2 Local Representatives Survey
Process Evaluation and Special Studies Related to the Long-Term Care Ombudsman Program
Local-Representatives-Survey
Local Directors/Regional Representaitves and Local Representatives
OMB: 0985-0055
Write In Your Start Time: __________________________
Process Evaluation of the Long-Term Care Ombudsman Program (LTCOP) – Local Representatives Survey
PURPOSE OF THE STUDY:
NORC at the University of Chicago, with funding from the Administration for Community Living/Administration on Aging (ACL/AoA) is conducting an evaluation of the Long-Term Care Ombudsman Program. This survey is voluntary and is not part of an audit or a compliance review. The information you provide is confidential. We do not include names of respondents in any reports or in any discussions with supervisors, colleagues, or ACL/AoA. This survey will take approximately 30 minutes to complete. Please complete and return this form using the pre-paid envelope, or by scanning and emailing it to _______, or fax it to: _____.
Please contact NORC at _____ or _____@norc.org if you have any questions or concerns about this survey.
Name of person completing survey __________________________
Position/Title __________________________
Phone number __________________________
Email address __________________________
SURVEY TOPICS:
Background Information
Structure and Resources
State and Local Coordination
Program Activities
Program Quality Assurance
Demographic Information
__________________________________________________________________________________
Burden Statement
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The survey will be sent to staff of local ombudsman programs. The average time required to complete the survey is estimated at 30 minutes. Send comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing this burden, to the _____. Do not send your completed form to this address.
BACKGROUND INFORMATION
We’d like to begin by asking you a few questions about your position and your experience prior to working for the Long-Term Care Ombudsman Program (LTCOP).
What is your current position with the LTCOP? __________________________________
How long have you been working with the LTCOP in your current position?
{enter number years} ___ ___
+ {enter number months} ___ ___
How long have you worked with the Ombudsman program overall?
{enter number years} ___ ___
+ {enter number months} ___ ___
In what state does your program operate? __________
Do you work full-time or part-time for the LTCOP?
1
Full-time
2
Part-time
Do you share your time with any other program or entity (such as an Area Agency on Aging)?
1
Yes,
I work part-time for another agency or within the same agency (This
includes those who are full-time employees but who only dedicate part
of their time to the LTCOP.)
2
No
(Skip to Q9)
What percentage of your time do you spend on the LTCOP?
{enter %} ___ ___
What other programs do you spend your time on?
___________________________________________________________________________
____________________________________________________________________________
What motivated you to work for the LTCOP? {Check all that apply}
1
Personal
fulfillment (e.g., enjoyment in helping others)
2
Career
development
3
Interest
in the program’s mission
4
Family/relatives
received long-term services and supports
5 Personal experience with the program
9
6 Other
(Please specify): ______________________
What was your job immediately prior to working at the LTCOP?
______________________________________________________________________________
Have you held previous positions in the LTCOP?
1
Yes
If Yes, please describe: ________________________________________________________
____________________________________________________________________________
-
No
Had you ever interacted with the LTCOP or any other ombudsman program (as a client, facility staff member, etc.) before being hired?
1
Yes
2
No
STRUCTURE AND RESOURCES
Next, we’d like to discuss the organizational structure and resources of your local LTCOP.
Which of the following characterizes the structure of your program?
1
My
state has local programs that are created through contract (or
another arrangement such as an MOU) with an Area Agency on Aging
(AAA) or other entity.
2
My
state has a centralized structure where we do not have separate local
programs. (Skip to Q4)
9
7 Don’t
know
2. On average, how often do you personally interact with representatives from the Office of the State LTCO (state office staff)? This interaction may take any form (i.e., communication in person, by phone, or by email).
1
Daily
2
Several
times a week
3
Once
a week
4
Twice
a month
5
Once
a month
9
6 Other
(Please specify): ________________________
-
Not
applicable (I work in the State office.)
3. Overall, how would you describe the relationship between the Office of the State LTCO and your local Ombudsman entity (program)?
1
Very
effective
2
Somewhat
effective
3
Neutral
4
Somewhat
ineffective
5
Very
ineffective
9
7 Don’t
know
9
8 Not
applicable (My program does not have local Ombudsman entities.)
