0005 Supporting Statement LTCOP Final Aug 21

Supporting Statement for the State Annual
Long Term Care Ombudsman Report for FFY 2021-2023
A.

Justification
1. Circumstances Making the Collection of Information Necessary
The State Annual Long-Term Care Ombudsman Report is needed to:
• Comply with Administration for Community Living/Administration on Aging
(ACL/AoA) reporting requirements in the Older Americans Act (OAA); and 45
CFR 1324.21(b) (1) and (b)(2)(v)1
• Measure the services and strategies that are provided to assist residents in the
protection of their health, safety, welfare or rights
• Advocate at the state and federal levels for changes needed to improve the quality
of life and care in long-term care facilities; and
• Effectively manage the Long-Term Care Ombudsman Program at the state and
federal level.
The National Ombudsman Reporting System (NORS) was developed in response to these
needs and directives and was approved by the Office of Management and Budget for use
in FFY 1995-96. It has been extended for use since that time with slight modifications.
The most recent modification was approved on February 1, 2017 for FFY 2016-2020 to
include organizational conflict of interest reporting as required by the 2016
reauthorization of the Older Americans Act and the LTC Ombudsman program rule 45
CFR 1324.21. This current request is to acquire approval for a revised modification of
instructions and data collection elements for FFY 2019-2021.
The proposed templates, definitions, reporting tips (Tables 1-3) are attached and posted
at: https://www.acl.gov/about-acl/public-input
Section 712(c) of the OAA requires the state agency to establish a statewide uniform
reporting system to:
(1) Collect and analyze data relating to resident complaints and conditions in longterm care facilities for the purpose of identifying and resolving significant problems.

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The Ombudsman shall identify organizational conflicts of interest in the Ombudsman program and describe steps
taken to remove or remedy conflicts within the annual report submitted to the Assistant Secretary through the
National Ombudsman Reporting System. Assure that the Ombudsman has disclosed such conflicts and described
steps taken to remove or remedy conflicts within the annual report submitted to the Assistant Secretary through the
National Ombudsman Reporting System.

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and
(2) Submit the data on a regular basis to the state licensing/certifying agency, other
state and federal entities that the Ombudsman determines to be appropriate, the
Assistant Secretary for Aging, and the National Long-Term Care Ombudsman
Resource Center.
Section 712(h)(1) requires the state agency to require the Office of the State Long-Term
Care Ombudsman to prepare an annual report describing the activities carried out by the
Ombudsman office in the year for which the report is prepared. The report is to contain :
•

The data and an analysis of the data collected under Section 712(c);

•

Evaluation of the problems experienced by, and the complaints made by or on
behalf of, residents;

•

recommendations for improving the quality of the care and lives of the residents;
and protecting the health, safety, welfare, and rights of the residents;

•

Analysis of the success of the program, including success in providing services to
residents of board and care facilities and other similar adult care facilities;

•

Identification of barriers that prevent the optimal operation of the program; and

•

Policy, regulatory, and legislative recommendations to solve identified problems,
to resolve the complaints, to improve the quality of care and life of residents, to
protect the health, safety, welfare, and rights of residents, and to remove barriers.

Section 712(h)(2) also requires the Ombudsman to analyze and comment on the
development and implementation of Federal, State, and local laws, regulations, and other
government policies and actions that pertain to long-term care facilities and services and
to the health, safety, welfare, and rights of residents in the State, and recommend any
changes in such laws, regulations, and policies as the Office determines to be appropriate.
Section 712(h)(3)(A) requires the state agency to ensure that the Office of the
Ombudsman provides such information as the Office determines to be necessary to public
and private agencies, legislators, and other persons, regarding the problems and concerns
of older individuals residing in long-term care facilities, and recommendations related to
the problems and concerns.
Section 712(h)(B) requires the state agency to require the Office of the Ombudsman to
make the annual report available to the public, and submit it to the Assistant Secretary for
Aging, the chief executive officer of the State, the State legislature, the State agency
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responsible for licensing or certifying long-term care facilities, and other appropriate
governmental entities.
Older Americans Act – Ombudsman Reporting Requirements for ACL
Title II of the OAA requires the Assistant Secretary for Aging to compile an annual
national Ombudsman report. The report must:
•

Summarize and analyze the data collected by the states under Section 712(c) and
(h) for the most recently concluded fiscal year;

•

Identify significant problems and issues revealed by such data (with special
emphasis on problems relating to quality of care and residents' rights);

•

Discuss current issues concerning the Long-Term Care Ombudsman programs of
the states; and

•

Make recommendations regarding legislation and administrative actions to
resolve such problems.

