SUA Director Survey

Evaluation of the Long-Term Care Ombudsman Program (LTCOP)
State Unit on Aging (SUA) Director Survey
PURPOSE OF THE STUDY:
NORC at the University of Chicago, with funding from the Administration for Community
Living/Administration on Aging (ACL/AoA), is conducting an evaluation of the Long-Term Care
Ombudsman Program. The purpose of this survey is to obtain insight on your previous experience as a
State Long-Term Care Ombudsman and how your role was perceived. This survey is voluntary and is not
part of an audit or a compliance review. The information you provide is confidential. We do not include
names of respondents in any reports or in any discussions with supervisors, colleagues, or ACL/AoA. This
survey will take approximately __ minutes to complete. Please complete and return this form using the prepaid envelope, or by scanning and emailing it to [email protected], or by faxing it to 301-634-9582.
Please contact NORC at 1-877-XXX-XXXX or [email protected] if you have any questions or
concerns.
OMB Control No.:
Expiration Date:

SECTION A: Background Information
We’d like to begin by asking you a few questions about your position and your experience prior to serving as
the State Unit on Aging (SUA) Director.

1. How long have you served as the SUA Director?
{Enter number years}

+

___ ___

{Enter number months} ___ ___

2. Prior to your position as the SUA Director, did you have any experience working with the
LTCOP?
1

Yes
If so, in what capacity? ________________________________________________

2

No

3. What was your job immediately prior to becoming the SUA Director?
_________________________________________________________________________

SECTION B: Structure and Activities
Next, we’d like to ask about the structure and activities of the SUA and Office of the State LTCOP.

Program Structure
1. What agencies/programs are housed within your SUA? {Check all that apply}
1

Office of the State Long-Term Care Ombudsman (SLTCO)

2

Adult Protective Services (APS)

3

Licensing and Certification Agency

4

Medicaid Case Management

5

Medicaid Agency

6

Medicaid Waiver programs

7

Legal Services Developer, Legal Assistance program

8

State Health Insurance Program (SHIP)

9

Senior Medicare Patrol (SMP)

10

Information and Assistance Program

11

Public Guardianship

12

Aging and Disability Resource Center (ADRC)

13

Board of Nursing Home Administrators

96

Other (Please specify): _______________________________________________

2. Is the Office of the SLTCO a distinct and separately identifiable entity (regardless of its
organizational placement) within the SUA or other agency or organization in which it is housed?
Some examples may include the SLTCO having a separate program logo and/or website, and the
SLTCO (rather than the SUA Director) being seen by other entities as the head of the Office of
the SLTCO.
1

Yes

2

No

3

Somewhat
If so, please describe? ________________________________________________

Legal Counsel
3. Who is the Ombudsman program’s assigned legal counsel? {Check all that apply}
1

Office of the Attorney General

2

Host agency attorney (state government)

3

Host agency attorney (non-government)

4

In-house attorney (legal counsel is part of Ombudsman program staff)

5

Private attorney under contract

6

Other Please specify: ____________

97

Don’t know

2

4. Is the legal counsel assigned to the LTCOP knowledgeable about the following? {Check all that
apply}
1

Ombudsman programmatic issues

2

Long-term care issues

3

Federal, state, and local laws related to long-term care facilities

97

Don’t know (I don’t know if the legal counsel assigned to the LTCOP is knowledgeable about
Ombudsman programmatic issues and/or long-term care issues)

Program Activities
5. Which of the following management activities does your SUA perform? {Check all that apply}
1

Provides personnel and management oversight of the LTCOP

2

Provides contractual oversight (if LTCOP is contracted out to another entity)

3

Provides training and technical assistance opportunities to the LTCOP

4

Monitors the LTCOP budget, including ensuring there are adequate funds for the program

5

Monitors LTCOP activities to provide program oversight

6

Enables the LTCOP to determine use of its fiscal resources

96

Other (Please specify): ________________________________________________

6. What types of supports does your SUA provide to the LTCOP? {Check all that apply}
1

Ensures the LTCOP has sufficient authority and access to facilities, residents, and information
needed to fully perform duties

2

Conveys the independence of the LTCOP to the legislature and other organizations

3

Facilitates coordination with other entities (for example APS, Licensing and Certification, etc.)