4. In the last year, on which of the following topics did your Office of the State LTCO provide you with training and technical assistance? {Check all that apply}
1
Case
guidance
2
Legislation
3
State
mandates and regulations
4
Legal
advice or consultation
5
Outreach
to consumers and stakeholders
6
LTCOP
fiscal/budget information
7
LTCOP
policies and procedures
8
Trends
in long-term care that impact the program (e.g., growing aging
populations, nursing home use of psychotropic medication, etc.)
9
NORS
reporting
1
0 Systems
advocacy
9
6 Other
(Please specify): _____________________________
9
8 Not
applicable (My program does not have local Ombudsman entities.)
5. Overall, how would you describe the effectiveness of your Office of the State LTCO?
1
Very
effective
2
Somewhat
effective
3
Neutral
4
Somewhat
ineffective
5
Very
ineffective
-
Don’t
know
6. How often do you interact with volunteers?
1
Daily
2
Weekly
3
Every
other week
4
Monthly
9
6 Other
(Please specify): ________________________
9
8 Not
applicable
Are lines of authority and accountability clearly defined for your role?
1
Yes
2
No
If No, please describe: ________________________________________________________
Program Resources
Legal Counsel
Does your local ombudsman program have dedicated legal counsel for technical representation and support on issues?
1
Yes
2
No
(Skip to Q10)
-
Don’t
know
Where does your local program get legal counsel for technical representation and support on issues? {Check all that apply}
1
Legal
services attorney
2
Agency/department
attorney
3
Private
attorney
9
6 Other
(Please specify): _______________________
9
7 Don’t
know
Does your local ombudsman program have dedicated legal counsel for legal representation?
1
Yes
2
No
(Skip to Q12)
-
Don’t
know
Where does your local program get legal counsel for legal representation? {Check all that apply}
1
Legal
services attorney
2
Agency/department
attorney
3
Private
attorney
9
6 Other
(Please specify): _______________________
9
7 Don’t
know
Where does your program refer residents for legal representation (e.g., related to a complaint)? {Check all that apply}
1
Attorney
General’s office
2
LTCOP
employed in-house attorney(s)
3
State
Unit on Aging has in-house attorney(s) assigned to serve residents on
behalf of the LTCOP
4
Contracts
or other arrangements with private attorneys
5
Legal
assistance developer
6
Legal
services agencies (including those funded by Title IIIB legal
assistance programs)
9
6 Other
(Please specify): _______________________
9
7 Don’t
know
9
8 Not
applicable
Have you ever requested and not been able to obtain timely legal assistance?
1
Yes
If Yes, what was the nature of the legal issue for which you were requesting assistance?
_______________________________________________________________________________
_______________________________________________________________________________
2
No
9
8 Not
applicable
Overall, how effective is the legal assistance your program receives?
1
Very
effective
2
Somewhat
effective
3
Neutral
4
Somewhat
ineffective
5
Very
ineffective
9
7 Don’t
know
STATE AND LOCAL LEVEL COORDINATION
Next, we’d like to understand your program’s relationship with other organizations.
Below is a list of entities that have responsibilities relevant to the health, safety, well-being or rights of residents of long-term care facilities. For each one, please indicate if you work on a regular basis with that entity and then indicate the purpose of that interaction. {Please check “Yes,” “No,” or “Don’t know” in all four columns for each item}
|
Regular Interaction? |
Purpose? |
|||
|
|
Individual Resident Advocacy |
Systems Advocacy |
Education/ Outreach |
Other |
|
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
|
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
|
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
|
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
|
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
|
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
|
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
|
1 2 9 |
1 2 9 |
1 2 9 |
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|
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
|
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
1 2 9 |
Overall, does the nature of your relationship with the following entities enable you to meet resident and program needs?
Yes
No
Not Applicable
Area Agency on Aging
1
2
98
Aging and Disability Resource Center
1
2
98
Adult Protective Services
1
2
98
Protection and Advocacy Systems
1
2
98
Facility and long-term care provider licensure and certification program
1
2
98
State Medicaid fraud control
1
2
98
Victim assistance programs (for people who have been victimized by a crime such as rape, assault, financial exploitation, etc.)