The Assistant Secretary is required to submit the report to the congressional committees
of jurisdiction for the OAA and to the Administrator of the Centers for Medicare &
Medicaid Services, the Office of the Inspector General of the Department of Health and
Human Services, the Office of Civil Rights of the Department of Health and Human
Services, the Secretary of the Department of Veterans Affairs, and agencies which house
the state Ombudsman office.
Consultation with State and Local Ombudsman programs and State Agencies on
Aging
From the beginning of the NORS development and redesign, ACL has worked with state
and local Ombudsman programs to develop and improve the reporting system. ACL staff
and the National Ombudsman Resource Center continue to provide training and technical
assistance on the NORS definitions, codes and effective uses of data.
A notice was published in the March 10, 2021 Federal Register, Vol. 86, No. 45,
announcing that ACL was requesting comments on proposed revisions to the NORS
template and instructions directing readers to the ACL website where these documents
are posted, and providing an opportunity for public comment.

2. Purpose and Use of Information Collection

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The information will be provided to the legislative and executive branch officials cited in
the OAA, state directors on aging, state Ombudsmen, national organizations involved in
residential long-term care issues, and private citizens who request it. Data sets will be
posted on the Aging Integrated Database (AGID) and the National Ombudsman Resource
Center’s website.
Information from the national reports issued to date has been used:
•

by ACL to advocate within the Department on specific issues affecting persons
living in long-term care facility settings, for monitoring purposes and to identify
areas where technical assistance and program direction to the states are indicated,
and to prepare planning and reporting documents, including budgets;

•

by ACL, the states and local Ombudsman programs to determine program
objectives and outcome measures and to assist the state and local programs to use
their data to develop their own objectives, targets and outcomes;

•

by state and local Ombudsman programs to determine problems that residents in
their state and other states are experiencing and to plan systems advocacy
activities, training, technical assistance and public education programs to address
these problems; and

•

by other agencies, researchers and the general public in all manner of inquiry
related to residential long-term services and supports.

3. Use of Improved Information Technology and Burden Reduction
Improved Technology: The NORS Reporting tool, part of the ACL “Older Americans
Act Performance System,” (OAAPS ) employs modern methodologies for data
submission, which are efficient, effective, and improve data quality. These methodologies
reduce the burden on the states and ACL in collecting this essential data.
States have upload templates, which allows a streamlined ability to upload data and
prevent data entry errors. The OAAPS has set business rules and restrictions, such as
amount, order, boundaries and relationship which enables state IT staff and vendors to
prepare the data for submission with assurance that the basic file structure is correct.
The Case and Complaint components (Tables 1 & 2) are non-identifiable data that
describes complaint investigation services provided by the State Ombudsman program
during the reporting period (federal fiscal year.)
Once the Case Component file is ready, the state uploads the file through the OAAPS
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secured website. Automatically, additional validation is conducted by the system and the
state receives electronic validation and summary data reports. The state can review the
results, determine if corrections are needed, and upload a corrected file until satisfied.
When ready, the state submits the file to ACL for final validation that includes human
review. The online validation lessens the number of resubmissions and th e burden on the
state and ACL. State Ombudsmen reported that in their first year of using the new
OAAPS that the submission, review of variance and other data quality checks was much
improved over the previous system.
The State Program Component sections (Table 3) includes such things as, narratives,
funds expended data, program activities, number of facilities and beds, etc. This data can
be manually entered or provided through an upload file. The NORS reporting tool
instantly validates the data to identify errors and allow states to correct the errors before
submitting them to ACL. The reporting tool displays helpful instructions for each data
element as it is entered. This helps to improve the consistency and accuracy of the
answers. It provides immediate feedback before the file is submitted to ACL; thus,
lessening the number of resubmissions.
States can begin entering the data, save it, and return to complete the data multiple times.
When satisfied with the data and having passed all validation checks, the state submits it
to ACL. For archival purposes, a state may download their data in Excel format. The final
report is securely saved and only accessible through the OAAPS website by the
submitting state and ACL. The data from the previous reporting period is accessible to
the same online form for the next reporting period, making them easily updatable (when
appropriate, such as with organizational conflicts of interest) from the prior year, thereby
reducing the level of effort in subsequent years.
4. Efforts to Identify Duplication and Use of Similar Information
All information in the Ombudsman report is unique to the Ombudsman Program.
Although the number of nursing facilities certified by Medicare and Medicaid is available
from the Centers for Medicare & Medicaid Services, states may also have licensed only
nursing homes. Therefore, NORS requires Ombudsman programs to report a count of all
nursing homes and beds licensed or certified in their state. While sporadic studies have
provided estimates on the number of residential care community 2 facilities and beds, the
annual ACL Ombudsman report provides the only consistent national data on the number
of nursing homes and beds classified as residential care communities.
ACL/AoA collects data from states’ adult protective services (APS) agencies. The
National Adult Maltreatment Reporting System (NAMRS) addresses the requirements of
the Elder Justice Act of 2009, which amended title XX of the Social Security Act
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Previously called “Board and Care, Assisted living and similar facilities”

