An ombudsman receives, investigates, and works to resolve complaints involving issues of quality. The long-term care ombudsman and the managed care ombudsman are especially helpful to older adults, and have separate roles. The role of each is discussed below.
Long-Term Care Ombudsman
Long-term care ombudsmen work to resolve complaints involving quality of care issues. They assist residents in exercising their rights and mediate concerns between residents and/or their families and the facility. They also provide residents and their families with information about government benefits and other agencies that may be of assistance. Long-term care ombudsmen help older adults living in:
- A long-term care facility
- Nursing home
- A board and care home
- Assisted living facility
- Participating in an adult care facility.
While residing in a long-term care facility, people have the right to:
- To be treated with consideration and respect
- To keep their medical and personal records private
- To manage their own finances
- Discuss their concerns or fears without feeling threatened
- To communicate and associate with people privately
- Not be chemically or physically restrained
- Seek state or federal assistance without discrimination
- Receive advance notice prior to transfer or discharge.
If you feel that these rights have been violated, a long-term care ombudsman can:
- Provide information about Long-Term Care Services,
- Identify, investigate and resolve complaints, representing residents before government agencies,
- Help pursue legal and other means to assure resident's rights,
- Advocate and be a source of knowledge about public policy related to laws and regulations related to the health, safety and rights of residents,
- Help create citizen organizations, resident and/or family councils who are interested in protecting the rights of Long-Term Care residents, and
- Educate you about issues and concerns related to Long-Term Care.
In Virginia, the Office of the State Long-Term Care Ombudsman is part of the Virginia Department for Aging and Rehabilitative Services (DARS) . The toll free number to assist persons who want to make a complaint or learn more about long-term care is 1-800-552-3402.
If you are not in Virginia, contact: The Eldercare Locator at 1-800-877-1116 and ask for the local ombudsman nearest the long-term care facility where the resident lives.
Managed Care Ombudsman
If you are a Virginia resident who has health insurance provided by a managed care health insurance plan such as a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO), you may need the help of a managed care ombudsman if you want to appeal a decision made by your managed care health insurance plan. A managed care ombudsman can help you:
- Understand your rights and how to appeal based on a particular Managed Health care Plan
- Find information about your Managed Health Care Plan
- Teach you how to advocate on your own behalf
- Tell you about laws (designed to protect citizens) governing activities of managed health insurance plans including mandatory benefits
- Find the right person to help you in your appeals process.
If you are a consumer, health care provider or other individual with a general question or have an inquiry regarding MCHIPs, managed care, health insurance or related subjects, you can contact the Office via the following:
- Toll free phone 1-877-310-6560, select option 1
- Fax (804) 371-9944
- Email firstname.lastname@example.org
- Office of Managed Care Ombudsman website
- Office of the Managed Care Ombudsman, Bureau of Insurance, P.O. Box 1157, Richmond, Virginia 23218