Long-Term Care Ombudsman Program: Advocacy Services for Long-Term Care Residents

In 2016, when Gorgi Talevski’s dementia progressed to the point his family members could no longer care for him, they placed him in a nursing home near their home in Indiana. When he entered the facility, he could talk, feed himself, walk, socialize, and recognize his family. However, his condition quickly deteriorated – he began to lose his ability to communicate and could no longer feed himself. Although the nursing home claimed this was the natural progression of his dementia, outside physicians discovered they were sedating – or chemically restraining – Mr. Talevski with six different psychotropic drugs. His medication was then tapered down, and he regained the ability to eat on his own. During this time the state’s regulatory agency conducted its periodic inspection of the nursing home, and the resident’s family filed a formal complaint with inspectors regarding the chemical restraints.

Toward the end of 2016, the nursing home asserted that Mr. Talevski was harassing female residents and staff. Based on that claim, it began sending him to a psychiatric hospital 90 minutes away for several days at a time. While the nursing home readmitted him the first two times it sent him away, the third time, instead of accepting him back, it tried to force his permanent transfer to a dementia facility in Indianapolis – a 2 1/2-hour drive away from his family. The nursing home executed these changes without first notifying the resident or his family, ultimately resulting in a June 8, 2023, U.S. Supreme Court decision that delivered a victory to nursing home residents living in publicly-owned Medicaid-funded nursing facilities. The Court found that these residents have the right to commence legal proceedings or file a lawsuit (a private right of action) against a nursing home if it violates the rights conferred upon residents by the Federal Nursing Home Reform Act of 1987 (FNHRA).

FNHRA includes the rights to be free from chemical restraints and not be subjected to illegal discharges, among many others. It also requires each nursing home to care for its residents in a manner that promotes and enhances the quality of life of each resident, ensuring dignity, choice, and self-determination. All nursing homes are required "to provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care that… is initially prepared, with participation, to the extent practicable, of the resident, the resident's family, or legal representative." This means a resident should not decline in health or well-being as a result of the way a nursing facility provides care.

While this was a hard-won success for residents living in publicly-owned Medicaid-funded nursing homes, many long-term care (LTC) residents continue to endure daily injustices similar to what Mr. Talevski experienced. A LTC Ombudsman advocates for residents’ rights through education, training, and empowering residents and their legal representatives/family members on how to speak up for themselves. LTC Ombudsmen are resident-directed, meaning that they act only upon permission of the resident. All Ombudsman program services are free and confidential.

Purpose of LTC Ombudsman Program (LTCOP)

The primary purpose of the LTCOP is to promote and protect rights guaranteed to long-term care residents under federal and state laws. Under the federal Older Americans Act, every state is required to have an Ombudsman program that addresses complaints and advocates for improvements in the long-term care system.

LTC Ombudsmen advocate for residents of nursing homes, board and care homes, and assisted living facilities. They are trained to assist residents with complaints and resolve problems. Ombudsmen also provide information about how to find a facility and what to do to improve the quality of care.

LTC Ombudsmen are advocate ombudsmen; they are not neutral. They act at the direction and benefit of LTC residents. Advocate ombudsmen do not represent their own views but amplify those of the person they are supporting. The goal is resolution to the satisfaction of the resident.

Other Ombudsmen responsibilities include:

• Educating residents, their family and facility staff about residents’ rights, good care practices, and similar long-term services and supports;
• Ensuring residents have regular and timely access to ombudsman services;
• Providing technical support for the development of resident and family councils;
• Advocating for changes to improve residents’ quality of life and care;
• Providing information to the public regarding long-term care facilities and services, residents’ rights, and legislative and policy issues;
• Representing resident interests before governmental agencies; and
• Seeking legal, administrative, and other remedies to protect residents.

“I had the pleasure of working with the Ombudsman when the facility gave me an involuntary discharge…Making that call was the best thing I did to navigate unfair treatment…He was a terrific advocate for me and it was only because of his efforts that we reached an acceptable compromise. My outcome and recovery would have suffered considerably if I did not have the Ombudsman to work with me.”  —A LTC resident 

Would the assistance of a LTC Ombudsman from the beginning have made a difference in the outcome for Mr. Talevski? It’s hard to say for sure, but Ombudsman involvement early on – perhaps after the overmedication complaint survey findings – may have resulted in improved communications between the resident/family members and the facility. The Ombudsman Program provides education, empowerment, and direct advocacy to help the resident improve their quality of life.