HJBR Sep/Oct 2025

HEALTHCARE JOURNAL OF BATON ROUGE I  SEP / OCT 2025 17 In today’s complex aging landscape, protecting dignity while delivering quality care isn’t just ideal — it’s essential. That’s why col- laboration between medical teams and long-term care ombudsmen is gaining recognition as a winning approach. Whether in a nurs- ing facility, assisted-living residence, or small group home, aligning clinical expertise with resident-directed advocacy not only prevents crises, it fosters communication, strengthens trust, and promotes outcomes that honor the whole person. A Legacy of Rights and Advocacy The roots of this collaboration can be traced to the Older Ameri- cans Act (OAA) of 1965, a landmark piece of legislation signed into law by President Lyndon B. Johnson as part of the Great Society ini- tiative. The OAA laid the foundation for the aging services network in the United States, establishing theAdministration onAging under what is now the Department of Health and Human Services and creating a coordinated system of support — includingAreaAgencies on Aging, nutrition programs, caregiver services, and legal assis- tance — for older Americans to live with independence and dignity. In 1972, the Long-TermCare Ombudsman Program began under the OAAas a demonstration effort to protect the rights of residents in nursing homes. In 1978, Congress amended the OAA to require every state, territory, and the District of Columbia to operate an inde- pendent ombudsman program. These programs assign trained staff and volunteers to advocate for residents in long-term care facilities, offering confidential complaint resolution, education, and support that centers the voice of the resident. Another milestone came in 1987 with the passage of the Nursing Home ReformAct, part of the Omnibus Budget Reconciliation Act of 1987 (OBRA ’87). This transformative law shifted long-term care from a custodial model to one focused on person-centered care. OBRA ’87 guaranteed residents specific rights — such as the right to participate in their care, to be treated with dignity, and to live free from abuse or unnecessary restraint — and it emphasized the impor- tance of meeting not only physical but also psychosocial needs. Together, the Older Americans Act and OBRA ’87 form the back- bone of a national commitment to resident rights, dignity, and well-being. They established the legal and ethical foundation for the Long-Term Care Ombudsman Program and created space for meaningful collaboration between ombudsmen and healthcare pro- viders. That collaboration continues today, built not only on shared values, but on a shared responsibility to ensure that older adults receive care that respects their wishes, protects their rights, and promotes their quality of life. What an Ombudsman Is and Isn’t The word “ombudsman” (pronounced OM-buds-man) may be unfamiliar, but the role is essential to understanding how advo- cacy and care intersect in long-term care settings. At its core, an ombudsman is an advocate for the resident, not for the facility, not for the family, and not for the state. Their allegiance is solely to the individual living in care. Unlike physicians, social workers, or state surveyors, ombuds- men are not part of the care team or regulatory structure. They do not make medical decisions or enforce facility policy. Instead, they follow a different compass: the resident’s expressed wishes. Ombudsmen act only when invited, and only in the manner the resident directs. Even when a concern is raised by staff or family, the ombudsman’s role remains rooted in what the resident wants, not what others believe is best. Ombudsmen serve people living in licensed long-term care set- tings, including nursing homes, assisted-living communities, adult residential care homes (ARCHs), and skilled nursing facilities (SNFs). While they do not provide services in private homes, they often help families with resources for finding a nursing home or assisted-living facility that best fits their or their families’ needs and preferences and understand their options for home- and community-based care, Medicaid waiver programs, and safe transitions out of insti- tutional care. Core Principles of the Ombudsman Program The ombudsman program operates from three core principles: • Confidentiality Above All: An ombudsman does not share a resident’s concerns or identity, even with family members, without the resident’s clear permission. This legal protection builds trust and reinforces the resident’s right to privacy. • Autonomy Is Sacred: Every step an ombudsman takes must be directed by the resident. Advocacy is never imposed. Even when others disagree or believe a resident is making a “bad choice,” the ombudsman defends the individual’s right to decide while ensuring that the resident is aware of the con- sequences of their choice and alternatives. • Education Is Empowerment: Ombudsmen inform residents, families, and staff about rights, regulations, and care options. Through education, they empower individuals to ask ques- tions, express concerns, and make informed choices. Even when staff invite an ombudsman to attend care plan meet- ings, they cannot and will not participate without the resident’s express consent. That boundary is both legal and ethical, and it sits at the heart of what makes ombudsman advocacy so distinctive: resident-directed, not system-directed. PART 1 The Medical Team/Ombudsman Collaboration: A Winning Approach to Older Adult Care