1
2
98
State and local law enforcement agencies
1
2
98
Courts
1
2
98
State legal assistance developer and legal assistance/legal aid programs
1
2
98
Do you work with any of the following entities not listed above? {Check all that apply.}
1
Managed
Care Organizations (MCOs)
2
Quality
Improvement Organizations (QIOs)
3
Centers
for Independent Living
4
Senior
Medicare Patrol (SMP)
5
Consumer
Advocacy Groups
6
Physician
Groups
7
Veterans
Administration – State
8
Veterans
Administration – Federal
9
6 Other
(Please specify): __________
Does your program work with any of the following local level or state level work groups? {Check all that apply.}
1
Culture
change coalitions
2
WINGS
(guardianship groups)
3
Elder
abuse task forces
4
Ethics
committees
5
LANEs
(Advancing Excellence in Nursing Homes)
9
6 Other
(Please specify): __________
Overall how would you describe the effectiveness of your relationship with the following types of facilities and providers?
|
A majority of the relationships are effective |
Some of the relationships are effective |
A few of the relationships are effective |
None of the relationships are effective |
Not Applicable |
|
1
|
2
|
3
|
4
|
98
|
|
1
|
2
|
3
|
4
|
98
|
*Board and care homes and similar facilities include residential care facilities, adult congregate living facilities, assisted living facilities, foster care homes, and other adult care homes similar to a nursing facility or board and care home which provide room, board, and personal care services to a primarily older residential population.
Please describe the factors that went into your response above. ______________________________________________________________________________________________________________________________________________________________
Does your program have the authority to serve consumers of in-home services?
1
Yes
2
No
(Skip to next section on “Program Activities.”)
Overall, how would you describe the effectiveness of your relationship with in-home service providers?
|
A majority of the relationships are effective |
Some of the relationships are effective |
A few of the relationships are effective |
None of the relationships are effective |
Not Applicable |
|
1
|
2
|
3
|
4
|
98
|
Please describe the factors that went into your response above. ______________________________________________________________________________________________________________________________________________________________
PROGRAM ACTIVITIES
Next we’d like to explore the role you play in your LTCOP and the activities that you carry out.
In your role, which of the following program management functions do you perform? {Check all that apply}
1
Program
administration
2
Data
management, including entry, quality control, reporting, etc.
3
Data
collection, including documenting activities and cases/complaints
4
Analysis
of trends and sharing findings, such as with Office of State LTCO or
sharing of facility information with surveyors prior to survey, etc.
5
Developing
partnerships
6
Providing
staff training
9
6 Other
(Please specify): _____________________________
9
8 Not
applicable
Do you personally handle, investigate or resolve complaints or assist representatives with complaints?
1
Yes
-
No
(Skip to Q9)
What types of complaints do you handle?
1
I
handle all types of complaints.
-
I
handle only some types of complaints.
Please describe the types of complaints that you handle:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
How do you handle complaints? {Check all that apply}
1
I
handle complaints on my own.
2
I
support other program staff as they handle complaints.
3
I
consult with other program staff, as needed.
4
I
refer the complaint to the appropriate entity when I have resident
consent.
-
Other
(Please specify):
___________________________________________________
Do you investigate and work to resolve complaints of abuse, gross neglect and/or exploitation?
1
Yes
-
No
(Skip to Q9)
Does your program use a standard method/procedure for conducting investigations into abuse/neglect/financial exploitation?
1
Yes
-
No
(Skip to Q9)
Which of the following steps are included in the complaint investigation protocol your program uses for conducting investigations into abuse/neglect/financial exploitation? {Check all that apply}
1
Begin
the investigation within a certain time frame (i.e., standard of
promptness for beginning an investigation)
2
Assure
that the resident’s perspective, wishes and goals are
identified, including protection from abuse, neglect, and
exploitation when this is the goal
3
If
the resident was not the person making the complaint, meet with the
resident to advise that a concern has been raised
4
Secure
consent from resident or resident’s representative to conduct
investigation
5
The
resident or resident’s representative consent is documented
6
Determine
the wishes of the resident (or resident representative, where
applicable) with respect to resolution of the complaint
7
Advise
the resident of the resident’s rights
8
a The
identity of the complainant is kept confidential and not disclosed
without consent
8
b The
identity of the resident(s) at issue is not disclosed without consent
9
Observe
location in which the event(s) were alleged to have occurred
1
0 Interview
other people who may have knowledge or information relevant for the
investigation. (This could include facility staff and managers, family members, legal representatives of the resident, resident’s roommate, therapists, medical providers, etc.)
