NORS Table 3

NORS Table_3 _Final_01-25-18.pdf

State Annual Long-Term Care Ombudsman Report

NORS Table 3

OMB: 0985-0005

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0985-0005 can be found here:

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Administration for Community Living/Administration on Aging- Office of Long-Term Care Ombudsman Programs
National Ombudsman Reporting System (NORS)
Table 3: State Program Information

OMB Control Number 0985-XXXX
Expiration Date: XX/XX/XXXX

State Program Data Elements
States will submit a wide range of elements describing their statewide Ombudsman program grouped into a range of categories. Each of these sets of elements
is presented in the subsections below.
Part A-Complaint Example
States will submit complaint example data that provide narrative description and disposition information regarding two to three closed complaints during the
reporting period.
Composite
Data Element

Element Description

Quantifier

Type

Codes and Values

Examples and Reporting Tips

Complaint
Example

Provides information regarding
two to three complaints during
the reporting period.

Multiple

Composite
data element
subsuming
element
numbers
S01-S06

Not Applicable (NA)

Selection of complaint examples is at the
State Ombudsman’s discretion.

(not a coded
element)

Elements included for each case example:
Element Number Data
Element

Element
Definition

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-01

Facility or
Setting

Type of Facility
or setting for the
complaint.

Single per
complaint
example

Alphanumeric See Table 1, CD0107.

Select one example from a nursing facility,
and one from a residential care
community facility. A third example is
optional.

S-02

Description

Narrative of the
problem.

Single per
complaint
example

Alphanumeric NA (not a coded
element)

Maximum length of 3,400 characters
(about 500 words).

S-03

Complaint
code

See Table 1, CD
03 for complaint
definition.

Single per
complaint
example

Alphanumeric See Table 1, CD 03
and Table 2

Select the complaint code associated with
each complaint example.

Element Number Data
Element

Element
Definition

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-04

Verification

See Table 1, CD
06 for verified
definition.

Single per
complaint
example

Numeric

See Table 1,CD 06.

Select the verification code associated
with each complaint example.

S-05

Disposition

See Table 1, CD
07 for
definitions of:

Numeric

See Table 1, CD 07.

Select the disposition code associated
with each complaint example.

S-06

Description

Partially or fully
resolved;
Withdrawn; or
No action
needed.
Narrative of the
resolution.

Single per
complaint
example

Alphanumeric NA (not a coded
string
element)

Maximum length of 3,400 characters
(about 500 words).

Part B: Systems Issues Data Elements
Describe up to three priority long-term care, services or supports issues identified by the Ombudsman and the leadership and advocacy activities the Office
employed to address these priority issues.
Composite
Data Element

Element Description

Quantifier

Type

Codes and
Values

Examples and Reporting Tips

Systems Issue

Provides information on priority
long-term care systemic issues
the program identified and
addressed during the reporting
period.

Multiple
(1 to 3)

Composite data
including element
numbers
S-07 to S-13

NA (not a
coded
element)

Describe at least two and up to three
priority long-term care systems issues
identified by the Ombudsman. Describe
the leadership and advocacy activities the
Office used to address these systems
issues.

Elements included for each systems issue:
Element
Number

Data Element

Element
Definition

Quantifier

Type

Codes and Values

S-07

Systems Issue

Provides
information on
priority long-term
care issues the
program identified
and addressed
during the
reporting period.

Single per
systems
issue

Alphanumeric
code

A- Abuse, Gross Neglect,
Exploitation

Examples and Reporting
Tips

B-Access to Information
C-Admission, Transfer,
Discharge, Eviction
D-Autonomy, Choice, Rights
E-Financial, Property
F-Care
G-Activities, Community
Integration and Social Services
H- Dietary
I-Environment
J-Facility Policies, Procedures
and Practices
K-Complaints about an Outside
Agency (non-facility)
L-System: Others (non-facility)
O-Other issue not identified in
A-L

Element
Number

Data Element

Element
Definition

Quantifier

S-07.1

Systems issue
not associated
with codes A-L

Provides
information on a
priority long-term
care issue the
program identified
and addressed
during the
reporting period
not associated
with categories AL.

Single per
systems
issue

S-08

Problem
description

Description of the
issue or problem.

Single per
System
Issue

S-09

Barriers
description

Description of the
barriers for the
issue.

S-10

Status

Status of the
issue.

