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Long Term Care Ombudsman Program Final Rule

Since 1978, the functions of the State Long-Term Ombudsman program have been delineated in the Older Americans Act; however, regulations have not been promulgated.  In the absence of regulatory guidance, there has been significant variation in the interpretation and implementation of the program among States. AoA/ACL believes that consumers and long-term care providers will benefit from the implementation of this rule. Consumers and other complainants across the country will receive services from Ombudsman programs with more consistent quality and efficiency of service delivery. This rule became effective July 1, 2016.

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​State Long-Term Care Ombudsman Programs Rule

Final Rule Language

Final Rule: 45 CFR Parts 1321 and 1324 State Long-Term Care Ombudsman Programs (February 2015)
The Final Rule was published February 11, 2015 by the Department of Health and Human Services. Read the rule in its entirety. Final Rule: 45 CFR Parts 1321 and 1324 State Long-Term Care Ombudsman Programs. A revised version of the Final Rule with corrected typos was published on December 20, 2016. The revised version can be viewed here. 

Note: Effective July 1, 2016 the Administration for Community Living (ACL) consolidated their regulations into one subchapter resulting in the LTCOP rule number changing from 45 CFR 1327 to 45 CFR 1324. Information about the consolidation is available here.

 

Resources Produced by AoA/ACL

Older Americans Act Crosswalk
ACL published an Older Americans Act (OAA) Regulations 1988 to 2024 Comparison Chart. This chart is intended for informational and summary purposes only. The final rule, published in the Federal Register, is the official document.

Frequently Asked Questions (FAQs)- Long Term Care Ombudsman Programs
These FAQs were produced by AoA/ACL and are intended to assist State Agencies on Aging, State Long-Term Care Ombudsman Programs, and other entities that work with Ombudsman programs with the implementation of the State Long-Term Care Ombudsman Programs Rule, which took effect July 1, 2016. 

Long-Term Care Ombudsman Program Final Rule Webinar
This webinar was presented by Becky Kurtz, Former Director, Office of LTCO Programs with AoA of ACL, with an introduction by Kathy Greenlee, Former Administrator, Administration for Community Living; Assistant Secretary, Administration on Aging. View the slides here.

The webinar provided an opportunity to review sections of the rule including:

  • 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

  • State Long-Term Care Ombudsman Programs NPRM: Consumer Voice Briefing (July 2013)
    This presentation by Becky Kurtz, Former Director, Office of LTCO Programs with AoA of ACL, gives an overview  of the proposed rule. Listen to the recording and follow along with Becky’s presentation. View the slides here.

2015 Long-Term Care Ombudsman Rule: Guidance to Strengthen Services to Long-Term Care Residents (September 2015)
This PowerPoint presentation was part of an N4A Webinar presented by Becky Kurtz and Lori Smetanka. View this presentation as a PPT.

How the LTCO Rule Supports Person-Centered Advocacy (November 2015)
Presented by Becky Kurtz of the Administration for Community Living, this PowerPoint presentation details the historical and more recent developments in federal laws relating to LTCO.

Resources Produced by NORC

Webinars

LTCOP Rule: Supporting Person-Centered Advocacy - Complaint Investigations and Abuse Reporting

The National Ombudsman Resource Center (NORC) hosted the first webinar of a two-part series on the LTCOP Rule. Speakers included, Louise Ryan, Ombudsman Program Specialist, Office of Long-Term Care Ombudsman Programs, AoA/ACL; Carol Scott, Ombudsman Specialist, National Ombudsman Resource Center; and Jan Brown, Ombudsman Specialist PA Department of Aging. The objectives of this webinar were to:

  • Understand the complaint process responsibilities as outlined in the LTCOP Rule
  • Remain focused on the primary role and duties of the Ombudsman program:
    • to investigate and resolve complaints, whether on an individual or systemic level,
    • obtain resident consent for ombudsman action,
    • know when and how to disclose information, and
    • remember that the goal is to resolve complaints to the resident’s satisfaction.

Handouts

LTCOP Rule: Identifying and Addressing Individual Conflicts of Interest

This webinar was designed to assist Ombudsman program representatives in understanding the Conflict of Interest provisions in the LTCOP Rule and how to apply them in your work. Speakers include Louise Ryan, Ombudsman Program Specialist, Administration on Aging/Administration for Community Living; Patty Ducayet, Texas State Long-Term Care Ombudsman; Stacey Premo, Director, Ombudsman Program, Toledo, Ohio; and Sara Hunt, NORC Consultant.

