Long-Term Care Ombudsman Program

Older Americans Act (OAA), Title VII, Chapter 2, Sections 711/712

The Purpose of the Program and How It Works

States’ Long-Term Care (LTC) Ombudsman programs work to resolve problems related to the health, safety, welfare and rights of individuals who live in LTC facilities (i.e. nursing homes, board and care, assisted living, and other residential care communities). Ombudsman programs promote policies and consumer protections to improve long-term services and supports (LTSS) at the facility, local, state, and national levels. 

Begun in 1972 as a demonstration program, today the Ombudsman program operates in all states, the District of Columbia, Puerto Rico and Guam, under the authorization of the OAA. Each state has an Office of the State LTC Ombudsman (Office), headed by a full-time State LTC Ombudsman (Ombudsman) who directs the program statewide. Ombudsmen designate staff and thousands of volunteers as representatives to directly serve residents.

The OAA requires Ombudsman programs to:

  • Identify, investigate, and resolve complaints made by or on behalf of residents;
  • Provide information to residents about LTSS;
  • Ensure that residents have regular and timely access to ombudsman services;
  • Represent the interests of residents before governmental agencies and seek administrative, legal, and other remedies to protect residents; and
  • Analyze, comment on, and recommend changes in laws and regulations pertaining to the health, safety, welfare, and rights of residents.
Funding History

OAA Title VII Chapter 2 (Ombudsman Program)
Congressional Appropriations

Fiscal Year Dollar Amount
FY 2015 $15,870,051
FY 2014 $15,862,868
FY 2013 $15,869,941
FY 2012 $16,723,160
FY 2011 $16,749,234

Total program expenditures from all sources, including
OAA Title III, Title VII, and other federal, state and local sources:

Fiscal Year Dollar Amount
FY 2015 $96,964,406
FY 2014 $94,038,915
FY 2013 $92,501,893
FY 2012 $90,776,521
FY 2011 $87,576,960

National Ombudsman Reporting System (NORS)

State Form and Instructions for the National Ombudsman Reporting System (NORS)

Form for the State Annual Ombudsman Report to AoA 

Instructions for Completing the NORS Form

Complaint Codes 

Data Show Extensive Services Provided to Persons in LTC Facilities

Data for FY 2015 indicate that LTC ombudsman services to residents were provided by 1,300 full-time-equivalent staff and 7,734 volunteers, trained and designated to investigate and resolve complaints. The program:

  • Worked to resolve 199,238 complaints initiated by residents, their families, and other concerned individuals;
  • Resolved or partially resolved 74% of all complaints to the satisfaction of the resident or complainant;
  • Provided 398,057 instances of information and assistance to individuals;
  • Visited 67% of all nursing homes and 27% of all board and care, assisted living, and similar homes at least quarterly;
  • Conducted 5,054 training sessions in facilities on such topics as resident rights;
  • Provided 122,213 instances of information and assistance to LTC facility managers and staff; and
  • Participated in 22,281 resident council and 2,073 family council meetings.

The five most frequent complaints in board and care, assisted living, and other residential care communities handled by ombudsman programs were:

  • Administration and organization of medications;
  • Quality, quantity, variation and choice of food;
  • Improper eviction or inadequate discharge/planning;
  • Lack of respect for residents, poor staff attitudes; and
  • Building or equipment in disrepair or hazardous.  

The five most frequent nursing facility complaints handled by ombudsman programs were:

  • Improper eviction or inadequate discharge/planning;
  • Unanswered requests for assistance;
  • Lack of respect for residents, poor staff attitudes;
  • Administration and organization of medications; and
  • Quality of life, specifically resident/roommate conflict.

Learn more about ombudsman activities and the types of cases/complaints that they investigated.

Recent Changes in Requirements: 2016 OAA Reauthorization

The OAA was reauthorized by Congress in April 2016. For a summary of changes and other material, see the Older Americans Act page.

Recent Changes in Requirements: State LTC Ombudsman Programs Rule

The State Long-Term Care Ombudsman Programs rule was published in February 2015 and became effective on July 1, 2016. A culmination of several years of collaborative work with states and other partners, this rule guides implementation of the portions of the OAA governing grants to states for operation of LTC Ombudsman programs.

The rule addresses:

  • 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.

For more information see:

Resources and Useful Links


Last modified on 05/03/2017