Type

Codes and Values

Examples and Reporting
Tips

Provide a brief description of
the issue not associated with
codes A-L (500 characters.)

Alphanumeric
String

NA (not a coded element)

Maximum length of 3,400
characters (about 500 words).

Single per
System
Issue

Alphanumeric
String

NA (not a coded element)

Maximum length of 3,400
characters (about 500 words).

Single per
System
Issue

Numeric
Code

01-Newly identified in this
reporting year and not fully
resolved.

Use code 02, if the Office is
still working to resolve this
issue.

02-Ongoing issue from last
fiscal year.
03-Fully or Partially Resolved
including issues that are newly
reported or an ongoing issue
from last year.

Element
Number

Data Element

Element
Definition

Quantifier

Type

Codes and Values

Examples and Reporting
Tips

S-11

Setting

Setting affected by
the issue.

Multiple

List of
Numeric
Codes

01- Nursing Facility

Select codes for every facility
or setting type that is
associated with this systems
issue.

02-Residential Care Community
03-Not specific to a setting

Examples of systems issues
not specific to a setting may
include: legislative budget;
emergency preparation and
response; advance care
planning that is not facility
specific; guardianship; etc.

Element
Number

Data Element

Element
Definition

Quantifier

Type

Codes and Values

Examples and Reporting
Tips

S-12

Resolution
Strategies

Strategies applied
to resolve the
reported systems
issues.

Multiple

List of
Numeric
Codes

01-Provided information to
public or private agency

A systems issue may have
multiple Resolution Strategy
codes.

Alphanumeric
String

02-Provided Information to
legislator or legislative staff
03-Recommended changes to
laws, regulations, policies or
actions through written or oral
testimony.
04-Provided leadership or
participated on a task force
05-Provided information to the
media.
06-Provided educational
forums; facilitated public
comment on laws, regulations,
policies or actions
07-Developed and
disseminated information.

Use 03 for providing written or
oral testimony to a legislative
committee or providing
testimony at a public hearing
or during a comment period.

Use 05 for interviews with
media, editorial opinions,
press releases, press
conferences, etc.

Use 07 for reports or issue
briefs, social media,
newsletters, and other
educational material.

08-Legal action where an
Ombudsman program initiates
legal action
09- Engaged in LTC facility
corporate wide strategy
including providing information
or recommendations to
corporate leadership
S-12.1

Other resolution
strategy
description

Strategy employed
but not included in
codes 01-09.

99-Other

Provide a brief description of
the strategy (500 characters).

Element
Number

Data Element

Element
Definition

Quantifier

Type

Codes and Values

Examples and Reporting
Tips

S-13

Resolution
description

Narrative
description of
resolution
strategies used
during fiscal year.

Single per
System
Issue

Alphanumeric
String

NA (not a coded element)

Maximum length of 3,400
characters (about 500 words).
Include any policy, regulatory,
legislative or other outcomes
that were achieved.

Part C: Organization Structure Data Elements
Element
Number

Data Element

Element
Description

Quantifier

Type

Codes and Values

Examples and Reporting tips

S-14

Organizational
structure

Organizational
location of Office
of the State
Long-Term Care
Ombudsman.

Single

Numeric Code

01-State Unit on
Aging

Use the location as of last day of federal
fiscal year (September 30.)

02-Inside state
government

01-State Unit on Aging, means the
agency designated under section
305(a)(1) of the OAA

03-Stand-alone
agency inside state
government
04-Within a private,
non-profit agency
05-Stand-alone
private, non-profit
agency.

02-Inside state government, not in State
Unit on Aging, such as Housing
Department, Commerce, Treasury, etc.
03-Inside state government, in a standalone agency where the only program is
the Office of Long-Term Care
Ombudsman.
04-Outside state government within a
private, non-profit agency with 501(c)(3)
status
05-Outside state government in a
stand-alone private, non-profit agency
with 501(c)(3) status where the only
program is the Long-Term Care
Ombudsman Program.

Local Ombudsman Entity Data Elements
For states choosing to operate a decentralized model using local Ombudsman entities, specify the type of agency and the number of local Ombudsman entities
located in each type.
Composite
Data Element

Element

Organizational
structure

Organizational location of local
Ombudsman entities.

Quantifier

Type

Codes and Values

Examples and Reporting Tips

Multiple

Composite
data element
including
element
numbers
S15, S16

NA (not a coded
element)

A local ombudsman entity is an entity
designated under section 712(a)(5)(A)
to carry out the duties described in
section 712(a)(5)(B) with respect to a
planning and service area or other
sub-state area.