Handouts

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Issue Briefs

LTCOP Rule Issue Brief: Considerations for Identifying and Addressing Individual Conflicts of Interest
The purpose of this document is to assist states to identify and remedy or remove conflicts of interest (COI) of individuals designated as the Ombudsman or as representatives of the Office as required by the State Long-Term Care Ombudsman Programs, Final Rule. The Rule requires four steps regarding individual COIs:  

1. Establish and implement policies and procedures related to COI
2. Identify COIs
3. Avoid appointing or designating individuals with COI
4. Remove or Remedy the conflict. 

This brief consists of the following two sections pertinent to the topic: Implementation, Key Points to Consider; and a List of Authorities. 

LTCOP Rule Issue Brief: Complaint Processing and Abuse Reporting 
The purpose of this document is to assist states with complaint processing, including access, resident participation, abuse, and disclosure as required by the State Long-Term Care Ombudsman Programs Final Rule. This brief consists of the following sections pertinent to the topic: Implementation, Key Points to Consider, and a List of Authorities.

LTCOP Rule Issue Brief: Grievance Process
The purpose of this document is to assist states to address requirements regarding a grievance process related to the determinations or actions of the Ombudsman (State Long-Term Care Ombudsman) and representatives of the Office of the State Long-Term Care Ombudsman (the Office) required by the State Long-Term Care Ombudsman Programs, Final Rule.

State LTCO Program Statutes and/or Regulations Chart
This chart includes links to state statutes and regulations regarding the LTCO Program (as of February 2016).

Individual Conflict of Interest Screening Template
This document contains information based on the LTCOP Rule, §1324.21(d), Conflicts of Interest. The content is adapted from similar tools developed by State Ombudsman programs, such as Ohio, Texas, Oklahoma, and Iowa. This template is intended for use as a guide when Ombudsman programs develop or revise individual conflict of interest screening tools. States are responsible for adding any state specific requirements, definitions, or processes that may not be included in this document. 

LTCOP Organizational Conflict of Interest – Examples of Identification, Remedies, and Removal (Office of the State Long-Term Care Ombudsman and Local Ombudsman Entities)
These charts provide examples of how to identify and remedy organizational conflicts of interest for the Office of the State Long-Term Care Ombudsman and local Ombudsman entities. The charts also identify specific conflicts that are prohibited per the LTCOP Rule and removal is the only acceptable way to address the conflict.

LTCOP Rule Issue Brief: State LTCOP Organizational Level Conflict of Interest
The purpose of this document is to assist states to identify and remedy or remove conflicts of interest (COI) within the Office of the State Long-Term Care Ombudsman (the “Office”) as required by the State Long-Term Care Ombudsman Programs, Final Rule.

*Additional resources on this topic are available under "Additional Resources Regarding COI"

LTCOP Rule Issue Brief: Local Ombudsman Entity Organizational Level Conflict of Interest
The purpose of this document is to assist the State Ombudsman to identify and remedy or remove conflicts of interest (COI) within an agency hosting a local Ombudsman entity as required by the State Long-Term Care Ombudsman Programs, Final Rule. Organizational COI are conflicts that may impact the effectiveness and credibility of the work of the Office of the State Long-Term Care Ombudsman.

Additional Resources Regarding COI

  • Conflict of Interest and the Long-Term Care Ombudsman Program
    This resource paper discusses the Older Americans Act provisions and dimensions of conflict of interest. Key resources and approaches utilized by several state and local ombudsman programs are included as examples of program management practices to address issues such as policies and procedures, remedies, decision-making criteria, and COI forms.

  • Long-Term Care Ombudsman Strategy Session
    In this document conflicts of interest are discussed in the session summary, as well as in two briefs about COI in the appendices.

  • Real People, Real Problems: An Evaluation of the Long-Term Care Ombudsman Programs of the Older Americans Act (Institute of Medicine (IoM), 1995)

  • A Self-Evaluation and Continuous Quality Improvement Tool for State and Local Ombudsman Programs (COI discussed on page 47 of the state LTCOP version and page 62 of the local LTCOP version)
    This tool provides State and Local Long-Term Care Ombudsmen with an instrument for conducting a self-assessment of their program to identify the program’s strengths and areas in need of improvement.

