A Free Advocate in Every Nursing Home: The Long-Term Care Ombudsman Program

When a person moves into a nursing home or assisted living facility, they do not lose their rights. They retain the right to be treated with dignity and respect, to receive adequate medical care, to be free from abuse and neglect, to manage their own finances, to have privacy, to voice complaints without retaliation, and to participate in decisions about their care. But the reality of institutional living is that these rights are violated with distressing frequency. Understaffing leads to neglect. Overmedication is used as a chemical restraint. Personal belongings disappear. Calls for help go unanswered. Families are told their loved one is “fine” when they clearly are not.

The Long-Term Care Ombudsman Program exists to be the voice of residents who may not be able to speak for themselves. Authorized by the Older Americans Act and present in every state, the District of Columbia, and every U.S. territory, the program deploys over 1,200 paid staff ombudsmen and approximately 5,700 trained volunteer ombudsmen to visit long-term care facilities, investigate complaints, advocate for residents, and work to resolve problems. In a single recent year, ombudsmen investigated over 195,000 complaints and provided information and assistance to over 350,000 individuals.

The word “ombudsman” comes from a Swedish term meaning “representative” or “agent.” That is precisely what a long-term care ombudsman is—a representative of the resident, an advocate whose sole loyalty is to the people living in these facilities. Ombudsmen are not employees of the facilities they oversee. They are not regulators (though they work with regulatory agencies). They are independent advocates who visit facilities, talk with residents, listen to concerns, investigate complaints, and work within the system to achieve the best possible outcomes for the people they serve.

All services of the Long-Term Care Ombudsman Program are free. There is no income test, no age requirement (the program serves all long-term care residents, including younger adults with disabilities), and no complicated application process. If you are a resident of a long-term care facility or if you have a concern about someone who is, the ombudsman is there for you.

Opportunity Snapshot

What Ombudsmen Do

Complaint Investigation

The core function of the ombudsman is investigating complaints about long-term care facilities. Complaints can come from residents, family members, friends, facility staff, or anyone with a concern. Common complaints include:

Quality of care issues: Inadequate nursing care, medication errors, failure to follow care plans, insufficient pain management, untreated pressure ulcers (bedsores), dehydration, malnutrition, failure to assist with eating, improper use of physical or chemical restraints, and failure to provide rehabilitative services.

Abuse, neglect, and exploitation: Physical abuse (hitting, pushing, rough handling), sexual abuse, verbal and emotional abuse, financial exploitation (theft of money or belongings, unauthorized use of funds), neglect (failure to provide food, water, medical care, hygiene, or supervision), and involuntary seclusion.

Rights violations: Denial of the right to make personal decisions, restrictions on visitors, interference with mail or phone calls, violation of privacy, failure to accommodate religious or cultural preferences, retaliation against residents who complain, and improper discharge or transfer.

Administrative concerns: Billing disputes, inadequate staffing, facility cleanliness, food quality, laundry services, maintenance of personal belongings, and facility policy complaints.

When a complaint is received, the ombudsman visits the facility, interviews the resident and relevant staff, reviews records with the resident’s permission, and works to resolve the issue. Resolution strategies range from informal mediation and facility communication to formal complaints to regulatory agencies, referrals to adult protective services, and connections with legal services.

Regular Facility Visits

Ombudsmen do not wait for complaints—they proactively visit long-term care facilities on a regular basis to talk with residents, observe conditions, identify problems before they escalate, ensure that residents know about the ombudsman program, build relationships with residents and staff, and monitor facility compliance with regulations and resident rights. Federal law requires that ombudsmen have access to any long-term care facility at any time, and facilities may not deny entry or retaliate against residents who speak with ombudsmen. In a recent year, ombudsmen made over 171,000 visits to long-term care facilities.

Resident and Family Education

Ombudsmen provide information and education on understanding resident rights under federal and state law, what to look for when choosing a nursing home or assisted living facility, how to read and understand a facility’s inspection reports, how to participate effectively in care planning meetings, how to address concerns directly with facility staff and management, and how to file complaints with the ombudsman, the state survey agency, and other authorities.

Systemic Advocacy

Beyond individual complaint resolution, ombudsmen engage in systemic advocacy to improve conditions for all long-term care residents. This includes analyzing complaint data to identify patterns and trends, advocating for stronger regulations and enforcement, testifying before legislatures on long-term care policy, participating in rulemaking processes, educating policymakers about conditions in long-term care, and promoting best practices in person-centered care.

Discharge and Transfer Assistance

One of the most urgent situations ombudsmen address is improper facility discharge or transfer. Federal law gives nursing home residents significant protections against involuntary discharge, including the right to advance notice, the right to appeal, and the right to remain in the facility during the appeal process. When a resident faces discharge or transfer, the ombudsman can explain the resident’s rights, help the resident appeal the discharge, advocate for appropriate placement if transfer is necessary, ensure that the facility follows all legal requirements, and connect the resident with legal services if needed.