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(42.U.S.C. 13976 et seq.) and requires that the Secretary of the U.S. Department of
Health and Human Services “collects and disseminates data annually relating to the
abuse, exploitation, and neglect of elders” (Sec. 2041 (a)(1)(B) and “conducts research
related to the provision of adult protective services” (Sec. 2041 (a)(1)(D).
NAMRS differs in several ways from NORS. NAMRS collects data on investigations by
APS agencies into allegations of abuse, neglect, or exploitation of older persons and
adults with disabilities, regardless of residence type. The state programs that respond and
collect NAMRS data are different from state Ombudsman programs. NORS collects
complaint data concerning the health, safety, welfare and rights of residents in long term
care facilities, which includes complaints related to abuse, neglect and exploitation, but is
not limited to those types of issues. NORS also collects other information relevant to the
Ombudsman program, such as providing facility visits, instances of information and
assistance, participation in surveys, etc. The definitions in NAMRS have been closely
aligned with definitions in NORS, wherever applicable. No duplication of effort will
result from the revised NORS data collection.
5. Impact on Small Businesses or Other Small Entities
No small businesses or other small entities will be involved in this study.
6. Consequences of Collecting the Information Less Frequently
If collection were less frequent than annual, neither the states nor ACL would be able to
meet reporting requirements in the OAA; and both advocacy and program management
functions dependent on the information in the NORS would suffer from lack of current
data.
7. Special Circumstances Relating to the Guidelines of 5 CFR 1320.5
None of the listed circumstances apply to this submission.
8. Comments in Response to the Federal Register Notice/Outside Consultation
A notice was published in the Federal Register on March 10, 2021 (86 FR 13720). There
were four public comments received during the 60-day FRN, please see ACLs response to
comments listed below. A 30-day notice published in the Federal Register on July 29, 2021
(86 FR 40848).
Readers were directed to the ACL website where the documents were posted and
provided an opportunity for public comment. ACL received comments from four
individuals and groups: the National Association of State Ombudsman Programs
(NASOP); the Maryland State Ombudsman, the Iowa state Ombudsman program and an
assistant professor in Family Medicine & Gerontology.
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Globally, there was not significant comment on the data elements to be collected, but
rather on ways to enhance the quality, utility, and clarity of the information to be
collected. These comments were very helpful and ACL adopted some of the proposed
edits and language suggestions.