4

Facilitates the LTCOP’s participation in relevant advisory committees, workgroups and/or task
forces related to the long-term care service system

5

Integrates the goals and objectives of the LTCOP into the State Plan

6

Coordinates with SLTCO to develop policies and procedures for monitoring, confidentiality, and
disclosure

96

Other (Please specify): ________________________________________________

7. Which of the following systems advocacy activities does your SUA perform? {Check all that apply}
1

Communicates regularly to the SLTCO about policy or legislative issues

2

Supports the ability of Ombudsmen program staff to speak directly with the media

3

Aware of and understands LTCOP legislative priorities

4

Facilitates introductions/meetings with, and appearance before the legislature

96

Other (Please specify): ________________________________________________

3

8. Do your SUA and the LTCOP jointly carry out any of the following activities? {Check all that apply}
1

Educate other state officials (for example, state agency staff or elected officials) about issues in
the long-term care system

2

Conduct long-range strategic planning (for example, for activities related to older adults and/or
persons with disabilities)

3

Coordinate cross-training among state agencies and programs

4

Develop training programs (for LTCOP staff and/or LTC facility staff)

96

Other (Please specify): ________________________________________________

98

Not applicable

9. Do the SLTCO and their staff have unrestricted access to the following entities? {Check all that
apply}
1

Elected and appointed state officials

2

The media

3

Advocacy groups

4

Facility administrators

5

Insurance providers

6

Health care providers

3

None of the above
If so, why? _________________________________________________________

10. Is the SLTCO able to provide written and public testimony on current and proposed laws,
regulations, policies and procedures without prior approval or restriction?
1

Yes

2

No
If not, why? _________________________________________________________

11. Are there any barriers which prevent the LTCOP from engaging in systems advocacy?
1

Yes

2

No (Skip to Q13)

97

Don’t know

4

12. What barriers prevent Ombudsmen from engaging in systems advocacy? {Check all that apply}
1

State laws

2

Organizational structure

3

Competing priorities with State government, including the Governor’s office

4

Competing perspectives or philosophies among agencies

5

Competing priorities among agencies

6

Competing priorities with the SUA

7

Lack of adequate funding

8

Concerns about conflict of interest

9

Lack of training in systems advocacy

10

Insufficient staff time/program capacity

96

Other (Please specify): ________________________________________________

98

Not applicable

13. Are there any barriers which prevent the LTCOP from engaging in individual resident advocacy?
1

Yes

2

No (Skip to Q15)

97

Don’t know

14. What barriers prevent Ombudsmen from engaging in individual resident advocacy? {Check all
that apply}
1

State laws

2

Organizational structure

3

Competing perspectives or philosophies among agencies

4

Competing priorities among agencies

5

Lack of adequate funding

6

Concerns about conflict of interest

7

Lack of adequate training in individual advocacy

8

Lack of adequate legal counsel

9

Challenging relationships with facility administrators and staff

10

Insufficient staffing within the LTCOP (e.g., number of available Local Ombudsmen and/or
Volunteer Ombudsmen)

96

Other (Please specify): ________________________________________________

98

Not applicable

5

SECTION C: Program Strengths and Challenges
1. In which areas has the Ombudsman program demonstrated expertise? {Check all that apply}
1

Serving residents of board and care facilities

2

Elder abuse (for example, task forces, staff training/in-services)

3

Culture change (for example, person-centered service planning, dementia-competent care, etc.)

4

Assisting residents in transitioning out of facilities

5

Providing support during bankruptcy proceedings

6

Providing advocacy around inappropriate drug use (for example, chemical restraints, misuse of
anti-psychotic drugs)

7

Supporting residents with end of life care (for example, advance directives, access to hospice
services, facility practices when someone dies)

8

Managing family conflicts

9

Addressing involuntary discharges/transfers

10

Systems advocacy (for example, activities related to state or federal laws, regulations, or
policies)

11

Developing a volunteer program

12

Emergency response

96

Other (Please specify): ______________________________________________________

2. What are the LTCOP’s main strengths?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

6

3. What challenges does your LTCOP face? {Check all that apply}
1

Insufficient funding

2

Insufficient program autonomy

3

Insufficient access to adequate legal counsel

4

High turnover of paid staff

5

High turnover of volunteers

6

Difficulty hiring qualified paid staff

7

Difficulty recruiting and/or supporting volunteers

8

Difficulty working with other state agencies or programs (for example, APS or the
Licensing and Certification Agency)

9

Difficulty accessing residents in rural areas

10

Working with facility administrators, corporate owners, and provider associations

11

Working with other organizations

12

Working with family members

13

Working with resident councils

14

Working with family councils

15

Insufficient peer-to-peer support to share what works and what does not

16

Insufficient access to training in areas where staff need to be knowledgeable
If so, please explain: ____________________________

17

Difficulty working with non-English/limited English speakers

96

Other (Please specify): ___________________________________________

98

Not applicable (the LTCOP does not face any challenges.)