Definition

Elements included for each Local Ombudsman Entity:
Element
Number

Data Element

Element
Definition

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-15

Organizational
location of
local
Ombudsman
entities

Identifies the
agency in which a
local Ombudsman
entity is located.

One per
local
Ombudsman entity
group

Numeric
Code
Alphanumeric
String

01-Area agency on aging
(AAA)

Use 01 for an entity located in an
area agency on aging designated
under section 305(a)(2)(A) of the
Older Americans Act or a State
agency performing the functions of
an area agency on aging under
section 305(b)(5) of the OAA.

02-Non-profit agency, with
501(c)(3) status
03-Legal services provider
04-Stand-alone non-profit
agency
98-There are no local
Ombudsman entities
99-Other

Use 02 for an entity located within
a private, non-profit with 501(c)(3)
status, other than AAA
Use 03 for an entity located in a
Legal services provider
Use 04 for a stand-alone private,
non-profit agency with 501(c)(3)
status, where the only program is

Element
Number

Data Element

Element
Definition

Quantifier

Type

Codes and Values

Examples and Reporting Tips

the local Ombudsman entity.

S-15.1

Description of
other type

Entity description
not identified in
01-04.

S-16

Number of
Entities

Number of local
Ombudsman
entities for the
location.

Provide a brief description (500
characters) of the type of agency
or organization in which the local
ombudsman entity is located.
One per
local
Ombudsma
n entity
group

Numeric

NA (not a coded element)

For the location specified (S15),
provide the associated number of
local Ombudsman entities as of
last day of federal fiscal year
(September 30.)

Part D: Staff and Volunteer Data Elements
This is a total count of staff that work full-time and part-time for the Ombudsman program as of the last day of the fiscal year (September 30.) Each staff person
who works full-time on the program is counted as one full-time equivalent (FTE.) If, however, an employee works only part-time, the FTE for that employee
would reflect the percent of time dedicated to the Ombudsman program up to two decimal places – .25, .50, .75, for example. Each program can determine
what constitutes full time, i.e. 40 hours per week, 37.5 hours, etc.
Element
Number

Data Element

Element Definition

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-17

Staff in Office of
State LTCO

Total number of
Office of State
Ombudsman
employees.

Single

Numeric

NA (not a coded element)

The number of employees (both
full-time and part-time) of the
Office of the State Ombudsman
who are representatives of the
Office, trained to investigate and
resolve complaints and perform
other functions of the State LongTerm Care Ombudsman Program.
Whole number

S-18

Full-time
equivalent in
Office of state
LTCO

Total number of
FTE’s of the Office of
state LTCO.

Single

Numeric

NA (not a coded element)

FTEs are calculated by converting
the weekly work hours of
employees into a ratio. For
example, a person who works fulltime and 100% of the time with the
Ombudsman Program counts as 1
FTE. A person who works full-time,
but only 50% of the time with the
Ombudsman Program counts as .5
FTE, and similarly, a person who
works 10 hours a week and 100%
of the time with the Ombudsman
Program counts as .25 FTE.
May not be a whole number. For
example: 2.5, 5.75,etc.is
acceptable
Do not include overtime or holiday
hours.

Element
Number

Data Element

Element Definition

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-19

State level
volunteer
representatives

Total number of state
level volunteers
designated as
representatives of the
Office.

Single

Numeric

NA (not a coded element)

Report the number of volunteers
who serve in the capacity as
representatives of the Office,
trained to investigate and resolve
complaints and perform other
functions of the State Long-Term
Care Ombudsman Program as
described in 45 CFR 1324.19.
It must be a whole number

S-20

Hours donated
by state level
volunteer
representatives

Total number of
volunteer hours
donated by volunteer
representatives of the
Office.

Single

Numeric

N/A (not a coded element)

Report hours for those volunteers
who report directly to the state
Office.
Includes all time donated, such as,
training, travel, phone calls and
documentation.
May not be a whole number. For
example: 52.5, 60.75, etc. is
acceptable.

S-21

Other state level
volunteers

Total number of other
type of volunteers
who are not
representatives of the
Office.

Single

Numeric

N/A (not a coded element)

Examples of other volunteers may
include: volunteers who serve on a
program advisory or governing
board; assist with fund raising;
provide other in-kind services such
as accounting or strategic
planning, etc.
It must be a whole number.

