Specialized Information for:

Nursing HomesAssisted Living/Board & Care Home and Community Based Services

Ombudsman Outlook: June 2022

In this issue:

Federal Updates

On June 29, 2022, the Centers for Medicare & Medicaid Services (CMS) released revised long-term care surveyor guidance. The CMS memo, QSO-22-19-NH, provides an overview of the revisions, links to the updates and changes in regulations and guidance, and a link to guidance training for nursing home surveyors and providers in the Quality, Safety, and Education Portal (QSEP).

Highlights of the changes include:

  • Revised Surveyor Guidance
    • Phase 2 and 3 Requirements: Clarifications and technical corrections of Phase 2 guidance issued in 2017, and new guidance for Phase 3 requirements which went into effect in November 28, 2019.
    • Arbitration Requirements: Guidance on the new requirements which became effective September 16, 2019.
  • Effective Date: Surveyors will begin using this guidance to identify noncompliance on October 24, 2022.
  • Complaint and Facility Reported Incidents (FRIs): CMS revised the guidance in Chapter 5 and related exhibits of the State Operations Manual (SOM) to strengthen the oversight of nursing home complaints and FRIs. CMS also revised its guidance for all Medicare-certified provider/supplier types to improve consistency across the State agencies in their communication to complainants.
  • Psychosocial Outcome Severity Guide: CMS revised guidance to clarify the reasonable person concept and examples across the different severity levels.

Links to memo and materials:

Stayed tuned for additional information from Consumer Voice and/or NORC regarding the revised guidance.

New and Updated Resources

NEW! Virtual Office Hour
NORC will begin hosting a virtual open office hour the last Wednesday of each month at 2:00 pm ET starting in July. We will focus on volunteer management for the first few months. These Zoom calls do not include a structured presentation and are open to all State Ombudsman and their program representatives. It is an opportunity for Ombudsman program representatives to ask questions, share information, and have open conversations. These calls will not be recorded. We invite all State Ombudsmen and program representatives to attend and ask us your burning questions about volunteer management.

NEW! Fact Sheet on Representing Residents During Nursing Facility Discharge Appeal Hearings
The purpose of the fact sheet, Representing Residents During Nursing Facility Discharge Appeal Hearings: The Basics, is to provide a basic overview about residents’ rights in appealing nursing facility discharges and tips for Ombudsman program advocacy considerations before, during, and after an appeal hearing.

NEW! Webinar Recording and Materials on Long-Term Care Ombudsman Programs and Legal Services
The National Long-Term Care Ombudsman Resource Center (NORC) and the National Center on Law & Elder Rights (NCLER) hosted the webinar, Long-Term Care Ombudsman Programs and Legal Services: Working Together to Protect Residents from Nursing Facility-Initiated Discharges, that discussed the roles and responsibilities of the Long-Term Care Ombudsman program (LTCOP) and legal services and how they can work together to protect rights of residents in nursing facilities. 

NEW! Technical Assistance (TA) Talk Materials on Investigating Complaints Involving Allegations of Abuse
To increase direct access to technical assistance (TA) and peer support, NORC hosts quarterly live technical assistance dialogues. The June 29 TA Talk discussed Investigating Complaints Involving Allegations of Abuse, view the recording and materials here. The next TA Talk will be in September 2022. Have questions, an idea for a future topic, or examples of training, consumer education, or successful advocacy? Email NORC at ombudcenter@theconsumervoice.org

NEW! Webinar Recording and Materials on the Treatment and Workplace Conditions for Direct Care Workers
This discussion was an opportunity for State Ombudsmen and Ombudsman program representatives across the country to share their observations related to workforce conditions in long-term care settings and how it impacts the quality of life and care of residents. ADvancing States shared information from their recent work regarding workplace conditions, specifically about the treatment of direct care workers in long-term care settings. Directly related to the workforce issues, Consumer Voice staff shared information regarding the opportunity to comment in response to the Centers for Medicare & Medicaid Services request for information about the implementation of a minimum staffing standard in nursing homes. 

NEW! Webinar Recording and Materials on Recognizing the Importance of Volunteers
This webinar focused on volunteer representative recruitment and retention. Volunteer representatives discussed why they stay with the program and Ombudsman programs shared state and local level examples of successful recruitment and retention activities. 

UPDATED! Fact Sheet on Residents’ Rights and the LGBTQ+ Community
The fact sheet, Residents’ Rights and the LGBTQ+ Community: Know Your Rights as a Nursing Home Resident, was updated. This resource highlights federal residents' rights and nursing home requirements that may be of particular importance to lesbian, gay, bisexual and transgender (LGBTQ+) residents and provides options for complaint resolution, information for reporting abuse, and resources regarding long-term care and LGBTQ+ advocacy.

