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Adequacy of Resources
Pages 185-204

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From page 185...
... Some states fall short in not having expanded to board and care (B&C) homes, other states do not have adequate cycles of visiting all LTC facilities, some states operate fragmented programs and individual advocacy efforts that have no link to preventive or educational system efforts, and still others lack appropriate access to legal services.
From page 186...
... staff) , others relate to the processes and activities of the program (paid staff per numbers of LTC beds)
From page 187...
... , arid the seven lowest-rar~ked [scores 1 1-133~. In addition, the table shows the total nursing home and B&C beds, dollar expenditure per LTC bed for FY 1993, and ratio of FTE paid staffing to beds.
From page 188...
... (FY 1993 $) LTC Beds Highest-Ranked States Massachusetts 27 58,509 2,000,321 34.19 1:1,950 District of Columbia 27 4,966 244,767 49.29 1:1,655 California 25 269,149 6,007,226 22.32 1:1,759 Michigan 23 95,052 892,311 9.39 1 :4,526 Oregon 23 27,744 349,378 12.59 1 :9,248 New Mexico 23 9,397 278,740 29.66 1:1,342 Middle-Raniced States Connecticut 19 33,294 769,273 23.11 1 :3,329 Maryland 19 32,766 186,631 5.70 1:1,927 West Virginia 19 12,778 431,356 33.76 1:1,420 Rhode Island 19 11,147 89,814 8.06 1:11,147 South Dakota 19 8,955 107,830 12.04 1:128 Vermont 19 5,845 224,829 38.47 1:1,169 Wyoming 19 4,127 171,404 41.53 1:1,032 Lowest-Raniced States Pennsylvania 13 133,002 1,752,924 13.18 1 :4,290 South Carolina 13 24,449 146,224 5.98 1:4,890 Nebraska 13 24,181 90,497 3.74 1 :24,181 Indiana 12 68,582 403,712 5.89 1 :5,276 Iowa 12 42,286 205,496 4.86 1 :5,286 Hawaii 12 6,047 101,571 16.80 1 :3,024 Kansas 11 29,358 195,880 6.67 1 :7,340 NOTE: States are listed in order by OIG index score and then number of LTC beds (nursing home and B&C beds)
From page 189...
... Some regard staff as a form of"resources," but as the acquisition and deployment of paid staff or even of unpaid volunteers presupposes adequate financing, staffing levels are regarded here as a structural measure of program quality or performance. Financial support to the states and their localities for their ombudsman activities is available through several channels: the federal funds that flow to the states, state "matching" funds, state general revenues that may exceed funds used as matching funds, local host agency matching funds, and other monies raised at the state or local level through various fund-raising activities in public and private sectors.
From page 190...
... 190 REAL PEOPLE, REAL PROBLEMS TABLE 6.2 Summary of Total Funding for the State Long-Tenn Care Ombudsman Programs by State, FY 1993 State Federala State Otherb Total Alabama $155,791 $12,461 $190,707 $358,959 Alaska 107,743 107,743 Arizona 110,465 116,000 226,465 Arkansas 375,181 12,497 387,678 California 2,245,032 2,019,256 1,742,938 6,007,226 Colorado 455,360 26,222 43,896 525,478 Connecticut 204,605 559,559 5,109 769,273 Delaware 148,081 33,441 181,522 District of Columbia 116,789 127,978 244,767 Florida 872,150 19,733 470,045 1,361,928 Georgia 776,251 401,385 63,708 1,241,344 Hawaii 54,943 46,628 101,571 Idaho 312,182 24,653 336,835 Illinois 1,274,897 342,950 1,617,847 Indiana 348,821 13,372 41,519 403,712 Iowa 205,496 205,496 Kansas 167,023 28,857 195,880 Kentucky 485,798 110,125 191,713 787,636 Louisiana 570,240 90,910 98,607 759,757 Maine 75,291 48,465 3,246 127,002 Maryland 186,631 186,631 Massachusetts 1,903,341 97,980 2,001,321 Michigan 235,138 448,167 209,006 892,311 Minnesota 664,721 152,149 193,115 1,009,985 Mississippi 403,205 29,147 30,525 462,877 Missouri 509,346 107,322 153,818 770,486 Montana 67,147 8,050 75,197 Nebraska 80,962 9,535 90,497 Nevada 78,937 52,068 131,005 New Hampshire 207,768 50,358 258,126 New Jersey 136,069 797,945 934,014 New Mexico 189,231 76,042 13,467 278,740 New York 2,231,708 215,163 242,918 2,689,789 North Carolina 818,390 105,091 82,669 1,006,150 North Dakota 61,088 61,088 Ohio 1,396,036 484,286 618,044 2,498,366
From page 191...