Element
Number

Data Element

Element Definition

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-22

Staff in local
Ombudsman
entity

Total number of local
Ombudsman entity
employees
designated as
representatives of the
Office.

Single

Numeric

NA (not a coded element)

The number of employees (both
full-time and part-time) of local
ombudsman entities who are
representatives of the Office,
trained to investigate and resolve
complaints and perform other
functions of the State Long-Term
Care Ombudsman Program as
described in 45 CFR 1324.19.
If no staff select – “no staff” or
enter zero.
It must be a whole number

S-23

Full-time
equivalent in
local
Ombudsman
entity

Total number of
FTE’s at the local
Ombudsman entity.

Single

Numeric

NA (not a coded element)

Element
Number

Data Element

Element Definition

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-24

Local level
volunteer
representatives
of the Office

Total number of local
level volunteers
designated as
representatives of the
Office.

Single

Numeric

NA (not a coded element)

S-25

Hours donated
by local
volunteer
representatives

Total number of
volunteer hours
donated by
designated volunteer
representatives of the
Office.

Single

Numeric

NA (not a coded element)

Report hours for those volunteers
who report directly to the local
Ombudsman entity.
Includes all time donated, such as,
training, travel, phone calls and
documentation.
May not be a whole number For
example: 42.5, 65.75, etc. is
acceptable.

S-26

Other local
volunteers

Total number of other
volunteers who are
not representatives of
the Office.

Single

Numeric

NA (not a coded element)

Part E: Conflict of Interest Data Elements
Composite
Data
Element

Element Description

Quantifier

Type

Codes and
Values

Examples and Reporting Tips

Conflict of
Interest

Organizational conflicts of
interest include, but are not
limited to, placement of the
Office, or local entity, or
requiring that an Ombudsman
or representative of the Office
perform conflicting activities, in
an organization that provides
services and supports as
described in codes and values
01-15 and 99 (other conflict
that may impact the
effectiveness and credibility of
the work of the program.)

Multiple

Composite
data
element
subsuming
element
numbers S27, S-28
and S-29

NA (not a
coded element)

If the same conflicts exist among several entities and the
same remedy was used to address the conflicts then
describe the remedy and type of entity once. For
example: State Ombudsman program X has 15 local
Ombudsman entities that are housed at Area Agencies
on Aging that provide Medicaid assessment and case
management on behalf of the State Medicaid agency.
The Ombudsman can describe the steps and remedy
one time and indicate that it applies to all 15 AAA’s.

Elements included for each conflict of interest:
Element
Number

Data
Element

Element
Description

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-27

Conflict
of
Interest
Type

Type of
conflict that
exists as
described in
45 CFR
1324.21(a).

Single per
Conflict of
Interest

Numeric
Code

01-Licenses, surveys or Certifies LTC facilities

If 98 (None) is specified, no
other Conflict of Interest data
should be specified.

Alphanu
meric
String

02-Licenses, surveys or certifies LTC services
03- An association (or an affiliate) of LTC facilities
04-Has ownership, investment interest, receives
grants or donations from LTC facility
05-Has governing board, ownership, investment or
employment interest in LTC facility

Indicate which, if any conflicts
of interest were identified; the
organizational location of the
conflict and a narrative
description of the remedy.

06-Provides LTC long-term care to residents
07-Provides LTC coordination or case
management for residents
08-Provides LTC services, including
Medicaid/waivers
09-Sets reimbursement rates for LTC facilities
10-Sets reimbursement rates for LTC services
11-Provides adult protective services
12-Responsible for eligibility determinations for
Medicaid or public benefits
13-Conducts preadmission screening
14-Makes decisions on admissions or discharges
15-Provides guardianship, fiduciary, or surrogate
decision making services
98-None
99-Other

Element
Number

Data
Element

Element
Description

S-27.1

Other

Narrative of
other type of
conflict not
identified in
items 1-15.

S-28

Conflict
of
Interest
Location

Organizational location of

Conflict
of
Interest
Remedy

Description
of remedy
used to
remove the
conflict of
interest.

S-29

the conflict
of interest.

Quantifier

Type

Codes and Values

Examples and Reporting Tips

Provide a description of the
conflict (500 characters).