1
1 Review
relevant resident records maintained by the facility
1
2 Review
other documentation (not maintained by the facility such as banking
activity or a Will) relevant to investigation
1
3 Interview
alleged perpetrator(s)
1
4 Consult
with the supervisor in the LTCO program on investigation and
resolution strategies
1
5 Consult
with legal counsel, as needed
1
6 Make
appropriate referrals for complaint resolution when the resident (or
resident representative) consents to such disclosure
1
7 Complete
investigation within a certain number of days (i.e., standard of
promptness for completion of investigation)
1
8 Write
up an investigation report that documents your investigation steps
and impressions
of what happened. Include whether the alleged abuse/neglect/exploitation complaint is verified for not.
1
9a When
investigation is complete, communicate the investigation findings to
the complainant and/or resident (or resident’s representative).
1
9b Document
these communications.
2
0 Complete
resolution within a certain number of days (i.e., standard of
promptness for completion of resolution).
2
1 Check
with the resident (or resident’s representative) to determine
whether the issue was resolved to the resident’s satisfaction.
2
2 Make
a follow-up contact to the resident (or resident’s
representative) to determine whether the issue continues to be
resolved.
9
6 Are
there other items included in your investigation plan?
_______________________________________________________________
______________________________________________________________________
______________________________________________________________________
How are you assigned to visit facilities? {Check all that apply}
-
I am assigned to a
specific facility or group of facilities to visit, based on
geography.
1
I
am assigned to a specific facility or group of facilities to visit,
based on facility characteristic(s) (e.g., size, ownership).
3
I
am assigned to visit facilities in response to information about
facility problems and resident complaints.
-
Other
(Please specify): ____________________________
Nursing home visits
Do you personally visit nursing homes?
-
Yes
2
No
(Skip to Q19)
What type of nursing home visit do you conduct? {Check all that apply}
1
Visit
on a routine basis (not complaint driven)
2
Visit
in response to facility problems and resident complaints
9
6 Other
(Please specify): ___________________________
How many nursing homes do you typically visit in a quarter?
{enter number} ___ ___
How often do you typically visit nursing homes?
1
Weekly
2
Less
than weekly but at least once a month
3
Less
than monthly but at least once every quarter
4
Twice
a year
5
Once
a year
9
6 Other
(Please specify): _____________
For each routine visit (non-complaint), on average how much time do you spend at the nursing home facility?
1
Less
than an hour
2
Between
1 to 2 hours
3
Between
1 to 3 hours
4
More
than 3 hours
9
8 Not
applicable (I do not conduct routine visits.)
Please indicate the category of complaint that a) you are most effective at resolving, b) you find most challenging to resolve, and c) takes up most of your time with regard to nursing homes. {Select one in each column.}
Most effective at resolving
Most challenging to resolve
Takes up most of your time
Resident’s Rights
Abuse, gross neglect, exploitation
1
2
3
Access to information by resident or resident’s representative
1
2
3
Admission, transfer, discharge, eviction
1
2
3
Autonomy, choice, preference, exercise of rights, privacy
1
2
3
Financial, property (except for financial exploitation)
1
2
3
Resident Care
Care
1
2
3
Rehabilitation or maintenance of function
1
2
3
Restraints – chemical and physical
1
2
3
Quality of Life
Activities and social services
1
2
3
Dietary
1
2
3
Environment
1
2
3
Administration
Policies, procedures, attitudes, resources
1
2
3
Staffing
1
2
3
Not Against Facility
Certification/Licensing Agency
1
2
3
State Medicaid Agency
1
2
3
System/Others
1
2
3
How frequently do you experience problems in accessing residents in nursing homes?
1
Often
2
Sometimes
3
Rarely
4
Never
How frequently do you experience problems with unannounced visits to nursing homes?
1
Often
2
Sometimes
3
Rarely
4
Never
How frequently do you experience problems in obtaining timely access to resident records in nursing homes?
1
Often
2
Sometimes
3
Rarely
4
Never
Board and care home visits
Next, we have questions about board and care homes. Board and care homes and similar facilities include residential care facilities, adult congregate living facilities, assisted living facilities, foster care homes, and other adult care homes similar to a nursing facility or board and care home which provide room, board, and personal care services to a primarily older residential population.
Do you personally visit board and care homes?
1
Yes
-
No
(Skip to Q28)
What type of board and care home visit do you conduct? {Check all that apply}
1
Visit
on a routine basis (not complaint driven)
2
Visit
in response to facility problems and resident complaints
9
6 Other
(Please specify): ___________________________
How many board and care homes do you typically visit in a quarter?
