The Impact of Long-Term Care Ombudsman Presence on Nursing Home Survey Deficiencies

Objectives: Each year states are required to survey nursing homes (NHs), including issuing deficiency citations when regulatory standards are not met. These deficiency citations can have substantial consequences for NHs. Because it is imperative that the survey process is conducted consistently across facilities, this study aims to determine whether deficiency outcomes vary with the presence of a long-term care ombudsman at the survey. Design: A retrospective secondary data analysis of facility-level data using panel regression techniques was used to determine whether the presence of an ombudsman at a survey affected deficiency outcomes. Additional analysis assured the results were not due to ombudsmen being more likely to be present at poorer performing facilities. Setting and participants: The data include freestanding NHs in the United States with at least 2 surveys between 2009 and 2015, resulting in 95,237 surveys from 14,996 unique NHs. Measures: The number and deficiency score were analyzed for 4 types of deficiencies: all deficiencies and the broad categories of quality of care, quality of life, and administration. The key explanatory variable is the presence of an ombudsman at survey. The regression model controlled for other important facility-level covariates. Results: The presence of an ombudsman varied across states (range: 0.8%–82.0%; mean: 29.9%). Regression analysis found ombudsman presence was associated with a 0.2 increase in the number of deficiencies and 2.2-point increase in deficiency score. These correspond to a 3.9% and 5.9% increase, respectively. On a percentage basis, the largest effects were found for quality of life and administration deficiencies. Conclusions/Implications: By being present at surveys, ombudsmen may bring issues to the attention of state surveyors, resulting in worse deficiency outcomes during annual surveys. This can have consequences for NHs, and further work is needed to assure that ombudsmen are using their resources where they are most needed.