Single per
Conflict of
Interest

Numeric
Code

01-State
02-Local
03- Both State and Local

Single per
Conflict of
Interest

Alphanu
meric
String

NA (not a coded element)

Maximum length of 3,400
characters (about 500 words).
Provide a remedy description
for each conflict of interest.

Part F: Funds Expended Data Elements
Element
Number

Data
Element

Element
Definition

Funds
Expended

Expenditure
means charges
made by a nonFederal entity to a
project or
program for which
a Federal award
was received.

Quantifier

Type

Codes and Values

Examples and Reporting Tips

Only include funds which were expended on
Ombudsman program activities authorized
under Section 712.
Do not include amounts which were
budgeted or obligated but not expended.
Do not include “in-kind” resources. These
are not “funds expended.”

S-30

Older
Americans
Act (OAA) Title VII,
Chapter 2

Dollar amount
expended from
Older American’s
Act (OAA) Title
VII, Chapter 2
(Ombudsman.)

Single

Numeric
(decimal)

NA (not a coded
element)

In dollars ($) and cents.

S-31

OAA -Title
VII, Chapter
3

Dollar amount
expended OAA
Title VII, Chapter
3 (Elder Abuse
Prevention.)

Single

Numeric
(decimal)

NA (not a coded
element)

In dollars ($) and cents.

S-32

OAA Title III
state level

Dollar amount
expended OAA
Title III – State
level.

Single

Numeric
(decimal)

NA (not a coded
element)

In dollars ($) and cents.

Element
Number

Data
Element

Element
Definition

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-33

OAA Title III
local level

Dollar amount of
OAA Title III,
funds expended
to support the
Ombudsman
program at the
local level.

Single

Numeric
(decimal)

NA (not a coded
element)

In dollars ($) and cents.

S-34

Other
Federal

Total dollar
amount expended
from all other
federal sources,
not OAA.

Single

Numeric
(decimal)

NA (not a coded
element)

In dollars ($) and cents.

S-35

Identification
of Other
Federal
Sources

Indicate the types
of federal sources
not from the OAA.

Multiple

Numeric
Code

01-Medicaid
Administrative
Claiming

Identify all federal sources.

Report funds expended by a local
Ombudsman entity. Report funds expended
for purposes of providing local Ombudsman
services (not by a local Ombudsman entity.)
For example the state Office provides local
services directly to a tri-county region of the
state, the Tri-County AAA provides OAA
Title III funds to the state Office for purposes
of supporting Ombudsman services at the
tri-county planning and service area.

02-Other Medicaid
03-Social Services
Block Grant or
Community Services
Block Grant
04-Community
Development Block
Grant
05-Senior Medicare
Patrol
06-Victims of Crime
Act Funds

Element
Number

Data
Element

Element
Definition

Quantifier

S-35.1

Other
Federal
Sources,
Other
Description

Other source not
described in 0106.

Single, per
other
sources

S-36

State funds

Total funds
expended from
state government
sources or from
grants, donations,
etc. at the state
level.

Single

S-37

Identification
of other
sources state level

Specification of
other state funds
expended.

Multiple

Type

Codes and Values

Examples and Reporting Tips

99-Other federal
sources of funds

Provide a brief description (up to 500
characters) of a federal funding source
expended but not identified in codes 01-06.

Numeric
(decimal)

NA (not a coded
element)

In dollars ($) and cents.

Numeric
Code;;
Alphanumeric
String

01-State general
funds (appropriated by
the legislature)

Select all sources that apply.

02-State fee or tax
03-Civil Monetary
Penalties
04-Private funds –
foundation grants, etc.

S-37.1

Other state
level
sources

Other source not
described in 0104.

Single, per
other
sources

S-38

Local funds
expended

Total funds
expended by
local programs

Single

Numeric
(decimal)

99-Other state
sources of funds
(Text)

Provide a brief description (up to 500
characters) of a state funding source
expended but not identified in codes 01-04.

NA (not a coded
element)

In dollars ($) and cents.

Element
Number

Data
Element

Element
Definition

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-39

Identification
of funds
expended at
the local
level

Total funds
expended from
local sources
from grants,
donations, etc. at
the local level.

Multiple

Numeric
Code;
Alphanumeric
String

01-Local government

Select all sources that apply.

02-Private
grants/funds
03-Other state funds
expended at local (but
not statewide) level
04-Other federal
funding obtained at
local (but not
statewide) level

S-39.1

Other local
funds
expended

Other source not
described in 0104.