{enter number} ___ ___
How often do you typically visit board and care homes?
1
Weekly
2
Less
than weekly but at least once a month
3
Less
than monthly but at least once every quarter
4
Twice
a year
5
Once
a year
-
Other
(Please specify): _____________
For each routine visit (non-complaint), on average how much time do you spend at the board and care home facility?
1
Less
than an hour
2
Between
1 to 2 hours
3
Between
1 to 3 hours
-
More
than 3 hours
3
Not
applicable (I do not conduct routine visits.)
Please indicate which category of complaint that a) you are most effective at resolving, b) you find most challenging to resolve, and c) takes up most of your time with regard to board and care homes? {Select one in each column.}
Most effective at resolving
Most challenging to resolve
Takes up most of your time
Resident’s Rights
Abuse, gross neglect, exploitation
1
2
3
Access to information by resident or resident’s representative
1
2
3
Admission, transfer, discharge, eviction
1
2
3
Autonomy, choice, preference, exercise of rights, privacy
1
2
3
Financial, property (except for financial exploitation)
1
2
3
Resident Care
Care
1
2
3
Rehabilitation or maintenance of function
1
2
3
Restraints – chemical and physical
1
2
3
Quality of Life
Activities and social services
1
2
3
Dietary
1
2
3
Environment
1
2
3
Administration
Policies, procedures, attitudes, resources
1
2
3
Staffing
1
2
3
Not Against Facility
Certification/Licensing Agency
1
2
3
State Medicaid Agency
1
2
3
System/Others
1
2
3
How frequently do you experience problems in getting access to residents in board and care homes?
1
Often
2
Sometimes
3
Rarely
4
Never
How frequently do you experience problems with unannounced visits to board and care homes?
1
Often
2
Sometimes
3
Rarely
4
Never
How frequently do you experience problems in obtaining timely access to resident records in board and care homes?
1
Often
2
Sometimes
3
Rarely
4
Never
Program Strengths and Challenges
Are there any areas for which your program has specific expertise? {Check all that apply}
1
Providing
advocacy in board and care facilities
2
Elder
abuse (e.g., task forces, staff training/in services)
3
Culture
change (e.g., person-centered service planning, dementia-competent
care, etc.)
4
Assisting
residents in transitioning out of facilities
5
Providing
support during bankruptcy proceedings
6
Providing
medication advocacy
7
Supporting
residents re: End of life care (e.g., advance directives, access to
hospice services, facility practices when someone dies)
8
Supporting
residents re: Managing family conflicts, power of attorney
9
Supporting
residents re: Involuntary discharge/transfers
1
0 Systems
advocacy
1
1 Developing
a volunteer program
9
6 Other
(Please specify): ______________________________
What challenges does your program face? {Check all that apply}
1
Insufficient
funding
2
Insufficient
program autonomy
3
Insufficient
legal counsel
4
High
turnover of paid staff
5
High
turnover of volunteers
6
Difficulty
hiring qualified paid staff
7
Difficulty
recruiting and supporting volunteers
8 Working with facility administrators
9
Working
with other organizations
1
0 Working
with resident councils
1
1 Working
with family councils
1
2 Working
with families
1
3 Offering
greater peer-to-peer support to share what works and what does not
1
4 Providing
more training in areas where I need to be knowledgeable
9
6 Other
(Please specify): __________________________________
Does your program have any difficulty serving any of the following populations? {Check all that apply}
1
People
who live in rural areas
2
People
who have disabilities including physical, intellectual,
developmental, mental
health, or communication disabilities
3
People
with cognitive limitations, such as Alzheimer’s, dementia, and
related diseases
4
People
who speak a language other than English
5
People
of diverse cultural backgrounds
6
People
from the lesbian, gay, bisexual, or transgender (LGBT) community
7
Veterans
8
Tribal
elders
9
6 Other
(Please specify): __________________________________
Which of the following experiences, skills, and characteristics/styles do you bring to your role as an ombudsman? {Check all that apply}
Experience
1
Training
caring for people who are ill, assisting older adults or working with
persons with
disabilities (e.g., as a doctor, nurse, health aide, social worker, etc.)
