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August 3, 2010

Assembly Member Mariko Yamada, Chair

Assembly Committee on Aging and Long-Term Care
1020 N Street, Room 360
Sacramento, CA 95814

RE: Oversight Hearing: The Long-Term Care Ombudsman Program – Protecting the
Protectors of California’s Most Vulnerable Adults

Dear Assembly Member Yamada:

On behalf of CISO – Committee for an Independent State Office, we want to thank you for holding
today’s hearing on the predicament of California’s long-term care ombudsman program, and want
to give our recommendation for an independent state office structure that would safeguard and
strengthen the ombudsman program.

In January 2009, the Committee for an Independent State Ombudsman Office (CISO), made up of
ombudsman program coordinators, advisors, and stakeholders, was created with the sole purpose of
working toward the development of an independent state office.

When the local Ombudsman programs – the actual providers of direct service to long term care
seniors - lost half of their funding in 2008, it was overwhelmingly clear how this would dreadfully
impact the lives of some of our most compromised and vulnerable citizens.
When asked for help and intervention from the State Long-Term Care Ombudsman (OSLTCO), the
local ombudsman coordinators were informed that the OSLTCO could not intervene or advocate for
restoration of funding due to their status as state employees, or in the case of our State Ombudsman,
and the Director of the California Department of Aging (CDA), governor appointees.

In order to preserve the ombudsman programs and build them to an effective service level, it is
crucial that the OSLTCO is free to take action, and speak out on legislation that affects the
wellbeing of elderly persons in long term care, and without real or perceived barriers, work on
behalf of the local programs that protect and support the vulnerable and dependent seniors in long
term care.

A second crucial reason to have an independent voice at the state level is that the leader will have
the freedom and power to fulfill all the other mandates. One such mandate that will bring immense
value to residents in long term care is that an independent state ombudsman will have the freedom
to speak out and up for residents in long term care regarding any matter that may affect them. This
could be legislation, or any other issue that might affect their quality of life. The impact of this kind
of advocacy would be vastly beneficial to our seniors, and most likely what the federal government
had in mind when they authorized it in the Older American’s Act. Title VII, Chapter 2, §712 (a)(5)
(iv) “Represent the interests of residents before government agencies and seek administrative,
legal, and other remedies to protect the health, safety, welfare, and rights of the residents.”

The concept of an independent state ombudsman office is not new. Placing the Ombudsman
program outside state government is exactly what the Institute of Medicine recommended as the
most conflict free and effective model for the Ombudsman Program. Many states, seeing the value
of such a model to long term care residents, no longer house the Ombudsman program within state
government. The findings from the two year research project on the New York and California
Ombudsman Program, which was conducted by Carroll Estes PhD, Institute for Health & Aging,
UC San Francisco, named creating an independent state ombudsman office as one of the three main
priorities for the California Ombudsman Program. In 2010, the California Senior Legislature has
made an independent state ombudsman office as a top priority.

There is now a mountain of research and evidence that specifically speaks to the conflicts of interest
and impropriety of housing the state ombudsman office within a state unit on aging.

Our recommendation is that the state ombudsman office, so that it may operate at its maximum
potential as a truly independent and effective voice for residents, be housed in an eligible not for
profit organization that operates through a contractual agreement with the state. Colorado and
Washington are just two of several states that have emerged as successful role models of such an

On behalf of the members and advisors to CISO, thank you for considering our recommendation.

Sylvia Taylor Stein,

CISO Team Leader
Cc: CISO Committee & Advisors
Clift Wilson, Manager, Program Services, Ombudsman & HICAP Services of Northern California
Eric M. Carlson, Director, Long Term Care Project, National Senior Citizens Law Center
Jackie McGrath, State Public Policy Director, Alzheimer’s Association of California
Joan Parks, Administrator, Ombudsman & HICAP Services of Northern California
Karen Jones, Ombudsman Program Coord., Long Term Care Ombudsman Svcs., San Luis Obispo
Kathleen Johnson, Executive Director, Advocacy Inc., Santa Cruz County
Linda Robinson, Ombudsman Program Coordinator, Advocacy Inc., Santa Cruz County
Michael Connors, Advocate, California Advocates for Nursing Home Reform
Molly Davies, Program Director, WISE & Healthy Services, Los Angeles
Nina Weiler Harwell, PhD, Associate State Director-Advocacy (Interim), AARP
Sylvia Taylor Stein, Executive Director, Long Term Care Services of Ventura County, Inc.,
Tippy Irwin, Executive Director, Ombudsman Services of San Mateo County, Inc.,
Carroll Estes, PhD, Professor & Founding Director, Institute for Health & Aging, UC San Francisco
Brooke Hollister, PhD, Assist. Professor, Dept. of Social & Behavioral Sciences, Institute for
Health & Aging, UC San Francisco