    There is also a condensed version (the minitool) of the original instrument that allows for a quick, initial assessment of a statewide program to identify areas for improvement and areas of strength. Once those program areas are identified, the user can move on to the comprehensive evaluation tool for an in-depth assessment of each component. Links to the comprehensive self-assessment, mini-tool, instructional brief, and instructional webinar recording (for both local and state LTCOPs) are available on this page.

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Side-by-Sides

Overview of the Long-Term Care Ombudsman Program Final Regulations
The information contained in this document is an overview of the Final Regulations for the Long-Term Care Ombudsman Program (amending 45 CFR Parts 1321 and 1324), published in the Federal Register, Vol. 80, No. 28, 7704-7767 (February 11, 2015). The purpose of this overview is to provide a quick reference to the provisions included in the regulation.

Side-by-side of the Long-Term Care Ombudsman Program Final Rule with the Pertinent Preamble Language
This document lists each section of the Final Rule alongside the pertinent response to comments from AoA found in the preamble. The preamble language is helpful as it gives insight into the considerations behind the language and intent of the regulation.

Side-by-side of the Long-Term Care Ombudsman Program Final and Proposed Regulations
This document lists the language of each section of the Final Regulations alongside the original section language in the proposed rule in chart form so the changes, additions, and omissions from proposed to final rule are apparent.

Worksheet - Long-Term Care Ombudsman Program Final Regulations
This document lists the language of the Final Regulations by section in chart form, alongside a blank column where corresponding state regulations or policy language can be inserted. This will give stakeholders in the states the opportunity to determine where the gaps are and additional language is needed in order to come into compliance with the new rules. NOTE: The comprehensive worksheet is broken down into four charts with a blank column for notes for specific sections of the rule below.  

How State Ombudsmen Are Involving Locals in the Implementation of the Final Rule
NORC asked State Ombudsmen how they were including program representatives (ombudsmen staff and/or volunteers) in the implementation of the LTCOP Final Rule. This graphic, provided in the link, highlights the results. 31 out of the 53 state ombudsman programs responded to this query. 

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Technical Assistance Responses

Legal Counsel (March 2016)
This document answers the question, "Are there examples of how states are equipping the Long-Term Care Ombudsman Program to pursue administrative, legal, and other remedies to protect residents?" and "Are there examples of how states are providing legal counsel that is adequate and without conflict of interest for the program?"

Designation and De-Designation (December 2015)
This document answers the question, “Are there examples of SLTCOPs policies and procedures on designation and de-designation?”

Grievance Procedure (December 2015)
This document answers the question, “Are there examples of LTCO policies and procedures regarding how to respond complaints against the LTCO program?” 

Disclosure of LTCO Information (September 2015)
This document answers the question, “How do State LTCOPs address disclosure of LTCOP information in program policies and procedures, e.g. determining what information to release, to whom, and under what circumstances, and delegation by the Ombudsman for disclosure?”

Complaint Response Time (June 2015)
This document answers the question, “In the Final Rule 1324.11 (v) Standards to assure prompt response to complaints by the Office and/or local Ombudsman entities which prioritize abuse, neglect, exploitation and time sensitive complaints in which consider the severity of the risk to the resident, the imminence of the threat of harm to the resident and the opportunity for mitigating harm to the resident through provision of Ombudsman program services. What are other State Ombudsman policy and procedures response time to complaints?”

 

State Policies and Procedures

NORC receives many requests from SLTCO regarding the development or updating of policies and procedures. When developing or revising your policies and procedures, you may find it helpful to visit the NORC website to review samples of various state policies and procedures from other state ombudsman programs.

SLTCOP Policies and Procedures: Conflict of Interest
Use this chart to quickly identify SLTCOPs with similar program structure and review their policies and procedures regarding conflict of interest. For the states that shared their policies and procedures we've identified core aspects of their policies regarding conflict of interest and created a chart for easy access to that specific language by clicking on the state initials.


State Resources Regarding the Rule

Texas

Texas LTCOP Informational Resources Regarding Implementation of the LTCOP Rule

These documents were created to explain the impact of the LTCOP rule to program representatives (local LTCO and Managing Local Ombudsmen, MLOs), their supervisors, and host agencies (Area Agencies on Aging).

Pennsylvania

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