October 05, 2019

New York State Comptroller Thomas P. DiNapoli's audit finds that residents of many long-term care facilities in the state lack access to ombudsman services


Under the federal Older Americans Act of 1965, to be eligible for certain federal grants, each state is required to establish an Office of the State Long-Term Care Ombudsman. In New York, this office is within the New York State Office for the Aging (NYSOFA) and serves as an advocate and resource for the elderly and persons with disabilities who live in long-term care (LTC) facilities.

Among their duties, ombudsmen identify, investigate and resolve complaints made by or on behalf of residents. There are about 1,500 LTC facilities in the state, housing more than 160,000 residents who have a need for ombudsman services, according to NYSOFA.

Many residents of long-term care facilities in New York state lack regular access to ombudsman services due to a decline in the number of volunteers* and a severe shortage of paid staff, according to an audit released October 3, 2019 by State Comptroller Thomas P. DiNapoli.*

DiNapoli’s auditors found that as of January 2019, only about 600 of the state’s LTC facilities have an assigned volunteer ombudsman, leaving the remaining 900 facilities to be covered by just 50 paid local staff, about half the minimum number recommended in NYSOFA’s guidelines, which are based on information from the Institute of Medicine.

Eleven of NYSOFA’s 15 regional programs fell short of the recommended minimum number of staff for the federal fiscal year (FFY) ended Sept. 30, 2018, and about 30 percent of facilities were not visited by an ombudsman during that period. New York City, the region with the highest number of residents and facilities, was recommended to have 28 staffers, but had only five.

New York’s paid staff per 2,000 beds ranked 39th compared to other states as of Sept. 30, 2017.

According to NYSOFA, the number of facilities associated with at least one complaint increased significantly – by about 84 percent – from 247 in the FFY ended Sept. 30, 2016 to 454 in the FFY ended Sept. 30, 2018. Nearly all complaints – 98 percent – arose from facilities that had been visited prior to the complaint, indicating that an ombudsman’s visit plays a role in a key part of the office’s mission: being accessible to residents who wish to air their concerns.

Although ombudsmen may be volunteers or paid staff, NYSOFA relies heavily on citizen-volunteer ombudsmen to visit the LTC facilities and make contact with their residents. Each regional program has a full-time, paid ombudsman coordinator who recruits, trains and supervises its volunteers. Still, recruitment and retention has been a problem. NYSOFA data show a 37 percent decrease in the number of volunteer ombudsmen during the three-year period ending Sept. 30, 2018. NYSOFA officials suggested that a restructuring of the program that resulted in larger service areas for a reduced number of local offices could have contributed to the decline, and cited other recruitment and retention challenges.

To help retain volunteers. NYSOFA said that some regional programs have begun paying a monthly stipend to some volunteers who work at least four hours per week conducting additional facility visits or entering data.

DiNapoli’s auditors also found issues with ombudsman training. A look at training records for 50 volunteers for one calendar year found that 31, or 62 percent, did not meet the annual training requirements. That included 12 volunteers who missed four of the six annually required in-person training sessions.

Office personnel use an electronic system to maintain all information required by the federal Administration for Community Living (ACL) through that agency’s National Ombudsman Reporting System (NORS). This includes information on complaints received and investigated as well as number of facilities covered by the office, number of staff and volunteers in each region, and related training activities.

Auditors determined that certain data maintained in NYSOFA’s computer system may not be reliable. They found, at the individual entry level, incomplete fields and differences with other supporting information – that may limit the data’s usefulness in analyzing results and trends. For example, a comparison of system complaint data to hard copy complaint documentation showed that 46 of the 66 system records reviewed either differed from the complaint form, had incomplete fields, or had both types of issues.

DiNapoli recommended that NYSOFA:

1. Improve the reliability of system-generated office data;

2 .Take steps to identify and understand reasons for the decline in volunteers and differences in regional program results;

3. Develop and implement strategies to improve access to ombudsman services, including access to volunteer ombudsmen;

4. Strengthen efforts to ensure that volunteer ombudsmen receive required annual training; and

5. Develop a long-term advocacy plan that is informed by reliable data and that identifies key advocacy goals and activities.

* Those interested in volunteering for the Long Term Care Ombudsman Program (LTCOP), please  call (855) 582-6769 or visit the NYS LTCOP website at: ltcombudsman.ny.gov. LTCOP will welcome your assistance.

NYSOFA officials agreed with the audit recommendations and indicated the actions they have taken so far to implement them. Their full response is included in the audit. Read the report, or go to: 

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