The Extension of Long-Term Care Ombudsman Advocacy to Home and Community Care Recipients

Most Americans receiving some form of long-term care (LTC) receive it from home and community settings rather than nursing facilities. Yet while federal legislation requires all states to have a Long-Term Care Ombudsman Program (LTCOP), which provides an advocacy mechanism for care recipients having complaints, the mandate applies only to nursing homes and assisted living facilities. In those settings, every resident is guaranteed access to an ombudsman who is trained to advocate for resolution of their complaints, which usually involve general care but can include matters in other categories such as dietary concerns, financial conflicts, abuse, and others.

Despite the federal mandate covering only residential facilities, some state programs have chosen to extend services to those receiving LTC in their homes and communities. This fact sheet provides an overview of state LTCOP policies and practices for home and community settings, highlighting those states that provide services to home care users. Read the full report.

Key Takeaways:

• Only a limited number of state Long-Term Care Ombudsman Programs (LTCOPs) have chosen to explicitly include home care in their work, with only 14 states and the District of Columbia having clear, public-facing language stating that their advocacy function includes home care.
• States that extend their LTCOP to home care have wide variation in complaints and resulting workload; Wisconsin reported just over 750 complaints in 2025, while Vermont reported only 25.
• Every state program can promote the highest quality of care across all settings by showing clear ombudsman support for home-care users. Federal, state, and local governments can help expand the ombudsman role by providing additional funding for the support of home care recipients.