Lesson 1: Introduction This lesson provides basic information about the purpose, history and unique aspects of Florida's Long-Term Care Ombudsman Program.

What Makes the Long-Term Care Ombudsman Program Unique?

Compared to other services and programs in the aging and disability networks, the Ombudsman program is unique in many ways. There is often misunderstanding, confusion, and even tension when ombudsman interact with others who do not understand the program. Therefore, it is important to have a clear understanding about the role and unique characteristics of the program.

The Long-Term Care Ombudsman Program Does not work in the best interest of the resident

Best interest is subjective and based on individual thoughts, experiences, morals, values, etc. It is a personal determination about what is beneficial for someone else. The program does not determine what is best for residents, nor does it make decisions for the resident. Rather the program supports and advocates on behalf of the resident's wishes.

This approach may conflict with the perspective of long-term care facility staff, medical professional, family members, and others as they might feel that resident-directed advocacy is not in the best interest of the resident on specific issues. An example of a common situation: The facility refuses to honor Mary's choice in meals and snacks claiming it is in her best interest to follow a low-sugar diet since Mary has a diagnosis of diabetes. However, Mary understands the potential risks of not following a low-sugar diet and has the right to choose what to eat.

Long-Term Care Ombudsman Programs are Not Mandatory Reporters

More specifically, representatives are not allowed to report suspected abuse, neglect, or exploitation of a resident without permission to do so. Permission can only be granted by the resident, the resident representative if the resident is unable to communicate informed consent, or the State Ombudsman under special circumstances. This mandate may cause tension between the LTCOP and others not familiar with the program. As a representative, it is important to talk to the resident about their situation and the consequences of reporting or not reporting the alleged abuse, including any fears of retaliation. Educating the resident allows for the resident to make an informed decision. Why aren't we mandated reporters? Ombudsman and representatives are required to act on behalf of a resident per the resident's wishes and direction. Reporting without resident permission discredits the integrity of the program and harms the ombudsman-resident relationship.

The Long-Term Care Ombudsman program works towards resident satisfaction

The resident's perception is used to determine whether the problem has been resolved. The LTCOP determines resolution of the concern based on the resident's satisfaction of the outcome. In some situations, reporting the complaint to the facility or to the state agency (AHCA) responsible for investigating long-term care facilities may not satisfactorily resolve the resident's concern when the problem continues after the report has been made.

Learn more about the LTCOP in Long-Term Care Ombudsman Program What You Must Know and in Long-Term Care Ombudsman FAQ

Conflicts of Interest

The ombudsman program has a mandate to focus on the individual resident. If the ombudsman finds him or herself in a conflict of interest situation (whether it is a conflict of loyalty, commitment, or control), the resident, even more than the program, may suffer. The resident's problem may not be resolved, certain avenues of resolution may be foreclosed, the resident's voice may not be heard by policymakers, and the resident's interests will be inadequately represented or altogether absent from the table at which public policy is made.

The following definitions of conflict of interest include insertions to illustrate how the definitions may apply to the Long-Term Care Ombudsman program.

• Situation where a party's [ombudsman's] responsibility to a second party [employer or another program] limits its ability to discharge its responsibility to a third party [resident].
• a conflict between the private interests and the official responsibilities of a person [ombudsman] in a position of trust.

The Ombudsman program's most important asset is its independence, which is crucial to the program's success in advocating for residents. Key to this independence is freedom from conflicts of interest. An actual conflict of interest, or even the appearance of a conflict of interest, can seriously impact the effectiveness and credibility of the program as an independent advocate.

Three conflict-of-interest situations are described below to provide additional context to perceived or actual conflicts.

• Conflicts of Loyalty: These involve issues of judgment and objectivity and are typical situations almost everyone understands - financial and employment considerations. A representative's ability to be fair and act as a resident advocate might be questioned if the representative also is a consultant to a facility, a board member of a facility or management company, or work as a case manager with responsibility for assisting individuals with moving into long-term care facilities. Loyalty may also be an issue if the representative of the Office is assigned to a facility where the representative was previously employed.
• Conflicts of Commitment: These are issues of time and attention. Toward which goals or obligations does one direct one's efforts - i.e., one's time and energies? Concerns about the adequacy of resources come into play because pressures to do more occur when available resources are limited.
• Conflicts of Control: These are issues of independence. Do other interests, priorities, or obligations of the agency that houses the program materially interfere with the advocacy of the Ombudsman and/or representative on behalf of residents? Do administrative or political forces materially interfere with the professional judgment of the Ombudsman or representative? Is the Ombudsman or representative able to act responsibly without fear or retaliation by superiors? Learn more about conflicts of interest and the Long-Term Care Ombudsman program. Florida Statute 400.0070 Conflicts of interest.