UPDATED! Resident-to-Resident Mistreatment In-Service Training Guide and PowerPoint
The Preventing and Responding to Resident-to-Resident Mistreatment in-service training includes a training guide and PowerPoint with presenter notes. The materials are intended for use by Long-Term Care Ombudsman programs to provide in-service training for staff of nursing facilities and residential care communities on the topic of resident-to-resident mistreatment (RRM). By the end of the training attendees will be able to define RRM; provide practical solutions to prevent incidents of RRM; understand the importance of individualized, resident-centered care; and know how to report incidents of RRM.

UPDATED! PowerPoint on The Who, What, Where, Why, and How of the Long-Term Care Ombudsman Program
This presentation has been updated to include 2020 NORS data and it reviews the Ombudsman program responsibilities required by federal law so the information is applicable in every state. This presentation explains what the Ombudsman program does, who the Ombudsman program serves, and how to contact the program. Ombudsman program representatives can use this presentation when training potential program representatives, during Resident Council and Family Council meetings, community education, and in-services for facility staff. View the slides as a PDF or PPT.

TA Hot Topic: Avoiding Drugs as Chemical Restraints - Changing the Culture of Care

What do I do if a resident is being pushed to take antipsychotic drugs?

Everyone who enters a nursing home has a right to individualized, person-centered care. Some nursing facilities, however, are giving residents antipsychotic drugs, not to treat a medical diagnosis, such as Schizophrenia or Bipolar Disorder, but rather to control the resident’s behavior or for the staff’s convenience. When used this way, as a chemical restraint, these drugs pose special risks for older people and increase the risk of death in persons with dementia.

Consumer Voice developed materials to assist residents and their families in combatting the inappropriate use of antipsychotic drugs. Long-Term Care Ombudsman programs are encouraged to become familiar with these resources and share them with residents and families.

There are many resources for avoiding chemical restraints on the Consumer Voice website. One of the new advocate fact sheets covers the issue of residents who have been labeled as “difficult.” “Difficult” is Not a Diagnosis: What to Do When Your Loved One is Being Pushed to Take Antipsychotic Drugs discusses advocacy steps when a resident is given antipsychotic drugs. It also covers care planning, ideas for good care practices, and where to go for additional assistance.

A second consumer fact sheet, Avoiding Drugs as Chemical Restraints, includes information on signs that a resident may have been chemically restrained, the rights all residents have, and what to do if there are concerns about the care being provided.

To see podcasts, stories, articles, and other information on this campaign, visit the Avoiding Drugs as Chemical Restraints Consumer Education Campaign.

National Ombudsman Reporting System (NORS) Corner

When should the Ombudsman program be the complainant?

The Ombudsman program may be the complainant in a variety of circumstances. The most common examples include general observations about the facility environment that need attention; this may include circumstances where residents agree with the problem and want it addressed but do not want to be the complainant of record. The Ombudsman program may be the complainant when a resident needs assistance but is unable to communicate informed consent and has no resident representative available. 

See quiz question #8 in the Part I Case, Complaint, Complainant, and Information and Assistance Quiz Answer Sheet for additional information.

The Ombudsman program rule at 1324.19(b) (1)&(2) encourages resident participation regardless of the complainant and affirms that the Ombudsman program can be the complainant.

(1) With respect to identifying, investigating and resolving complaints, and regardless of the source of the complaint (i.e. complainant), the Ombudsman and the representatives of the Office serve the resident of a long-term care facility. The Ombudsman or representative of the Office shall investigate a complaint, including but not limited to a complaint related to abuse, neglect, or exploitation, for the purposes of resolving the complaint to the resident's satisfaction and of protecting the health, welfare, and rights of the resident. The Ombudsman or representative of the Office may identify, investigate and resolve a complaint impacting multiple residents or all residents of a facility.

(2) Regardless of the source of the complaint (i.e. the complainant), including when the source is the Ombudsman or representative of the Office, the Ombudsman or representative of the Office must support and maximize resident participation in the process of resolving the complaint.

It is typical for the Ombudsman to educate a resident about their rights and share an observation about the individual resident’s health, safety, or welfare. This discussion may result in the resident requesting Ombudsman assistance to resolve the complaint. In this example, the process of educating the resident encouraged the resident to request assistance; therefore, the resident is the complainant. 

See quiz question #10 in the Part I Case, Complaint, Complainant, and Information and Assistance Quiz Answer Sheet for additional information. 

Visit the NORC website for additional NORS Frequently Asked Questions.

