Specialized Information for:

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

Long-Term Care Ombudsman Programs and Protection & Advocacy Agencies Collaboration Toolkit


Persons with disabilities receiving or in need of long-term services and supports have available nationally at least two advocacy organizations – Protection and Advocacy (P&A) and the Long-Term Care Ombudsman program (LTCOP).  Individuals residing in long-term care facilities may encounter challenges and opportunities with which they need an advocate.  Ideally, P&As and Ombudsman programs can conduct outreach to residents of long-term care facilities so that when advocacy is needed the residents are informed of the services that our organizations provide.

Role, Responsibilities, and Opportunities for Collaboration

Long-Term Care Ombudsman Program

Authorized by the Older Americans Act (OAA), 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 and Title VII of the OAA and other federal, state, and local sources.

Protection and Advocacy (P&A)

P&A programs are located in each state and U.S. territory and work on the individual and systems level to protect the personal and civil rights of individuals with disabilities. P&A programs provide legal representation and other advocacy services to secure the rights of persons with all types of disabilities wherever they reside. The focus of P&A work includes monitoring, investigating and attempting to prevent abuse and neglect and remedy adverse conditions in large and small, public and private, facilities that provide services for people with disabilities. P&As also work to ensure individuals with disabilities have full access to educational programs, healthcare, accessible housing, transportation, and employment. The P&A programs are administratively independent from service providers and state agencies responsible for the provision of services to individuals with disabilities.

Roles, Responsibilities, and Opportunities for Collaboration: Long-Term Care Ombudsman and Protection and Advocacy Programs

Long-Term Care Ombudsman Program and Protection and Advocacy Program: Introduction to the Programs, National Resource Centers, and other Resources and Supports

Frequently Asked Questions: Program Placement, Services, Disclosure of Information, and Conflicts of Interest

Program Collaboration

Reports and Tip Sheets

Collaboration to Support Residents’ Right to Vote: Long-Term Care Ombudsman Programs and Protection & Advocacy Tip Sheet

Collaboration Regarding Residents’ Rights and Guardianship: Long-Term Care Ombudsman Programs and Protection & Advocacy Tip Sheet

Collaborations Between Long-Term Care Ombudsmen and Protection and Advocacy Agencies (2013)

Examples of Ombudsman Program and P&A Collaboration

Ombudsman and Protection and Advocacy Programs: Examples of Individuals and Systemic Advocacy


Brookdale, a senior care company in Oregon, is under investigation after sending its residents a letter urging them to oppose a ballot measure. Measure 97 would increase taxes on companies with more than $25 million in annual sales. The Oregon State Long-Term Care Ombudsman Program and Disability Rights Oregon notified the Secretary of State that the company may have violated a state law against exerting undue influence over how a person votes. The letter to residents suggested that if the measure was to pass, Brookdale's services could become more expensive. The letter also include a sample "letter to the editor" about how Measure 97 could be bad for seniors and asked residents to send the letter to their local paper. Fred Steele, OR SLTCO, and the Director of the State P&A are quoted. Read the article here.

The South Carolina State Ombudsman participated in the Protection and Advocacy (P&A) Voting Coalition and one of the coalition's products is a series of videos about voting (links below). These new voting rights videos are from SC Protection and Advocacy and The South Carolina Disability Voting Coalition.

Each video addresses a different voting topic including how to register to vote, the different ways a person with a disability can vote, and accessibility challenges that may exist at polling places.

The Alaska Long-Term Care Ombudsman Program partnered with AARP, League of Women Voters, Disability Law Center (P&A), and the Alaska Division of Elections to share information about residents’ rights and voting and provide opportunities to residents living in long-term care facilities to participate in the election process. Through this partnership two consumer education brochures were developed, individuals were trained to assist residents with registering to vote, registration events were held in six facilities, and some facilities have incorporated voter registration into their intake process. Additionally, the State Ombudsman sent the brochures and a letter regarding residents’ right to vote and how facility staff can and cannot assist them with registering to vote and completing a mail-in ballot to all nursing homes and assisted living facilities in the state.


LTC Ombudsman and Protection & Advocacy Systems – Partnering to Promote Rights and Good Care 
Presenters:  Elizabeth Priaulx, JD, Senior Disability Legal Specialist, National Disability Rights Network; Kelly Bagby, JD,  Senior Attorney, AARP Foundation Litigation

Collaborations Between Ombudsman Programs and Protection and Advocacy Agencies
Presenter: Lori Smetanka, Director, NORC

Working with Protection and Advocacy Programs to Identify and Combat Elder Abuse​
Presenter: Kelly Bagby, JD

Program Management

Memoranda of Understanding

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.  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.  

Protection and Advocacy Program and Long Term Care Ombudsman Program: Memoranda of Understanding (MOU) Tip Sheet

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


National Disability Rights Network (NDRN) - www.ndrn.org

Protection & Advocacy (P&A) and Client Assistance Program (CAP) Network (P&A/CAP Network) - http://www.ndrn.org/en/about/paacap-network.html

P&A/CAP Training and Advocacy Support Center (TASC) - http://www.ndrn.org/en/about/tasc.htm