Quality Long Term Care: The Role of the Volunteer Ombudsman Part 1: Survey
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The Long-Term Care Ombudsman Program is a federally mandated program to improve the quality of care received by residents of nursing homes throughout the United States. Certified volunteer ombudsman are specially trained to act as advocates and to help identify and solve problems on behalf of residents in long-term care facilitates. Texas relies heavily on volunteers to carry out this important role; the approximate ratio of paid staff to volunteers is 1:21. The primary aims of this survey of certified volunteer ombudsman in Texas were to (a) gain a better understanding of their experiences; (b) identify barriers to effective job performance; and (c) identify training needs and ongoing needs for education and support. Survey questionnaires were mailed to the 642 certified volunteer ombudsman in 28 regions in the state of Texas. Completed questionnaires were received from 361 volunteers for a return rate of 56%. Certified volunteer ombudsmen are predominantly women (73.6%) with an average age of 65 years. The majority of volunteers are retired and many have had previous experience in the health and social service fields. Many certified volunteer ombudsmen persist in the role for many years; in this study over 60 percent had been ombudsmen for three years or longer. In general, certified volunteer ombudsmen felt that they were most effective in performing tasks directly related to individual residents and in protecting the residents' rights. The certified volunteer ombudsmen felt least effective in resolving system-wide complaints and in influencing broader policy-related activities, such as promoting regulatory and legislative changes. Overall, certified volunteer ombudsmen were satisfied with their role and with their training program. Satisfaction was, however, related to age, education, and length of time as an ombudsman. Younger, better-educated volunteers, and especially those with professional nursing and social work experience, who had been in the ombudsman role for a shorter length of time were less satisfied with the role and with the training, than the older volunteers without professional experience in health care. Volunteers who had left the program were not surveyed. Training for certified volunteer ombudsmen occurs at the local level and is based on a curriculum developed by the State Ombudsman's Office. In general, certified volunteer ombudsmen were satisfied with the curriculum. However, many preferred a centralized training program in Austin to the current localized approach. Certified volunteer ombudsmen identified lack of a clear line of authority and lack of power as the two greatest barriers to their effectiveness. This report contains 30 recommendations for improvement including legislative changes, training suggestions, communication issues, and recruitment, recognition, reimbursement, and retention of volunteers.