News from the Network

Rhode Island State Ombudsman, Kathleen Heren, on Nursing Home Closures
The Rhode Island State Ombudsman, Kathleen Heren, was interviewed on nursing home closures. When a facility closes, residents and their families tell the Ombudsman program where they would like to be relocated. The State Ombudsman Office then facilitates the process, first by helping residents move their belongings, then by visiting weekly for six weeks to ensure a smooth transition. While the goal is to make it as least impactful as possible, the adjustment can be challenging for some. Read the full article »

Radio Interview with Edwin Walker, ACL, on Older American’s Month and Karen Morgan, Maryland Ombudsman Program Representative on Protecting Seniors from Scams and Fraud
On this broadcast of The Senior Zone, which aired Monday, May 23, the host focused their senior-friendly & senior-conscious attention on: Part 1: “Celebrating Older American’s Month 2022”. Guest: Edwin L. Walker, Deputy Assistant Secretary for Aging, Administration on Aging; and Part 2: “Protecting Seniors from Scams & Fraud”. Guest: Karen Morgan, AARP Volunteer & Lynn McCamie, Baltimore County Department of Aging. Listen to the radio interview »

Iowa State Ombudsman Angela Van Pelt Wants a "New Direction" for Office
Iowa State Ombudsman Angela Van Pelt was interviewed in the Iowa Capital Dispatch discussing new ways to move the office forward. She discusses rebuilding the team in her office and setting goals such as restoring the integrity of the office, increasing public awareness, and boosting the overall visibility of the office. Read the full article »

Volunteer Management: Recruitment, Retention, and Recognition of Long-Term Care Ombudsman Program Volunteers

Survey of Volunteer Ombudsman Representatives

NORC invited Long-Term Care Ombudsman program volunteers to share their thoughts on the topics of recruitment and retention. We received 596 responses from 35 states and the District of Columbia!

The information received will be very helpful to state and local programs as they continue rebuilding their volunteer base. Since FY 2015 there has been a dramatic decline in the number of volunteers, from 7,734 to 5,152 in FY 2020. That is over a 30% loss of volunteer representatives.

The LTCOP was designed as a volunteer program and  volunteers are needed to ensure regular, timely access for residents to program services. The following are some of the responses received.

What attracted you to the LTCOP?

  • Desire to be a voice for people living in nursing homes
  • Years of experience as a caregiver
  • A friend recruited me
  • An article in a local newspaper
  • Enjoy working with older adults
  • Giving back, paying it forward
  • Ability to make a difference
  • I have always been interested in solving problems
  • I have a background in healthcare and wanted to continue serving
  • Loved ones have lived in facilities and I saw the need to help change things 

Why have you continued to volunteer as an Ombudsman program representative?

  • My interest in helping residents
  • A needed service for those without families
  • Ability to make my own schedule
  • After what we've been through the last two years, I feel the residents need more support than ever
  • I feel good about myself and the work I do
  • I see where I have made a difference
  • Becoming friends with others and listening to them
  • Commitment
  • Emotionally rewarding
  • I believe in the mission
  • I feel needed and find the work challenging and rewarding
  • The work is not done
  • I love the residents

What is the most rewarding part of being involved with the Ombudsman program?

  • Recognizing that the elderly are real people, with real pasts
  • A feeling of accomplishment when you have helped a person solve their problem
  • A smile from a resident
  • Advocating for people who are in a vulnerable situation
  • Being a catalyst for improving resident’s lives
  • Being trusted by the residents
  • Closing a case where the resident is satisfied with the outcome
  • Critical thinking, problem solving
  • Empowering and educating residents and their families
  • Helping others
  • I have so much information, references, and resources
  • Interaction with the residents
  • Knowing that you have helped someone live a better life
  • Seeing things improve

What message (or key words) would you suggest programs use to recruit new volunteers?

  • A few hours a week can change a life
  • Motivating and challenging
  • Continuing Your Mission
  • Advocate for seniors in LTC facilities -- it could be you some day
  • An experience you will never forget
  • Be a change agent
  • Be the voice for those who can’t or won’t speak up for themselves
  • Can be hectic; but more importantly it is rewarding
  • Challenging, rewarding, interesting
  • Compassion and Empathy
  • Do you want to make a difference?
  • Essential. Important. Flexible hours.
  • Give a little, get a lot
  • The sense of being part of a team
  • Impactful, rewarding, fulfilling, community building, relationship building
  • Make a difference
  • Share real-life examples/stories

Recognizing Volunteers and Appreciating Their Work

During the month of April, many Ombudsman programs celebrated their volunteers. Watch and share the message from Beverley Laubert,  National Ombudsman Program Coordinator, Administration on Aging/Administration for Community Living, and messages and pictures from Ombudsman programs

The theme for the 2022 National Volunteer Week was Shining a Light on the People and Causes That Inspire Us to Serve. The Ombudsman program could not be its best without the volunteers who help carry out the mission of advocating for long-term care residents. Thank you for leading volunteers or being a volunteer. Your work is so important!