7

SECTION D: Program Resources
Next, we’d like to ask questions about program resources.
1. What resources does your SUA provide to the LTCOP? {Check all that apply}
1

In-kind contributions (for example, donated office space)

2

Staff

3

Data/information systems (for example, computers, software, etc.)

4

Administrative support

5

Fiscal resources

96

Other (Please specify): ________________________________________________

98

Not applicable

2. Does your SUA have staff positions that support the LTCOP? For example, an Ombudsman
Liaison that is employed by the SUA, but interfaces with the LTCOP.
1

Yes
If so, please describe the position(s): _____________________________________
___________________________________________________________________

2

No

3. What challenges does the SUA face in overseeing or supporting the LTCOP?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
4. Who are your main sources of information about the LTCOP? {Check all that apply}
1

ACL – Central Office

2

ACL – Regional Offices

3

State Ombudsman (Office of the SLTCO)

4

Local Ombudsmen

5

Advancing States

6

National Ombudsman Resource Center

7

National Association of State Ombudsman Programs (NASOP)
Other (Please specify): ___________________________________________

96

8

SECTION E: Relationships and Perceptions of the Ombudsman Program
The next questions ask about program relationships and perceptions about the LTCOP.
1. Overall, how would you rate the effectiveness of the SUA’s relationship with the following
entities?
Very
effective

Somewhat
effective

Neutral

Somewhat
ineffective

Very
ineffective

Don’t
know

a. Office of the State LTCO

1

2

3

4

5

97

b. ACL – Central Office

1

2

3

4

5

97

c. ACL – Regional Offices

1

2

3

4

5

97

d. National Association of
States United on Aging
and Disability
(NASUAD)

1

2

3

4

5

97

e. National Ombudsman
Resource Center

1

2

3

4

5

97

f. National Association of
State Long-Term Care
Ombudsman Programs
(NASOP)

1

2

3

4

5

97

g. National Association of
Local Long-Term Care
Ombudsmen
(NALLTCO)

1

2

3

4

5

97

2. Overall, how would you describe the effectiveness of the LTCOP statewide?
1

Very effective

2

Somewhat effective

3

Neutral

4

Somewhat ineffective

5

Very ineffective

97

Don’t know

3. Overall, how familiar are the following groups with the LTCOP?
Very familiar

Somewhat
familiar

Not familiar

Don’t know

a. Agencies within the aging
network

1

2

3

97

b. Nursing homes

1

2

3

97

c. Board and care homes and
similar facilities*

1

2

3

97

d. Consumers (residents/family
members)

1

2

3

97

*Board and care homes and similar facilities include residential care facilities, adult congregate living facilities,
assisted living facilities, foster care homes, and other adult care homes similar to a nursing facility or board and
care home which provide room, board, and personal care services to a primarily older residential population.

4. How would you describe the LTCOP’s reputation among the aging and disability network?
9

1

Very good

2

Good

3

Neutral

4

Poor

5

Very poor

97

Don’t know

5. What is the most important way that your SUA contributes to the LTCOP?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

SECTION F: Program Quality Assurance
In this section, we focus on program quality assurance activities.
1. Does the LTCOP Final Rule provide sufficient guidance and authority to the LTCOP to perform
its functions effectively and efficiently?
1

Yes

2

No
If not, what areas require clarification? ____________________________________

3

Somewhat
If so, what areas require clarification? _____________________________________

97

Don’t know

2. How does your SUA address LTCOP conflicts of interest (both organizational and individual)?
{Check all that apply}
1
2
3
4
96

Establishes policies and procedures
Clarifies role of SLTCO with other agencies
Clarifies role with AAA and/or other contractors
Enables SLTCO to enlist other legal counsel if the one assigned to them has a conflict of
interest
Other (Please specify): ________________________________________________

Data and Monitoring
3. Does your LTCOP provide your SUA with program data (for example, monthly or quarterly reports
for monitoring purposes)?
1

Yes

2

No

3

Don’t know
10

4. Does your SUA use other data for monitoring the work and progress of the LTCOP?
1

Yes
If so, please identify the data source used: _________________________________

2

No

5. What changes would you make to improve the effectiveness of the LTCOP?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
6. Is there any topic or issue that was not covered that you think is important to include in the
evaluation?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

THANK YOU FOR COMPLETING THIS SURVEY.

11