every nursing home to post a statement that residents may file a complaint with the State Survey Agency about any suspected violation of state or federal nursing facility regulations, including resident abuse, neglect and exploitation.3

So call the ombudsman when you want someone in your parent's corner working toward the outcome she wants. File with the State Survey Agency when you believe a nursing home violated a state or federal nursing facility regulation.3

If your question is about a Medicare claim or appeal rather than life in the facility, that's a different set of offices. Our guide to who to call for Medicare help sorts them out.

How to Find Your State's Long-Term Care Ombudsman

There are two easy places to start:

1. The posting in the nursing home. If your parent lives in a nursing home, federal rules require the nursing home to post the ombudsman program's contact information.3
2. The national state directory. ACL points people to a state-by-state directory run by the National Consumer Voice for Quality Long-Term Care. The Consumer Voice directory page, titled "Find the Long-Term Care Ombudsman Program in Your State," asks you to click on your state for contact information.1

When you call, have a few things ready: your parent's name and facility, what happened and when, and whether your parent knows you're calling. Expect the ombudsman representative to want to talk with your parent directly about the complaint.2

Learn More

Find personalized help sorting out a problem at your parent's nursing home or assisted living at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.