Form 1 NORS Table 1

Administration for Community Living/Administration on Aging- Office of Long-Term Care Ombudsman Programs
National Ombudsman Reporting System (NORS)
Table 1: NORS Parts A, B and C - Case and complaint codes, values and definitions

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

Table 1: Part A-Case Data Components
Each case must contain a complainant, complaint code (s), a setting, verification, resolution, and information regarding whether a complaint was
referred to another agency. Case and complaint data reported is only for those cases and complaints which were closed within the fiscal year.
Element
Number

Data
Element

Definition

Quantifier Type

CA-01

Case
Number

The unique
identifier used for
each case.

Single

AlphaNot Applicable (NA )
numeric
(not a coded element)

This is auto-created by the state software
program.

CA-02

Date Case
Opened

Month, day, and
year that the case
was opened.

Single

Date

Each case must have a minimum of one
complaint.

Codes and Values

NA (not a coded element)

Examples and Reporting Tips

Each case must have only one case open
date.
The case opened date must be on or before
the case closed date.

CA-03

Date Case
Closed

Month, day, and
year that the case
was closed.

Single

Date

NA (not a coded element)

The year of case closure must be in the
associated reporting period.
Each case must have only one case closed
date.
The case closed date must be on or after
the case open date.

Element
Number

Data
Element

Definition

Quantifier Type

CA-04

Facility or
Setting

Type of facility or
setting for the
case.

Single

Codes and Values

Alpha01-Nursing Facility
numeric
02-Residential Care
Code
Community

Examples and Reporting Tips

Only one setting is allowed for each case.
See Part C definitions (Element Number CA04, Data Elements 01, 02 & 99).

99-Other setting
CA-05

Complainant

Complainant: an
individual (i.e.,
resident, resident
representative,
family) who
requests
Ombudsman
program
complaint
investigation
services regarding
one or more
complaints made
by, or on behalf
of, residents.

Single

Alphanumeric
Code

01. Resident
02. Resident
representative,
friend, family
03. Ombudsman
program
04. Facility staff
05. Representative of
other agency or
program
06. Concerned person
07. Resident or family
council
08. Unknown

See Part C definitions (Element Number CA05, Data Elements 01-08).
Only one complainant per case is allowed.
Select the complainant type that best
represents the complainant(s) for the case.

Table 1: Part B - Complaint Data Components
Element Data
Number Element

Definition

Quantifier

Type

Codes and Values

Examples and Reporting Tips

2

Element Data
Number Element
CD-01

CD-02

CD-03

Definition

Quantifier

Type

Codes and Values

Examples and Reporting Tips

Complaint
number

The unique
identifier used for
each complaint.

Single

Alphanumeric

Not Applicable (NA )

This is auto-created by the state software
program.

Date
Complaint
Opened

Month, day and
year the
complaint was
opened.

Single

Date
Complaint
Closed

Month, day and
year the
complaint was
closed.

Single

(not a coded element)

NA (not a coded element)

Each complaint must have only one complaint
opened date.
The complaint opened date must be on or
after the case opened date and on or before
the case closed date.

NA (not a coded element)

Each complaint must have only one complaint
closed date.
The complaint closed date must be on or after
the case opened date and on or before the
case closed date.

3

Element Data
Number Element

Definition

Quantifier

CD-04

An expression of
dissatisfaction or
concern brought
to, or initiated by,
the Ombudsman
program which
requires
Ombudsman
program
investigation and
resolution on
behalf of one or
more residents of
a long-term care
facility.

Single

Complaint

Type

Codes and Values

A.

B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.

CD-05

Perpetrator Person(s) who
appears to have
caused the abuse
or neglect or
exploitation.

Multiple

Abuse, Gross
Neglect,
Exploitation
Access to
Information
Admission,
Transfer, Eviction
Autonomy, Choice
Financial, Property
Care
Activities and
Social Services
Dietary
Environment
Policies,
Procedures
Complaints about
an Outside Agency
System/Others
(non-facility)

01-Facility Staff,

Examples and Reporting Tips

For the full list of codes and values, see Table
2.

02-Another Resident

Only used for Abuse, Gross Neglect, and
Exploitation complaints A01 to A05.

03-Family, Resident
Representative, Friend

There can be multiple perpetrators for each
complaint.

99-Other

4

Element Data
Number Element
CD-06

Referral
Agency

Definition

Quantifier

The agency or
agencies to which
a complaint was
referred to as part
of the
Ombudsman
program’s plan of
action for
complaint
resolution.

Multiple

Type

Codes and Values

Examples and Reporting Tips

01-Licensing, regulatory,
or certification agency

See definitions in Part C.

02-Adult protective
services
03-Law enforcement or
prosecutor

There can be multiple referrals to agencies in
one complaint.
A code of 06 (None) cannot be combined with
other codes for a complaint.

04-Protection and
advocacy
05-Legal services
06-No referral was made
99-Other

CD-07

Complaint
Verification

A confirmation
that most or all
facts alleged by
the complainant
are likely to be
true.

Single

Numeric Code
01-Verified

Each complaint must have a verification status
(verified or not verified.)

02-Not verified

5

Element Data
Number Element

Definition

Quantifier

CD-08

Final resolution or
outcome of the
complaint.

Single

Complaint
disposition

Type

Codes and Values

Examples and Reporting Tips

Numeric Code

Each complaint can have only one disposition
code.

01-Partially or fully
resolved to the
satisfaction of the
resident, resident
representative or
complainant.
02- Withdrawn or no
action needed by the
resident, resident
representative or
complainant.
03- Not resolved to the
satisfaction of the
resident, resident
representative or
complainant.

