What Is a Healthcare Ombudsman? Illinois Guide for Facilities

An ombudsman is an independent, impartial official who investigates complaints, facilitates communication, mediates negotiations, and makes quality improvement recommendations. In healthcare, ombudsmen often support patients by advocating for higher care quality and better living conditions. If you’re a facility leader, you’re probably curious about the role of your state’s health ombudsman.

Illinois’ unique ombudsman program provides oversight of skilled nursing facilities (SNFs), assisted living facilities (ALFs), and other long-term care (LTC) facilities in the state. In this article, we’ll provide an overview on the role of an Illinois health ombudsman, describe the types of individuals they work with, and outline tips for facilities looking to navigate the ombudsman process effectively.

What Is the Illinois Ombudsman Program?

All states are required to build a patient advocacy program that assists long-term care facility residents in accessing safe and appropriate care. Illinois has developed its Long-Term Care Ombudsman Program to serve patients living in facilities across the state. The program enables patients to report incidents of substandard treatment and request care improvements to improve their quality of life.

The Illinois LTCOP is supported by federal and state laws, including the Older Americans Act and the Illinois Act on the Aging. In addition to providing patient advocacy services, health ombudsmen perform regularly scheduled facility visits to monitor conditions and identify areas for improvement.

In these circumstances, the ombudsman acts as an unbiased third party and intervenes on the patient’s behalf. They work to represent and empower residents with limited family support or diagnoses that inhibit their ability to speak for themselves.

What Does an Illinois State Ombudsman Do?

The Long-Term Care Ombudsman Program outlines a wide range of responsibilities that fall on the ombudsman. Illinois representatives don’t provide direct patient care, but instead serve patients by:

• Encouraging long-term care facility residents to speak up about their concerns.
• Investigating resident complaints and working to resolve issues within each facility.
• Educating residents about their rights, available support services, alternative care facility options, and community resources.
• Advocating for advancements in care quality to local, state, and federal government officials.
• Protecting patient privacy and confidentiality when completing advocacy duties.

Who Can Partner With a Healthcare Ombudsman?

Illinois state ombudsmen address complaints and concerns from a number of parties, including:

• Current, former, or prospective residents of an LTC facility.
• Relatives and friends of those living in an LTC facility.
• Facility staff and administrators who have concerns about resident care.
• Families or individuals exploring care facility options.
• Community groups focused on improving resident wellness.

Once an ombudsman receives a complaint or identifies an issue during a site visit, they’ll conduct a thorough investigation to uncover additional information. Then, they’ll collaborate with your facility to develop an outcome that works for everybody. It’s important to note that ombudsmen aren’t authorized to issue fines or pursue legal action, but instead offer recommendations and explore solutions with residents and government agencies.

How Can I Contact an Illinois Ombudsman?

Curious how to connect with your representative? The state’s ombudsman office encourages families, patients, and facility staff to reach out with any questions or concerns using the contact information listed below.

Tips for Facilities Working With a State Ombudsman

Illinois’ ombudsman program can be challenging to navigate. If you’re new to the state, you might be looking for some advice on how to best work with these patient advocates. The following tips can help you get the most out of ombudsman site visits to make the experience more positive for everyone .

• Cooperate: Comply fully with the ombudsman’s requests for information or facility access as they carry out an investigation. They may ask to interview staff and residents or review documents like incident reports and medical records. Be forthright in sharing what they need.
• Respect: Maintain clear and respectful communication throughout the process. All parties have the patient’s best interests in mind. Keeping that at the forefront of your interactions can help the process go smoothly.
• Act: If the ombudsman identifies areas of improvement, be sure to take appropriate action to address them. Be ready to work with the ombudsman to implement any necessary changes and submit any required plans of correction.

As a healthcare leader, your actions will influence how facility staff, patients, and other involved parties perceive the situation. Focus on improving the wellbeing of your residents and welcome any constructive feedback about how to provide the best care possible. As you lead by example, you’ll help your organization navigate the situation with integrity and confidence.

Discover More Ways to Improve Care Quality

Now that we’ve covered the basics of a health ombudsman, Illinois facility leaders should be better positioned to establish meaningful relationships with these patient advocacy representatives. Our free IntelyCare newsletter is full of additional nursing industry insights that can help you navigate the healthcare world and lead your facility or residence with purpose.