S-40

All Funds
Expended

Grand total
dollars expended
from all sources.

Single

Numeric
(decimal)

99-Other (Text)

If 99 other is used, write a brief description
(500 characters).

NA (not a coded
element)

In dollars ($) and cents.

Part G: Facility Data Elements
Report for both nursing facilities and residential care communities, in the appropriate section, the number of facilities which were licensed, ( or registered,
listed, certified, or otherwise regulated) by a state during the reporting period and the resident capacity (number of beds) of those facilities.
Element
Number

Data Element

Element Definition

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-41

Number of
nursing
facilities

Total number of
nursing facilities
within the state.

Single

Numeric)

NA (not a coded
element)

Count on last day of federal fiscal year. It
must be a whole number.

S-42

Total nursing
facility
resident
capacity

Number of beds for
which the facilities
are licensed.

Single

Numeric

NA (not a coded
element)

Count on last day of federal fiscal year. It
must be a whole number.

S-43

Number of
residential
care
communities

Total number of
residential care
communities within
the state.

Single

Numeric

NA (not a coded
element)

Count on last day of federal fiscal year. It
must be a whole number.

S-44

Total
residential
care
community
resident
capacity

Number of beds for
which the facilities
are licensed,
certified or
registered.

Single

Numeric

NA (not a coded
element)

Count on last day of federal fiscal year. It
must be a whole number.

Element Description

Quantifier

Type

Codes and Values

Examples and Reporting Tips

Residential
Care
Community
Type

Provide information regarding each
type of Residential Care Community.

Multiple

Composite
data
element
subsuming
element
numbers
S45, S46,
and S47

NA (not a coded
element)

Indicate the name of each type of Residential
Care Community that is licensed, registered,
listed, certified, or otherwise regulated by the
state and the state’s definition for each type.
Include the total number of beds licensed,
registered, listed or certified using this
definition. Indicate the minimum and
maximum number of beds permitted by the
license or other regulatory designation for
each type of facility.

Element
Number

Data
Element

Element
Description

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-45

Residential
care
community
name

License, registration
or License,
registration or
certification name of
the residential care
community.

Single per
Residential
Care
Community

Alphanumeric
String

NA (not a coded
element)

Reporting the number of unregulated or
unlicensed Residential Care
Communities is optional (not required.) If
the state chooses to report, write
“unregulated” as the Residential Care
Community name (500 characters).

Composite
Data
Element

Element
Number

Data
Element

Element
Description

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-46

Residential
care
community
definition

State definition of a
residential care
community facility.

Single per
Residential
Care
Community
Type

Alphanumeric
String

NA (not a coded
element)

Provide a brief description of the state’s
definition of residential care community.
Include a brief description of the
unregulated Residential Care
Community, if identified.
Maximum length of 3,400 characters
(about 500 words).

S-47

Residential
care
community
capacity
range

Minimum number of
beds permitted by
the license or other
regulatory
designation.

Single per
Residential
Care
Community
Type

S-47.1

Residential
care
community
capacity
range

Maximum number of
beds permitted by
the license or other
regulatory
designation.

Single per
Residential
Care
Community
Type

Alphanumeric
String

NA (not a coded
element)

If known, include the minimum capacity
(minimum number of beds allowed by
licensed beds). If capacity is not known
then select no minimum. If there is no
maximum or no minimum select that
option.
If known, include the maximum capacity
(maximum number of beds allowed by
license type). If capacity is not known
then select no maximum. If there is no
maximum or no minimum select that
option.

Part H: Ombudsman Program Activity Data Elements
Element
Number

Data
Element

Element Description

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-48

Certification
training hours

Total hours of training
required for an
individual (paid or
volunteer) to achieve
certification which
allows an individual
to be eligible for
designation as a
representative of the
Office of State LTC
Ombudsman.

Single

Numeric

NA (not a coded
element)

If a state has various levels of
training based on volunteer or paid
status, select the minimum number
of training hours required to perform
the duties as a representative of the
Office.

Annual number of
hours of in-service
training required for
all representatives of
the Office.

Single

S-49

Continuing
education

It must be a whole number.

Numeric

NA (not a coded
element)

If a state has various levels of
continuing education requirements
based on volunteer or paid status,
select the minimum number of
continuing education hours required
to maintain ability to perform the
duties as a representative of the
Office.
It must be a whole number.