6

Table 1: Part C - Case and Complaint Definitions
Element
Number

Data Element

Definition

CA-04

Facility or Setting

Description of where Ombudsman services are provided.

CA-04

01-Nursing Facility

(A) Any skilled nursing facility, as defined in section 1819(a) of the
Social Security Act (42 U.S.C. 1395i–3(a)); (B) any nursing facility,
as defined in section 1919(a) of the Social Security Act (42 U.S.C.
1396r(a)).

CA-04

02-Residential Care
Community

A type of long-term care facility as described in the Older
Americans Act that, regardless of setting, provides at a minimum,
room and board, around-the-clock on-site supervision, and help
with personal care such as bathing and dressing or health-related
services such as medication management.

Examples and Reporting Tips

Facility types include but are not limited to: assisted living; board
and care home; congregate care; enriched housing programs;
homes for the aged; personal care homes; adult foster/ family
homes and shared housing establishments that are licensed,
registered, listed, certified, or otherwise regulated by a state.
CA-04

99-Other setting

A code for Ombudsman services offered as a state option, in
settings beyond those defined as long-term care facilities in the
Older Americans Act.

CA-05

Complainant

An individual who requests Ombudsman program complaint
investigation services regarding one or more complaints made by,
or on behalf of, residents.

This code is used by Ombudsman
programs that provide in-home care
ombudsman services, managed care
ombudsman and similar ombudsman
services.

7

Element
Number

Data Element

Definition

CA-05

01-Resident

An individual who resides in a long-term care facility.

CA-05

02-Resident
representative,
friend, family

Resident Representative, Friend, & Family: Resident
Representative as defined in 45 CFR 1324.1 (1) An individual
chosen by the resident to act on behalf of the resident in order to
support the resident in decision-making; access medical, social or
other personal information of the resident; manage financial
matters; or receive notifications; (2) A person authorized by State
or Federal law (including but not limited to agents under power of
attorney, representative payees, and other fiduciaries) to act on
behalf of the resident in order to support the resident in decisionmaking; access medical, social or other personal information of
the resident; manage financial matters; or receive notifications;
(3) Legal representative, as used in section 712 of the Act; or (4)
The court-appointed guardian or conservator of a resident.
Friend is a non-relative with a personal relationship with the
resident as identified by the resident or complainant; family is
spouse, sibling, other relative or as identified by the resident or
complainant.

CA-05

03-Ombudsman
program

Ombudsman program: the program through which the functions
and duties of the Office are carried out, consisting of the
Ombudsman, the Office headed by the Ombudsman, and the
representatives of the Office.

CA-05

04-Facility staff

Any employee or contractor of a long-term care facility who brings
a complaint to the Ombudsman program regarding one or more
residents.

Examples and Reporting Tips

8

Element
Number

Data Element

Definition

Examples and Reporting Tips

CA-05

05-Representative
of other agency or
program

Any representative of an agency, program or organization that
refers a complaint to the Ombudsman program regarding one or
more residents.

Includes medical personnel not associated
with the facility, adult protective services,
licensing and certification, law
enforcement, other social services
agencies, faith based communities, and
bank employees.

CA-05

06-Concerned
person

Any person not closely associated to a resident that refers a
complaint to the Ombudsman program regarding one or more
residents.

Includes neighbor to the facility, family
member of another resident, person
delivering supplies, barista, etc.

CA-05

07-Resident or
family council

Organized, self-governing, decision-making groups of long-term
care residents (resident council) or families (family council) who
meet regularly to voice their needs and concerns and to have
input into the activities, policies, and issues affecting the facility.

CA-05

08-Unknown

The source of the complaint or the type of complainant is not
known to the Ombudsman program.

CD-06

Referral Agency

The agency or agencies to which a complaint was referred to as
part of the Ombudsman program’s plan of action for complaint
resolution.

01-Licensing,
regulatory or
certification agency

Licensing or Regulatory or Certification Agency: Government units
responsible for the licensing of facilities and agencies serving older
adults and adults with disabilities.

CD-06

Do not report complainants that wish to be
anonymous as “unknown,” unless the
source is not known to the Ombudsman
program.

9

Element
Number

Data Element

Definition

CD-06

02-Adult Protective
Services

Adult Protective Services: A social services program provided by
state and/or local governments serving older adults and adults
with disabilities who are in need of assistance because of abuse,
neglect, self-neglect, or financial exploitation.

CD-06

03-Law
enforcement or
prosecutor

Law Enforcement or Prosecutor: People employed by a local,
state, tribal, or federal justice agency. This includes police, courts,
district attorney's office, probation or other community
corrections agency, and correctional facilities; including the State
Medicaid Fraud Control Unit, as defined in section 1903(q) of the
Social Security Act (42 U.S.C. 1396b(q))

CD-06

04-Protection &
Advocacy

Protection & Advocacy Systems: A system to protect and advocate
the rights of individuals with developmental disabilities; as
designated by the State, and as established under the
Developmental Disabilities Assistance and Bill of Rights Act of
2000 (42 U.S.C. 15001 et seq.)

CD-06

05-Legal services

Legal services: Entity or individual attorney providing legal
representation and/or consultation to residents including but not
limited to legal services funded through Older Americans Act or
Legal Services Corporation funds, Ombudsman legal counsel or
any other attorney.

CD-06

06-None

No referral was made.

CD-06.1

99-Other

Other: Any other entity to which a referral is made.

Examples and Reporting Tips

10