Two of the four respondents (Maryland Ombudsman program and the National
Association of State Ombudsman Programs (NASOP)) recommended adding a new
complaint code “infection control.”
Response: ACL agrees to add one complaint code “infection control” and corresponding
definition, examples and reporting tips. The Iowa Ombudsman program recommended
adding clarifying information to the Code I05 (Housekeeping) to be inclusive of infection
control, ACL will incorporate its suggestion into the new “Infection con trol” code.
Two of the four respondents (Maryland Ombudsman program and NASOP)
recommended changes to the “examples and reporting tips” under complaint code J01.
Response: ACL agrees to modify the “examples and reporting tips” on Complaint Code
J01 “Administrative oversight” to incorporate problems with a facility planning and
responding to an emergency.
ACL received the following comments and did not accept them for inclusion in NORS.
The Maryland Ombudsman proposed adding more detail and examples in the description
fields in the following cells: S02, S06, S08, S09, S12.1, and S13 stating that this would
give the State Ombudsman more guidance on how to approach the narratives and to help
ensure greater consistency across the country.
Response: ACL in coordination with ACL’s grantee, the National Ombudsman Resource
Center (NORC) created in-depth training and training manuals on all aspects of NORS
reporting, including examples of narratives for both complaint examples and systems
issues and does not believe that additional guidance is necessary. See
https://ltcombudsman.org/omb_support/nors
The Maryland Ombudsman program also recommended the addition of a new complaint
code in Facility Policies, Procedures and Practices (Code J) for emergency planning
complaints. The Maryland Ombudsman program noted that there have been many
instances of facilities needing to temporarily or permanently relocate residents for a
variety of reasons from disasters to lack of appropriate staff in the building, facility
closure, or the facility did not have an appropriate plan or did not have a plan at all.
Response: ACL will not add a new complaint code, but will modify complaint code J01
“Administrative Oversight” to be inclusive of emergency planning.
One recommendation was to include the addition of a county field (e.g., Federal
Information Processing Standard code). The commenter noted that although looking at
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differences/variation between states is important and valuable, having the ability to look
at differences/variation within each state would be immensely beneficial for the conduct
of ACL’s functions and would allow for analytics to be shared with state ombudsmen and
other programs nationwide.
Response: ACL does not accept this recommendation because of the level of burden
necessary to gather and report this level of data.
NASOP made recommendations to broaden the types of activities reported on systems
issues work performed by the State Long-Term Ombudsman, the Office and local
Ombudsman entities. NASOP asserts that this reporting element would provide needed
depth and clarity about whether a State Long-Term Care Ombudsman has the necessary
independence and resources to perform systems advocacy as required by the Older
Americans Act. NASOP proposes that data collected as narrative examples of Systems
Issues is insufficient and does not have practical utility without additional data collection
to explain the scope of a state’s work on systems advocacy. “By only collecting two
examples of a systems issue from each state, ACL has no objective means of determining
a state’s compliance with the Act nor the independence of the Office. With our proposed
addition data collection in Table 3, ACL will collect and provide the public with a more
accurate picture of whether a state program is fulfilling the requirements of the Act.”
Response: ACL does not agree with NASOP’s assessment of the current data collection
on systems advocacy for several reasons. First, the FY 2020 data is not yet final and
ACL has not been able to share systems advocacy data. Additionally, while NORS is one
part of measuring program effectiveness it is not the only way that ACL determines
compliance with the Older Americans Act. ACL provides continuous technical assistance
on matters of compliance, conducted in-depth review of states compliance with the
Ombudsman program regulation, and worked with states to develop compliance plans.
ACL also has an on-going project to evaluate the effectiveness of the Ombudsman
program and has gathered in-depth data on both state and local level Ombudsman
program’s ability to conduct systemic advocacy. See https://acl.gov/programs/programevaluations-and-reports. In addition, the proposed data collection would be very
burdensome on state and local programs to collect and report because the two
recommended data elements include a sub-set of 10 possible elements to select and to
keep track of the number of instances of each sub-set ultimately resulting in 20 new data
elements. This type of data would not add meaningful information that would benefit
ACL considering the level of effort required of states to train on this type of data
collection, adapt software and report.