2
Familiarity
with the health care system
3
Case
work/client advocacy
4
Legal
training
5
Administrative
and/or volunteer management
9
6 Other
(Please specify): ________________________________
Skills
6
Conflict
resolution
7
Cultural
competence
8
Mediation
9
Social
skills (e.g., enjoy visiting with people, being a resource as a
problem solver)
1
0 Communication
skills
1
1 Investigative
skills
1
2 Speak
another language (including sign language)
9
6 Other
(Please specify): __________________________________
Characteristics/Style
1
3 Friendly
1
4 Collaborative
1
5 Diplomatic
1
6 Direct
1
7 Assertive
1
8 Persistent
9
6 Other
(Please specify): __________________________________
What are the most important systems advocacy issues for your program to address right now?
__________________________________________________________________________________
__________________________________________________________________________________
PROGRAM QUALITY ASSURANCE
In this section, we focus on aspects of the program that are designed to ensure that high quality services are delivered, and that staff receive the training and technical assistance they need to carry out their work.
Training and Support
What type of orientation, training, or support did you receive when you first joined the LTCOP? {Check all that apply}
1
Self-study
(on-line training or reviewing materials provided by state program)
2
Self-study
(on-line training or reviewing materials provided by the National
Ombudsman Resource Center)
3
In-person
classroom training
4
Mentoring/shadowing
with experienced staff
5
Training
in a long-term care facility
6
Attending
a resident or family council meeting
7
Introduction
to key stakeholders in my state
8
Outreach
by Federal or Regional ACL/AoA staff
9
Outreach
by State Ombudsmen from the National Association of State Long-Term
Care Ombudsman Programs (NASOP)
1
0 Training
by legal counsel
1
1 None
9
6 Other
(Please specify): ___________________________
How effective was the orientation training you received in preparing you for your role?
1
Very
effective
2
Somewhat
effective
3
Neutral
4
Somewhat
ineffective
5
Very
ineffective
9
7 Don’t
know
What aspect of your training did you find most relevant for doing your job?
__________________________________________________________________________________
__________________________________________________________________________________
Is there training that you did not receive during your orientation period that you think would have been helpful when you began in this role?
1
Yes
If yes, please describe: ___________________________________________________________
2
No
What type of ongoing training and support do you receive? {Check all that apply}
1
2
Informal
support from other staff or representatives of your office
2
Guidance
from other local or regional ombudsman offices
3
Guidance
from staff in the state ombudsman office
4
Online
training such as webinars or conference calls on special topics
5
a Office
of State LTCO provides training (via conferences, web-based training,
etc.)
5
b Office
of State LTCO provides relevant information and support
6
Support
from National Ombudsman Resource Center (NORC)
7
Support
from National Association of Local Long-Term Care Ombudsmen (NALLTCO)
8
Support
from other state or local agencies
9
Conferences
(e.g., Consumer Voice Conference)
9
6 Other
(Please specify): ___________________________
What additional support would you like from state or local program staff? {Check all that apply}
1
More
information from program staff
2
More
opportunities to discuss challenges (managing volunteers, case
consultation and resolution strategies, etc.) with supervisor
3
More
professional development opportunities
4
More
opportunities to discuss challenges with other ombudsmen
5
More
feedback on my performance and effectiveness
6
More
formal training (Please specify): ___________________________
How frequently do you receive performance reviews?
1
Semi-annually
2
Annually
96 Other
(Please specify): __________
Data Systems & Information Technology
Does your program provide training and assistance on documenting cases, complaints and other Ombudsman program activities? If so, are you expected to submit formal reports?
1
Yes
2 No
97 Don’t
know
How frequently do you submit reports?
1
Weekly
2 Monthly
3 Quarterly
9
6 Other
(Please specify): ____________
Does your program provide you with a form for submitting reports?
1 Y
es
If Yes, please specify the format: _____________________________________
2 No
Does your program offer a way to submit reports online?
1
Yes
2 No
9
7 Don’t
know
12. How would you characterize the ease of collecting data and submitting reports?
1
Easy
2
Somewhat
easy
3 Somewhat
difficult
-
Difficult
13. Does your program use NORS data for any of the following purposes? {Check all that apply}
-
Program planning
1
Program
improvement
3
Examining
trends for determining advocacy issues to focus on
4
Identifying
issues of concern as well as promising practices
5
Comparing
my program’s performance against programs in other states
6
Advocacy
purposes (e.g., present data to the Governor’s office,
legislature, state officials and other stakeholders to convey the
scope and depth of problems in the long-term care system)
-
Don’t
know
14. What security strategies are in place to protect resident-identifying and complaint-identifying information?
__________________________________________________________________________________
__________________________________________________________________________________
National, State and Local Resources
A number of resources are available to enhance the skills, knowledge and management capacity of program staff. How helpful have the following resources been to you?