Common Situations Where Ombudsmen Help

Your parent’s nursing home is understaffed and call lights go unanswered for hours. The ombudsman can investigate, document the staffing issues, advocate with facility management, and if necessary, refer the matter to state regulators.

You notice unexplained bruises on your spouse during visits to the assisted living facility. The ombudsman can investigate potential abuse, ensure the resident’s safety, and refer to adult protective services and law enforcement as appropriate.

Your loved one is being overmedicated and seems drugged. The ombudsman can review the medication situation, advocate for a medication review, and ensure that chemical restraints are not being used inappropriately.

A facility wants to discharge your family member for “difficult behavior.” The ombudsman can review the discharge notice, explain the resident’s appeal rights, help file an appeal, and advocate for alternatives to discharge.

Your grandmother’s personal items keep disappearing. The ombudsman can investigate theft and financial exploitation, advocate for the facility to address security issues, and refer to law enforcement if criminal activity is suspected.

You have questions about what to look for in a nursing home. The ombudsman can provide guidance on selecting a quality facility, explain how to read inspection reports, and share information about facilities in your area.

A resident has no family and no one to advocate for them. Ombudsmen routinely visit and advocate for residents who have no family involvement—these are often the most vulnerable residents in any facility.

How to Contact the Ombudsman

National Eldercare Locator: Call 1-800-677-1116 to be connected with your local ombudsman program. The Eldercare Locator is a free service available Monday through Friday, 9 AM to 8 PM Eastern Time.

Online: Visit the Eldercare Locator at eldercare.acl.gov to find your state and local ombudsman program contact information.

State ombudsman offices: Each state has a State Long-Term Care Ombudsman who oversees the program statewide. Contact information is available through the Administration for Community Living at acl.gov/ltcop.

Facility postings: Federal law requires nursing homes to post the ombudsman’s contact information in a prominent location within the facility. Look for it near the main entrance, in common areas, or on resident rights posters.

Facility visits: If you see an ombudsman visiting a facility, you can approach them directly. They are there to help.

Confidentiality

Confidentiality is a cornerstone of the ombudsman program. All complaints and investigations are confidential. The ombudsman will not reveal the identity of the complainant without permission. Residents who speak with ombudsmen are protected from retaliation. Facility staff may not punish, threaten, or discriminate against residents who file complaints or cooperate with ombudsman investigations. This confidentiality protection encourages residents and families to come forward with concerns without fear of consequences.

Frequently Asked Questions

Does the ombudsman have the authority to close a facility? No. Ombudsmen are advocates, not regulators. However, they work closely with state regulatory agencies and can refer serious issues for regulatory action, including citation, fines, and in extreme cases, facility closure.

Is the ombudsman program only for elderly residents? No. The program serves all residents of long-term care facilities regardless of age. Many nursing home and assisted living residents are younger adults with disabilities, traumatic brain injuries, or serious mental illness—all of whom are served by the ombudsman program.

Can I file a complaint anonymously? Yes. You can file a complaint without identifying yourself, and the ombudsman will investigate without revealing who filed the complaint.

What if the resident does not want help? Ombudsmen respect residents’ autonomy. If a resident does not want the ombudsman’s help, the ombudsman will respect that decision while ensuring the resident knows that services are available if they change their mind. However, if the ombudsman suspects abuse or neglect of a resident who cannot make decisions independently, they have a duty to act.

Are ombudsman services available in memory care units? Yes. Ombudsmen visit and advocate for residents in memory care units, specialized dementia care units, and all other areas of long-term care facilities. Residents with cognitive impairments are among the most vulnerable and are a priority for ombudsman services.

Can I become a volunteer ombudsman? Yes! Volunteer ombudsmen receive extensive training and play a vital role in the program. Contact your state ombudsman program to learn about volunteer opportunities.

Does it cost anything to file a complaint? No. All ombudsman services are completely free.

How to Get Started

1. Call the Eldercare Locator at 1-800-677-1116 to find your local ombudsman
2. Visit eldercare.acl.gov to search for ombudsman services by location
3. Visit acl.gov/ltcop for state program contacts
4. Look for posted ombudsman contact information in any nursing home or assisted living facility
5. Call 211 for long-term care advocacy referrals in your area

Every person living in a nursing home, assisted living facility, or other long-term care setting deserves to be treated with dignity, to receive quality care, and to have their rights respected. The Long-Term Care Ombudsman Program is the independent, free advocate that ensures these standards are upheld. Whether you are a resident, a family member, or a concerned friend—if something does not seem right, contact your ombudsman. They are there to help.