S-50

Number of
individuals
completing
certification
training

Total number of
individuals (paid or
volunteer) completing
certification training
within the federal
fiscal year.

Single

Numeric

NA (not a coded
element)

Report number of individuals who
completed training even if they have
not started fulfilling the duties of a
representative of the Office.
It must be a whole number.

Element
Number

Data
Element

Element Description

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-51

Training
sessions:
nursing
facility staff

Number of sessions
provided by
representatives of the
Office to nursing
facility staff.

Single

Numeric

NA (not a coded
element)

Training may be in person, or webbased and typically includes an
agenda and learning outcome(s).
If the Ombudsman program is
presenting to a large group that
includes multiple types of facility
staff, decide which staff type to
select based on majority in
attendance. If training is webbased, on-line or on-demand the
Ombudsman program must have a
way to count the number of
individuals who completed a training
session in order to report in NORS.
It must be a whole number

S-52

Training
sessions:
residential
care
community
staff

Number of sessions
provided by
representatives of the
Office to nursing
facility staff.

Single

Numeric

NA (not a coded
element)

Element
Number

Data
Element

Element Description

Quantifier

Type

Codes and Values

Examples and Reporting Tips

Information
and
Assistance

Providing information
about issues
impacting residents
(e.g., resident rights,
care issues, services)
and/or providing
assistance to access
services without
opening a case and
working to resolve a
complaint.

S-53

Information
and
assistance:
nursing
facility staff

Number of instances
provided by
representatives of the
Office.

Single

Numeric

NA (not a coded
element)

It must be a whole number.

S-54

Information
and
assistance:
residential
care
community
staff

Number of instances
provided by
representatives of the
Office.

Single

Numeric

NA (not a coded
element)

It must be a whole number..

S-55

Information
and
assistance to
Individuals

Total number of
information and
assistance instances
to individuals
provided by
representatives of the
Office.

Single

Numeric

NA (not a coded
element)

It must be a whole number.

Information and assistance may be
provided through various means,
including but not limited to
telephone, by written
correspondence such as e-mail, or in
person.

Element
Number

Data
Element

Element Description

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-56

Facilities
visited:
nursing
facility

Total number of
nursing facilities that
received at least one
visit by a
representative of the
Office during the
reporting year,
regardless of the
purpose of the visit.

Single

Numeric

NA (not a coded
element)

This is a count of the number of
facilities that received a visit. For
example 350 of the 350 nursing
facilities in State A had at least one
visit, regardless of purpose.

Total number of
nursing facility visits
no matter the
purpose of visit
(complaint or noncomplaint related) by
representatives of the
Office.

Single

Total number of
nursing facilities
visited, not in
response to a
complaint, in all four
quarters by
representatives of the
Office.

Single

S-57

S-58

Number of
visits: nursing
facility

Routine
access:
nursing
facility

It must be a whole number.

Numeric

NA (not a coded
element)

This is a count of the total number of
visits; for example, there were 1500
visits made to the 350 nursing
facilities in State A (both complaint
and non-complaint.)
It must be a whole number.

Numeric

NA(not a coded
element)

This count demonstrates routine
access. For example, of the 350
nursing facilities in State A, 150 had
a visit each quarter, not in response
to a complaint.
It must be a whole number.

Element
Number

Data
Element

Element Description

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-59

Facilities
visited:
residential
care
community

Total number of
residential care
communities that
received at least one
visit by a
representative of the
Office during the
reporting year,
regardless of the
purpose of the visit.

Single

Numeric

NA (not a coded
element)

This is a count of the number of
facilities that received at least one
visit. For example 700 of the 2000
residential care communities in State
B had at least one visit during the
reporting year, regardless of
purpose.

Total number of
residential care
community facility
visits no matter the
purpose of visit
(complaint or noncomplaint related) by
representatives of the
Office.

Single

Total number of
residential care
community facilities
visited, not in
response to a
complaint, in all four
quarters by
representatives of the
Office.

Single

S-60

S-61

Number of
visits:
residential
care
community

Routine
access:
residential
care
community

It must be a whole number.

Numeric

NA (not a coded
element)

This is a count of the total number of
visits; for example, there were 1400
visits made to the 700 residential
care communities in State B (both
complaint and non-complaint.)
It must be a whole number.

Numeric

NA (not a coded
element)

This count demonstrates routine
access. For example, of the 2000
residential care communities in State
B, 200 had a visit each quarter, not
in response to a complaint.
It must be a whole number.

