	Background

Quality of care in long-term care settings has been, and continues to be, a concern for federal policymakers. The Long-Term Care (LTC) Ombudsman Program is a consumer advocacy program that aims to improve the quality of care and quality of life for residents in nursing facilities and other residential care settings by responding to the needs of those facing problems in such facilities. The OAA Amendments of 2006 ( P.L. 109-365 ) authorized appropriations for OAA-funded activities, including the LTC Ombudsman Program, through FY2011 (authorizations of appropriations expired on September 30, 2011). However, Congress has continued to appropriate funding for OAA-authorized activities for FY2012 through FY2015. The 114 th Congress may choose to reauthorize the OAA. In doing so, federal policymakers may consider amending or deleting existing authorities under the Act or establishing new authorities, including those under the LTC Ombudsman Program. In addition, Congress will likely consider annual appropriations for LTC Ombudsman Program activities, as well as appropriations for authorities under the Elder Justice Act enacted in the Patient Protection and Affordable Care Act (ACA; P.L. 111-148 , as amended) that support the LTC Ombudsman Program. This report briefly describes the LTC Ombudsman Program's legislative history, administrative function and other activities, and funding. Authority for administering the project was transferred to the Administration on Aging (AoA) within the Department of Health and Human Services (HHS) in 1973. Administrative Function

There are 53 LTC Ombudsman Programs operating in all 50 states, the District of Columbia, Guam, and Puerto Rico, and 575 local programs as of 2013. Title VII programs received $20.7 million of federal funding in 2015. Table 1 shows total support for ombudsman activities in 2013, the most recent year for which data on funding from all sources are available. Total 2013 funding for ombudsman activities from all sources combined (federal and nonfederal) was $92.5 million. In 2013, ombudsmen reported over 16,500 nursing facilities and about 53,400 other residential LTC facilities operating nationwide. Workload

Due to the requirement that ombudsmen investigate and resolve the complaints of all residents in residential LTC facilities, the workload of staff and volunteers is substantial, as shown by the reported ratio of staff to facilities and beds. In 2013, the top five resident complaints in nursing homes and other LTC facilities accounted for over one-fifth of all complaints for each facility type. Program coordinators in both states similarly identified staffing, resident care, and residents' rights as the most pressing issues. Appendix. The Older Americans Act Reauthorization Act of 2015 (S. 192): Long-Term Care Ombudsman Provisions

The Older Americans Act Reauthorization Act of 2015 ( S. 192 ) was introduced January 20, 2015, and would authorize appropriations for most OAA programs, including the LTC Ombudsman Program, through FY2018. It would also amend the duties of designated local ombudsman entities and representatives to identify, investigate, and resolve complaints made by or on behalf of residents with limited decision making capacity in similar circumstances.
Quality of care in long-term care settings has been, and continues to be, a concern for federal policymakers. The Long-Term Care (LTC) Ombudsman Program is a consumer advocacy program that aims to improve the quality of care, as well as the quality of life, for residents in LTC settings by investigating and resolving complaints made by, or on behalf of, such residents. Established under Title VII of the Older Americans Act (OAA), the Administration on Aging (AoA) within the Administration for Community Living in the Department of Health and Human Services (HHS) administers the nationwide program. As of 2013, there were 53 state LTC Ombudsman Programs operating in all 50 states, the District of Columbia, Guam, and Puerto Rico, and 575 local programs. Title VII programs received about $20.7 million in FY2015. Total 2013 funding for ombudsman activities from all sources combined (federal and nonfederal) was $92.5 million, the most recent year for which data on funding from all sources are available. Of that total, 55.8% ($51.6 million) represented funding from federal sources.
Due to the requirement that ombudsmen investigate and resolve complaints of all residents in residential LTC facilities, the workload of staff and volunteers is substantial. In 2013, ombudsmen reported just over 16,500 nursing facilities and about 53,400 other residential LTC facilities operating nationwide. This translated to a nationwide ratio of one paid ombudsman for every 57 facilities and one paid ombudsman for every 2,400 resident beds. With respect to staffing, the program receives significant support from volunteers. In 2013, over 1,200 paid staff and about 8,300 certified volunteers investigated more than 190,000 resident complaints. Issues regarding residents' rights were the chief complaint in nursing homes, followed by residents' care issues in 2013. Among residents in other LTC facilities, the top complaint categories in 2013 were quality of life and residents' rights.
The OAA Amendments of 2006 (P.L. 109-365) authorized appropriations for the LTC Ombudsman Program through FY2011 (authorizations of appropriations expired on September 30, 2011). Congress has continued to appropriate funding for OAA-authorized activities for FY2012 through FY2015. The 114th Congress may choose to reauthorize the OAA. In doing so, federal policymakers may consider amending or deleting existing authorities under the Act or establishing new authorities, including those under the LTC Ombudsman Program. In addition, Congress will likely consider annual appropriations for LTC Ombudsman Program activities, as well as appropriations for authorities enacted under the Elder Justice Act enacted in the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) that support the program.
This report describes the LTC Ombudsman Program, including the program's legislative history, administrative function, other resident advocacy activities, and 2013 funding amounts by source. It also identifies selected issues for federal policymakers, including staffing and resources, in-home care ombudsman, and specialized ombudsman training. The Appendix includes a summary of provisions included in S. 192, the Older Americans Reauthorization Act of 2015, that would amend the LTC Ombudsman Program.