Nursing Home Complaint? Meet Your Long-Term Care Ombudsman

These offices work with residents to address problems related to their health, safety, welfare and rights. If a resident, family member, representative, staff member or an ombudsman themselves is worried about a resident’s care, they can file a complaint with the office.

“Our bread and butter, what we do every day, is visit facilities, talk and meet with residents, get to know them, build trust and rapport with them, then gather information as to what their concerns are about,” says Patricia Hunter, Washington state’s long-term care ombudsman and president of the National Association of State Long-Term Care Ombudsman Programs (NASOP). With permission from the resident to act on a complaint, which can range from subpar food to claims of neglect and abuse, ombudsmen will investigate the issue and work to resolve it. Their services are free of charge and, if desired, confidential.

Around 1,600 paid full-time staff and 3,500 certified volunteers formed the National Long-Term Care Ombudsman Program in 2024. Becoming a certified ombudsman requires at least 36 hours of training, including at least 10 hours of field training, according to federal regulation, but some states and regions require more. While the program is largely funded by the federal government through the Administration for Community Living, the ombudsmen work explicitly for long-term care residents. “We don't have the trappings of big government agencies,” Hunter says. “We have independence, which is critical.”

In addressing complaints, “we're always going to try low-level problem-solving first,” Hunter says. “That might entail literally just a phone call or an email, or it might involve getting everyone together — the resident, their family member, nursing staff, physical therapist, whoever needs to be involved — to implement a plan going forward that is going to support the resident and their needs.”

If that doesn't work, or if a facility refuses to cooperate, or if a complaint is particularly egregious, ombudsmen can refer complaints to higher-level regulatory or enforcement agencies with permission from the resident. Ombudsmen lack enforcement power, but they can refer cases to the state's health department overseeing nursing home licensing, adult protective services, the police or the courts.

A struggle to bounce back after the pandemic, AARP finds

The COVID-19 pandemic wreaked havoc in America’s long-term care facilities, killing more than 170,000 residents in the first year alone, according to the COVID Tracking Project; deaths tied to these facilities accounted for 35 percent of all U.S. COVID-19 fatalities, even though less than 1 percent of population lived in them.

As long-term care residents, their families and staff were thrown into the chaos of the virus, so, too, were the long-term care ombudsmen. Barred from visiting facilities in person for infection-control concerns, they were left to investigate complaints and try to advocate for residents from afar — a “huge hurdle,” Mark Miller, past president of NASOP, said at the time.

As a result, routine visits by ombudsmen to facilities plummeted, AARP’s report shows. In the years before 2020, close to 30,000 long-term care facilities nationwide had routine quarterly visits from ombudsmen each year. This figure dropped to nearly zero in 2020 and hadn’t quite recovered by 2024, when roughly 27,000 facilities nationwide were back to regular programming.

The slow rebound is likely due to a huge reduction in the number of volunteer ombudsmen in the program, AARP found. The peak pandemic years accelerated an existing decline in volunteerism, which has since continued. As of 2024, there were only about 3,500 volunteer ombudsmen nationwide, roughly half the amount in 2016.

While the workforce has shrunk, the workload has not. Each year since 2016, the program has consistently received about 200,000 complaints nationwide and formally pursued about 120,000 of those by opening cases (excluding the peak years of the pandemic, when complaint and caseloads both dropped). In 2024, complaints reached a record high of about 205,000.

As a result, the number of long-term care beds each ombudsman is responsible for has ballooned over time, AARP found. Nationally, the ratio has jumped from roughly one ombudsman per 350 beds in 2016 to about one ombudsman per 600 beds in 2024. There's significant variation across the states; ombudsmen in the District of Columbia responsible for 114 beds each, while ombudsmen in Michigan handle more than 3,000 each.

In Tennessee, paid full-time ombudsman Melinda Lunday looks after about 175 long-term care facilities across 13 counties with just two other paid ombudsmen. Her days are long, and her work can be challenging, she told AARP, but seeing the impact she has on residents’ lives gives her the fuel to keep going.

“Every time I feel like I just can’t do it anymore, I’ll have a resident say, ‘You are my guardian angel,’ ” Lunday says. “These are people who have laid the foundation for our generation to build upon. You have to treat them with dignity and respect and also give them a good quality of life. They deserve it.” ​