Element
Number

Data
Element

Element Description

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-62

Facility
survey
participation:
nursing
facility

Total number of
instances of survey
activity by
representatives of the
Office.

Single

Numeric

NA (not a coded
element)

Include participation in both standard
surveys and complaint surveys.
Survey participation includes but is
not limited to pre-survey information
to surveyors, sharing complaint
summary reports, participation in exit
conferences and informal dispute
resolution.
It must be a whole number.

S-63

Facility
survey
participation:
residential
care
community

Total number of
instances of survey
activity by
representatives of the
Office.

Single

Numeric

NA (not a coded
element)

Include participation in both standard
surveys and complaint surveys, (or
similar state surveys or inspections
conducted in Residential Care
Communities.) Survey participation
includes but is not limited to presurvey information to surveyors,
sharing complaint summary reports,
participation in exit conferences and
informal dispute resolution.
It must be a whole number.

S-64

Resident
council
participation:
nursing
facility

Total number of
instances of
attendance, at
resident councils,
including meeting
with council
leadership, and
training of resident
councils at nursing
facilities by
representatives of the
Office.

Single

Numeric

NA (not a coded
element)

Use S-55 to count technical support,
consultations and providing resource
information, for information and
assistance that was not offered
during a council meeting.
It must be a whole number whole
number.

Element
Number

Data
Element

Element Description

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-65

Resident
council
participation:
residential
care
community

Total number of
instances of
attendance, at
resident councils,
including meeting
with council
leadership, and
training of resident
councils at residential
care community
facilities by
representatives of the
Office.

Single

Numeric

NA(not a coded
element)

Use S-55 to count technical support,
consultations and providing resource
information, for information and
assistance that was not offered
during a council meeting.

Family
council
participation:
nursing
facilities

Total number of
instances of
attendance, at family
councils, including
meeting with council
leadership, and
training of family
councils at nursing
facilities by
representatives of the
Office.

Single

S-66

It must be a whole number.

Numeric

NA (not a coded
element)

Use S-55 to count technical support,
consultations and providing resource
information, for information and
assistance that was not offered
during a council meeting.
It must be a whole number.

Element
Number

Data
Element

Element Description

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-67

Family
council
participation:
residential
care
community

Total number of
instances of
attendance, at family
councils, including
meeting with council
leadership, and
training of family
councils at residential
care community
facilities by
representatives of the
Office.

Single

Numeric

NA (not a coded
element)

Use S-55 to count technical support,
consultations and providing resource
information, for information and
assistance that was not offered
during a council meeting.

S-68

Community
Education

Total number of
instances of
community education
outreach sessions by
Ombudsman
program.

Single

Numeric

N/A (not a coded
element)

Use for attendance at health fairs,
community events, general
presentations, etc. If education is
web-based or on-line/on-demand the
Ombudsman program must have a
way to count the number of
individuals who completed the
session in order to report in NORS.
Newsletters, blogs and other forms
of media do not count as community
education.
It must be a whole number.

Element
Number

Data
Element

Element Description

Quantifier

Type

Codes and Values

Examples and Reporting Tips

S-69

State and
local level
coordination
activities

Identifies the list of
agencies/programs
that have state or
local level
coordination activities
led by the
Ombudsman
program.

Multiple

List of
Numeric
Codes

01-Area agency on
aging programs

Report any leadership activities
and/or state/local-level coordination,
where the State Ombudsman
provides state-level coordination,
and support for appropriate local
Ombudsman entity coordination,
between the Ombudsman program
and other entities with
responsibilities relevant to the health,
safety, well-being or rights of
residents of long-term care facilities

02-Aging and
disability resource
centers
03-Adult protective
services programs
04-Protection and
advocacy systems
05-Facility and longterm care provider
licensure and
certification
programs

Select one or more agency or
program.

06-The State
Medicaid fraud
control unit
07-Victim assistance
programs
08-State and local
law enforcement
agencies
09-Courts of
competent
jurisdiction
10-The State legal
assistance
developer and legal
assistance programs
11-Centers for
Independent Living
98-None

Element
Number

Data
Element

Element Description

S-69.1

Other state
and local
activities.

Description of state
and local level
coordination
organization not
listed in 01-11.

Quantifier

Type

Codes and Values

Examples and Reporting Tips

99- Other (text)

Provide a brief description of the
organization (500 characters.)

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