Virtual Office Hours
Last Wednesday of each month at 2:00 pm ET starting in July | Join using this Zoom Link

NORC will begin hosting a virtual open office hour the last Wednesday of each month at 2:00 pm ET. We will focus on volunteer management for the first few months. These Zoom calls do not include a structured presentation and are open to all State Ombudsman and their program representatives. It is an opportunity to ask questions, share information, and have open conversations. These calls will not be recorded. We invite all State Ombudsmen and program representatives to attend and ask us your burning questions about volunteer management.

Quick Tips: Advocating for LGBTQ+ Older Adults

As advocates for long-term care consumers, it is imperative that Ombudsman programs are aware of the unique challenges facing LGBTQ+ older adults to ensure their rights are respected and they receive quality care. One way you can advocate for quality life and care for LGBTQ+ older adults is to share this information with your facilities.

Individuals living in nursing homes have the same rights to be free from discrimination and harassment as individuals living in the larger community. They have additional rights and protections provided by federal nursing home regulations and state and federal anti-discrimination provisions. The rights of all residents should be honored and respected, regardless of sexual orientation or gender identity or expression.

On June 15 President Biden issued an Executive Order granting protections and support for LGBTQI+ older people so that they may age with dignity and respect. The Executive Order directs the U.S. Department of Health and Human Services to publish a “Bill of Rights for LGBTQI+ Older Adults” and new guidance on the nondiscrimination protections for older people in long-term care settings. It also charges the U.S. Department of Health and Human Services with “exploring new rulemaking to establish that LGBTQI+ individuals are included in the definition of populations of “greatest social need” under the Older Americans Act."

The resources below will help Ombudsman programs develop better methods of advocating for LGBTQ+ consumers to ensure they receive care that is equal to all long-term care consumers.

Long-Term Care Equality Index (LEI)

The Long-Term Care Equality Index (LEI) is a joint project of SAGE and the Human Rights Campaign Foundation designed to promote equitable and inclusive care for LGBTQ+ older adults in residential long-term care and senior housing. With free resources, webinars, and a biennial survey of LGBTQ+ best practices, the LEI assesses and helps communities implement, grow, and innovate their LGBTQ+ inclusion efforts. The first LEI Survey opens in August 2022. Sign up to participate.

This introductory webinar (16 minutes) provides an overview of the criteria, the survey process, and tools to prepare for the August 2022 survey. Below are links for your records, documents, and images to pass along to anyone interested. 

NORC Resources

Resources from Long-Term Care Ombudsman Programs

California - Cultural Competency and Sensitivity related to serving LGBTQ+ Elders – Training

Kentucky - Presentation on LGBTQ+ Aging & Maltreatment Concerns (2021)

Ohio - Tipsheet on Promoting LGBTQ+ Inclusivity in Long-Term Care

Washington - Long-Term Care Ombudsman Program Logo for Pride Month (2022)

Additional Resources to Share with Consumers

For additional information on Ombudsmen supporting LGBTQ+ elders visit the NORC website.

Residents' Rights Month

October is Residents’ Rights Month, an annual event designated by Consumer Voice to honor residents living in all long-term care facilities and those receiving care in their home or community. It is an opportunity to focus on and celebrate the dignity and rights of every individual receiving long-term services and supports.

Being a part of a community is essential to our well-being. Throughout the pandemic, residents of long-term care facilities were disconnected from the resident and staff communities within their facilities when activities and group dining were limited. Residents were disconnected from the broader local community when visitation was restricted and many residents were unable to leave their facilities to participate in outside activities. 

This year's Residents’ Rights Month theme - Inspiring Unity within Our Community - emphasizes the importance of fostering meaningful community within the facility and encouraging residents’ connection to their local community. Download promotional materials to start planning how your program is going to celebrate Residents' Rights Month.

Resident's Voice Challenge

Creative writing and artistic expression are meaningful and compelling ways to highlight the importance of residents’ rights and how these rights can be carried out in all long-term care settings. For the Resident’s Voice Challenge, residents are encouraged to submit essays, poems, artwork, drawings, or videos related to the theme. The deadline is September 1, 2022. See full rules and criteria for submissions.


September 21, 2022: Save the Date - Quarterly Technical Assistance (TA) Talk – Topic TBD | 3:00 - 4:00 pm ET

October 2022: Residents' Rights Month - Learn more »

November 14-16, 2022: Consumer Voice In-Person Conference at the Lord Baltimore Hotel - Learn more »

December 8-9, 2022: Consumer Voice Virtual Conference - Learn more »