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9. Explanation of any Payment/Gift to Respondents
Not applicable.
10. Assurance of Confidentiality Provided to Respondents
Individuals are not identified in the report and, since no individual is identified in the data
collection process, no assurance of confidentiality will be needed. Ombudsman data
collection programs are designed to guarantee the confidentiality of residents and
complainants, which are requirements of the Ombudsman federal rule at 1324.11(e)(3)
and the Ombudsman provisions of the OAA.
11. Justification for Sensitive Questions
The data collection instruments will not collect any data of a sensitive nature.
12. Estimates of Annualized Burden Hours (Total Hours & Costs)
12A. Estimated Annualized Burden Hours
The hour burden is based on the number of cases managed by the nationwide Long-Term
Care Ombudsman Program (LTCOP), consisting of the 50 states plus the District of
Columbia and Puerto Rico, in the most recent year for which data is available. Closed
cases reported by the 52 state Ombudsman programs for FFY 2019 was 123,815. Based
on average time required by early pilot states to document a case by computer (10
minutes), total documentation time is calculated by multiplying total cases by 10 minutes,
totaling 1,238,630 minutes, divided by 60 = 20,644 hours of paid Ombudsman program
time. Previous estimates determined that about, about two-thirds of the information
entered for a typical case is for use at the state level and is not required for the ACL
report. However, based on state Ombudsman feedback, ACL assumes that half of the
estimate of 10 minutes is needed to document data needed for the ACL report.
Estimates on completion of other parts of the report are based on experiences from state
Ombudsman programs. For example, states estimate that they spend anywhere from 4
hours to 4 days checking and verifying data from the local programs and compiling their
annual report to AoA. Improved technology, which either allows for or requires the
uploading of data files will populate the case and complaint data and increase the
consistency and reliability of data, thereby reducing burden associated with manually
entering data. Thus, a fair estimate of the average burden for a state is 16 hours of staff
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time at the Office of the State Ombudsman.
The annual burden estimates are shown below.
Instrument

No. of
No.
Respondents Responses
per
Respondent

Average
Burden per
Response
(in hours)

Total Burden Hours

Annual State
Ombudsman
Report

52

214.5

11,153.9

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12B. Costs to Respondents
Type of
Respondent

Total
Burden
Hours

Local level
State Ombudsman Staff
Sub-total program cost
Benefits & overhead

198.50
16
198.5

Hourly
Wage Rate

Total Respondent Costs

$25.06
$36.13 3

Total State Program cost

$4974.37
$578.08
$5,552.45
$5,552.45
$11,104.90

13. Estimates of Other Total Annual Cost Burden to Respondents and Record
keepers/Capital Costs
There are no capital or other costs to respondents or record keepers.
14. Annualized Cost to Federal Government
The table below describes the annualized cost to the federal government. It is based on
the General Schedule Locality Pay Table for the Seattle, Washington area, which is the
location of the Ombudsman Program Specialist.
GS Grade/Step

Percent Time

GS 14-3

15%

Estimated Cost

$19,019.52

Contract Cost

$200,000

3 Based on the Bureau of Labor Statistics (BLS) mean hourly wage for Other Community and Social Service
Specialist for staff Ombudsmen (occupation code 21-1000) Social and Community Services Managers (occupation
code 11-9151) for State LTC Ombudsmen

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Training cost
Total

Annualized Cost
to Federal
Government

$1,500
$220,519.52

15. Explanation for Program Changes or Adjustments
There is a program change decrease of -475 annual burden hours.
16. Plans for Tabulation and Publication and Project Time Schedule
The highlights of the typical annual data collection schedule are as follows:
• September 30 - federal fiscal year closes
• Early October – training schedule and reminder of NORS reporting due
date sent to all states
• October – December training sessions provided
• January 31 final due date to submit report
• February –May data analysis and approval of reports
• June-August- data analysis.
• August –September – post data
ACL prepares reports, a fact sheet, and other information based on the data and posts the
data on https://agid.acl.gov/ The Aging, Independence and Disability Program Data
Portal (AGID) and on the National Ombudsman Resource Center (NORC) website.

17. Reason(s) Display of OMB Expiration Date is Inappropriate
The expiration date will be displayed on all of the data collection instructions and
instruments.
18. Exceptions to Certification for Paperwork Reduction Act Submissions
There are no exceptions to the certification statement.
B.
Collection of Information Employing Statistical Methods. If statistical
methods will not be used to select respondents and item 17 on Form 83 -I is checked
“No” use this section to describe data collection procedures.
These collections do not employ statistical methods. The Older Americans Act requires
all states to submit an annual Ombudsman report to ACL and ACL to submit an annual
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report to Congress and others.

Attachments:
Tables 1, 2, and 3 submission for approval

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