Very helpful
Somewhat helpful
Not helpful
Not applicable
Not familiar with this resource
Website (ltcombudsman.org)
1
2
3
98
9
Area Agency on Aging (AAA)
1
2
3
98
9
State Unit on Aging (SUA)
1
2
3
98
9
Office of the State LTCO
1
2
3
98
9
National Association of Local Long-Term Care Ombudsmen (NALLTCO)
1
2
3
98
9
National Ombudsmen Resource Center (NORC)
1
2
3
98
9
National Association of State Long-Term Care Ombudsman Programs (NASOP)
1
2
3
98
9
National Association of States United for Aging and Disabilities (NASUAD)
1
2
3
98
9
Administration for Community Living (ACL)
1
2
3
98
9
Other (Please specify):
_______________________
1
2
3
98
How often have you used the various resources available through the National Ombudsman Resource Center (NORC)?
|
Often |
Sometimes |
Rarely |
Never |
Support not available |
Not familiar with this resource |
|
1
|
2
|
3
|
4
|
5
|
9
|
|
1
|
2
|
3
|
4
|
5
|
9
|
|
1
|
2
|
3
|
4
|
5
|
9
|
|
1
|
2
|
3
|
4
|
5
|
9
|
|
1
|
2
|
3
|
4
|
5
|
9
|
|
1
|
2
|
3
|
4
|
5
|
9
|
|
1
|
2
|
3
|
4
|
5
|
9
|
|
1
|
2
|
3
|
4
|
5
|
9
|
_______________________ |
1
|
2
|
3
|
4
|
5
|
|
17. Where do you go for information and resources to stay informed about developments in long-term care that may impact program practices?
1
Area
Agencies on Aging (AAAs)
2
State
Unit on Aging (SUA)
3 State
Long-Term Care Ombudsman
4 National
Association of Local Long-Term Care Ombudsmen (NALLTCO)
5
National
Ombudsman Resource Center (NORC)
6 National
Consumer Voice for Quality Long-Term Care
7 Administration
for Community Living/Administration on Aging (ACL/AoA)
-
Other
(Please specify): ______________________________________________
18. How satisfied are you with your job at the LTCOP?
1
Very
satisfied
2 Somewhat
satisfied
3 Neutral
4
Somewhat
unsatisfied
-
Very
unsatisfied
19. To what do you attribute your satisfaction/dissatisfaction?
__________________________________________________________________________________
__________________________________________________________________________________
What can be done to make your program more effective? What improvements would you make?
__________________________________________________________________________________
__________________________________________________________________________________
Is there any topic or issue you expected us to cover that we have not brought up yet? Please describe the issue(s) and explain why you think it is/they are important.
__________________________________________________________________________________
__________________________________________________________________________________
DEMOGRAPHIC INFORMATION
The next several questions collect information about your characteristics, such as age, race, and education.
In what year were you born? __________
2. How do you identify your race? {Check all that apply}
1
American
Indian or Alaska Native
2
Asian
3
Black
or African American
4
Native
Hawaiian or Other Pacific Islander
5
White
-
Other
(Please specify): __________________________
3. Are you of Hispanic or Latino origin?
1
Yes
-
No
4. With what gender category do you identify?
1
Female
-
Male
5. What is the highest grade or year you completed in school?
1
Less
than high school or GED
2
High
school or GED
3
College
coursework but not degree (may include community college coursework)
4
Associate’s
degree
5
Bachelor’s
degree
6
Some
graduate work
7
Master’s
degree
8
Juris
Doctorate
9
Doctor
of Philosophy
1
0 Medical
Degree
Thank you for your
participation!
Please send your
completed form to NORC using the enclosed postage paid envelope.
You may also return the
completed survey by faxing it to:
_____
| File Type | application/msword |
| Author | mumford-elizabeth |
| Last Modified By | Windows User |
| File Modified | 2016-12-16 |
| File Created | 2016-12-16 |
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