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Long-Term Care Ombudsman Programs and Legal Assistance Developers Collaboration Toolkit


Long-Term Care Ombudsman Program

Every state has a Long-Term Care Ombudsman Program (LTCOP) that empowers residents, addresses complaints, and advocates for improvements in the long-term care system. Long-Term Care Ombudsmen are advocates for residents of nursing homes, board and care homes, assisted living facilities and similar adult care facilities. They work to resolve problems of individual residents and to bring about changes at the local, state and national levels that will improve residents' care and quality of life.

The program began in 1972 as a demonstration program. Now, the LTCOP exists in all states, the District of Columbia, Puerto Rico and Guam. Each state has an Office of the State Long-Term Care Ombudsman, headed by a full-time ombudsman. Thousands of local ombudsman staff and volunteers work in communities across the country as part of the statewide programs. These statewide programs are federally funded under Title III (page 44) and Title VII (page 150) of the OAA and other federal, state and local sources.

See Title VII Chapter 2 (page 154) of the Older Americans Act for the authorizing language of the LTCOP.

Legal Assistance Developers

Title VII (page 168) of the Older Americans Act (OAA) requires each state to appoint a legal assistance developer (LAD). This position is similar to an SLTCO in that the LAD is responsible for developing and coordinating the state's legal services and elder rights programs. The LAD's role is becoming more integral as more and more states are moving toward an integrated legal and aging service delivery model. See this section for the authorizing language of the LAD.

Title IIIB Legal Assistance Providers

Legal assistance provided under Title III-B of the Older Americans Act are targeted to “older individuals with economic or social needs” and protect these individuals against challenges to their independence, choice, and financial security. The OAA-funded legal services providers nationwide impact the ability of many older individuals to remain independent and autonomous in their homes and communities, as well as protecting their rights and access to care and services.

See Title III, Part B, Sec. 307 and 321 (pages 67 and 86).

Legal Services Corporation

Legal Services Corporation (LSC) is the largest funder of civil legal aid for low-income Americans in the nation, including elders. LSC was established in 1974 and operates as an independent 501(c)(3) nonprofit corporation. LSC provides grants for high-quality civil legal assistance to low-income Americans, and it distributes more than 90% of its funding to 134 independent nonprofit legal aid programs with more than 800 offices. Many cases involve protecting the elderly from being victimized by unscrupulous lenders or merchants, resolving complicated guardianship issues, and handling eviction disputes. Visit their website here. To find the grantee in your area, see Location of Legal Aid Grantees.

See the LSC Act, Section 1003 for the authorizing language of the LSC.

Program Management

There are a number of effective techniques employed between LTCOPs and LADs who successfully collaborate on cases together. These techniques include:

  • Utilizing memorandums of understanding (MOU) between the two programs to establish an official partnership
  • Setting up a seamless referral process for both the LTCOP and LAD
  • Conducting joint practices and trainings on common issues

Memorandum of Understanding (MOU)
Both programs need an understanding of what services each can provide and when and how programs will work together on individual and systemic advocacy issues. The Older Americans Act requires that the LTCOP “coordinate, to the greatest extent possible, ombudsman services with legal assistance provided under section 306(a)(2)(C), through adoption of memoranda of understanding and other means” [Older Americans Act Of 1965 (amended 3/25/2020) Section 712(h)(8)].

It is important to both organizations to have a written document that establishes a basic understanding and agreement on how they will work together. This written document may be called a – Memorandum of Understanding, Partnership Agreement, Working Protocol – or something else. The name of the document is not as important as the written commitment that both programs will coordinate activities benefiting consumers. The purpose of a broad written agreement (signed, shared with others, and reviewed at least annually for any needed changes) is to establish a basic understanding and agreement for working together.

See below for an MOU template and sample MOUs.

Sample MOU Template (Word version) - (PDF version here)


Time constraints are the biggest reported barrier to collaborations between the LTCOP and LAD. In addition to time constraints, a lack of role identification for both the SLTCO and the LAD, contributes to difficulties in collaboration. Finally, a lack of funding and resources also prohibits collaboration. 

Program Collaborations

SLTCOPs are natural partners with both Legal Assistance Developers and Legal Services Providers, and successfully collaborate on a variety of issues around both individual, as well as systemic, advocacy. Collaborative Efforts include: joint trainings for staff, volunteers, and others; provision of technical assistance; education of state and federal policymakers; joint efforts around legislative advocacy; participation on workgroups or task forces; and monitoring and commenting on laws and regulations. 

Examples of collaborations between the SLTCO and the LAD include:

  • LAD as the primary provider of technical assistance and information to the SLTCOP on issues such as guardianship and elder abuse
  • Development of consumer information on elder abuse and exploitation
  • Legislative advocacy, including increasing the personal needs allowance, and establishing an Office of Public Guardian
  • Review of program policies and procedures
  • Development of a plan of action for assisting residents moving out of facilities into the community

Examples of collaborations between the SLTCO and Legal Services Providers include:

  • Case referral – issues often include evictions from nursing homes or assisted living facilities; guardianship or other surrogate decision-making issues; Medicaid and other program eligibility issues; access to medically necessary services or supports; transitions out of nursing homes; concerns about abuse, neglect, or exploitation; etc.
  • Development of consumer information
  • Legal advice, counsel, opinions to LTCOPs
  • Training
  • Technical assistance
  • Policy analysis

Roles, Responsibilities, and Opportunities for Collaboration: Long-Term Care Ombudsman Program and Legal Services


Please click below to access other resources to learn how to collaborate with your local LTCOP or LAD.

NORC worked with the National Association of State Long-Term Care Ombudsman Programs (NASOP), the National Association of Legal Services Developers (NALSD), and the Center for Social Gerontology in the development of two questionnaires, one sent to State Ombudsmen, and the other to Legal Assistance Developers. This report includes in-depth information about the two programs and the current status of collaborations between LTCOPs and LADs. For more in-depth information, including the current status of collaborations between LTCOPs and LADs, read our report here.

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