... funding.2 The majority of states used funding from all three 2States vary in their interpretation of what constitutes state and other nonfederal funding for the ombudsman program, and thus some variation among states in expenditures reported to AoA may in fact be influenced more by interpretation of terminology than actual resources expended.
From page 192...
... As discussed elsewhere, data are not available to produce these types of ratios. Thus, the committee has elected to make some judgments about this question on the basis of a resource-related ratio—FTE paid staff to LTC beds.
From page 193...
... The committee recommends that by fiscal year 1998 Congress increase the appropriations through Title VII, Chapter 2 of the Older Americans Act for the state long-term care ombudsman programs to an amount that ensures that all state Offices of the Long-Term Care Ombudsman program are funded at a level that would permit them to perform their current functions adequately. The committee further recommends that the factor of 1 full-time equivalent paid staff working as an authorized, designated ombudsman per 2,000 long-term care beds be used as a base indicator of performance and a unit of effort to determine the amount of additional resources needed.
From page 194...
... The available data, however, does not indicate that a straightforward relationship exists between staffing relative to LTC beds and the fulfillment of the duties of the ombudsman program. No complete, verified data are available on the exact numbers of FTE paid staff associated with each state's ombudsman program.
From page 195...
... Thus, it calculated that, on average, national spending per FTE staff might be said to approximate $43,240. Using this figure, then, to calculate needed program funding levels to reach its goal of 1 FTE staff to 2,000 LTC beds (assuming no increase in beds beyond the nearly 2,334,000 nursing facility and B&C beds now in use and assuming for purposes of this discussion that all resources currently supporting the program were redistributed across the states)
From page 196...
... However, increases to ensure an adequate Finding level for every state should be directed expressly to the ombudsman program in appropriations through Title VII-2, and federal fiscal policy should continue to require SUAs and AAAs to maintain the level of expenditures for the ombudsman programs achieved in FY 1991. The potential shift of some OAA appropriations in Title III-B to Title VII-2 deserves to be revisited in the future.
From page 197...
... Arguably, the states with the greatest need for basic program funding will be those least likely to muster adequate public sector revenues within their own borders and, possibly, also least likely to be able to raise nonfederal, private sector funding. To the extent that "equity" for all elderly persons residing in LTC facilities across the nation demands a basic minimum of ombudsman program funding, the committee argues that baseline support should come from federal sources in a manner calculated to reflect more correctly the true level of need for ombudsman services in all states.
From page 198...
... At present state monetary matching is not required for federal dollars appropriated under Title VII of the OAA, as it is under Title III-B. This is a major inconsistency even within this single program, and one that may permit states to avoid giving the program its intended level of support, in particular if increases are made in federal appropriations through Title VII, Chapter 2, as is recommended by the committee.
From page 199...
... 6.4. The committee recommends that the Assistant Secretary for Aging issue program guidance to states that stresses the importance of delegating to the Office of the State Long-Term Care Ombudsman responsibility for managing all the human and fiscal resources earmarked for the state ombudsman program within the boundaries of what is permitted by state budget policy and procedures and required by federal mandates for compliance.
From page 200...
... , the committee recognizes that contracting and host agencies may need to use ombudsman program funds to offset some administrative costs. For the most part, according to information available, local host agencies tend to provide additional resources to the ombudsman programs rather than to take action that makes money flow in the opposite direction.
From page 201...
... -- ran -- I Vat The real responsibilities lie in managing the complaint-response task while undertaking both (a) to empower elderly LTC residents to look after their own concerns and (b)
From page 202...
... Its analysis included a review of such factors as the numbers of FTE paid staff per numbers of LTC beds, peer nominations of successful programs, and visibility. Through triangulating on data from several sources, the committee arrived at the conclusion that resources are not adequate for each state LTC ombudsman program to perform at a level that ensures compliance with even the basic, decade-old mandates of the OAA ombudsman program.
From page 203...
... Finally, the committee cautions Congress against adding responsibilities to the LTC ombudsman programs without providing additional appropriations.


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