[Federal Register Volume 67, Number 40 (Thursday, February 28, 2002)]
[Pages 9279-9281]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-4800]



Administration on Aging

Agency Information Collection Activities: Proposed Submission to 
the Office of Management and Budget (OMB) for Clearance: Comment 
Request; Revision of Information Collection

AGENCY: Administration on Aging, HHS.
    The Administration of Aging (AoA), Department of Health and Human 
Services, is submitting the following proposal for the collection of 
information in compliance with the Paperwork Reduction Act (Pub. L. 96-
511): State Annual Long-Term Care Ombudsman Report and Instructions for 
Older Americans Act Title VII.
    Type of Request: Revision of a currently approved collection.
    Use: To continue an existing information collection, State Annual 
Long-Term Care Ombudsman Report (and Instructions), from Older 
Americans Act Title VII grantees. Under section 712(c), section 
712(h)(1) and section 712(h)(2)(B) of the Older Americans Act, as 
amended, states are required to provide information on ombudsman 
activities to AoA, which AoA is then required to present to Congress. 
The information on complaints and conditions in long-term care 
facilities and the ombudsman program is also used by the states, other 
federal agencies, researchers and consumer groups for a variety of 
    Frequency: Annually.
    Respondent: State Long-Term Care Ombudsman Programs.
    Estimated number of responses: 53.
    Estimated Burden Hours: Approximately 3 hours per state program.
    Additional Information or Comments: The reporting system, the 
National Ombudsman Reporting System (NORS), was developed in response 
to needs identified and directives in the Older Americans Act and 
approved by the Office of Management and Budget for use in FY 1995-96. 
It was twice extended, with slight modifications, for use through 
August 2004. Although the NORS is approved through August 2004, we are 
planning to revise the form and instructions for use by the states in 
FY 2003 (beginning October 2002), with the first report using the 
revised form due to AoA in January 2004.
    The proposed revisions, provided in the attached table, were 
developed by state and local ombudsmen and have been reviewed by all 
state ombudsmen. The revised NORS form, with instructions, and a 
proposed expenditure certification form are posted on the AoA Web site, 
    Written comments and recommendations for the proposed information 
collection should be sent by Internet or postal mail to the following 
address within 60 days of the publication of this notice, via e-mail to 
[email protected] or regular mail at the following address: 
Administration on Aging, ATTN: Sue Wheaton, Cohen Building, Room 4737, 
Washington, DC 20101.

Josefina G. Carbonell,
Assistant Secretary for Aging.

     Proposed Changes in National Ombudsman Reporting System (NORS)
                Current                          Proposed change
Cases, complainants and complaints by    No change.
 type of facility; action taken on the
 complaints; a summary of long-term
 care issues; a detailed profile of the
 program and its activities, including
 the number and type of facilities
 licensed and operating in the state
 (and the number beds this represents);
 a description of geographic program
 coverage, by type of facility; the
 staffing and funding of local
 programs; and an overview of other
 ombudsman activities (including:
 training, technical assistance,
 resident visitation, community
 education, and all other items in Part
 III F of the current form).
The current NORS instructions provide    Direction on which codes to use
 general guidance but no specific         for which types of problems is
 direction on how to code specific        provided in an attachment to
 complaints.                              the NORS instructions.
The current form has nine categories     Retain the same number of case
 for types of complainants (cases) and    and complaint fields currently
 133 categories for types of problems     in use and the alphabetical
 (complaints). The specific complaint     order within the major groups,
 categories are organized by major        but adjust the wording on some
 types of complaints (Residents Rights,   of the categories to capture
 Resident Care, etc.) and the specific    problems not specified in the
 categories are listed alphabetically     current complaint codes (see
 within each major group.                 italicized words in this
                                          column below). (If they wish,
                                          states may add additional
                                          categories in their own
                                          systems and ``fold'' these
                                          back into the NORS categories
                                          for the report to AoA.).

[[Page 9280]]

For cases and complaints, the current    Add ``ALF'' (for assisted
 form has a type of facility heading      living facility) and RCF
 which reads ``Board & Care (or           (residential care facility) to
 similar)''.                              the board and care case and
                                          complaint column heading so
                                          the heading reads: ``B&C, ALF,
                                          RCF, etc.,'' with a footnote
                                          explaining the types of
                                          facilities that are included.
                                          In response to an ombudsman
                                          recommendation, the footnote
                                          clarifies that complaints may
                                          be from unregulated as well as
                                          regulated facilities.
Complaint Category F. 40 reads           Change to ``Accidental or
 ``Accidents, improper handling''.        injury of unknown origin;
                                          falls; improper handling.''
Category 41 reads ``Call lights,         Change to ``Call lights,
 requests for assistance''.               response to requests for
Category F.47 reads ``Pressure sores''.  Change to ``Pressure sores, not
Category F.49 reads ``Toileting''......  Change to ``Toileting,
                                          incontinent care.''
Category P. 117 reads ``Abuse/           Change to ``Abuse/neglect/
 abandonment by family member/friend/     abandonment by family member/
 guardian or, while on visit out of       friend/guardian or, while on
 facility, any other person''.            visit out of facility, any
                                          other person.''
Category P. 121 reads ``Financial        Change to read: ``Financial
 exploitation by family or other not      exploitation or neglect by
 affiliated with facility''.              family or other not facility''
                                          and emphasize in the
                                          instructions this addition and
                                          how to use this complaint
Major Category Q. reads ``Complaints in  Strike ``Shelters'' from Q.132
 Other Than Nursing or Board and Care/    and use Q.132 to capture
 Similar Settings'' and Q. 132 reads      ``Services from outside
 ``Shelters''.                            provider'' (i.e., personal
                                          care, transportation or other
                                          service provided to a facility
                                          resident by an outside
                                          provider). Change the heading
                                          of Q to read ``Complaints
                                          About Services in Settings
                                          Other Than Long-Term Care
                                          Facilities or By Outside
                                          Provider'' and emphasize/
                                          clarify in the instructions
                                          how to use the new Q.132.
NORS instructions providegeneral         Emphasize in the NORS
 guidance but emphasis and increased      instructions that category A.6
 clarity are required on some items.      ``Resident-to-resident
                                          physical or sexual abuse'' is
                                          for willful abuse of one
                                          resident by another resident,
                                          not for unintentional harm or
                                          altercations between residents
                                          who require staff supervision,
                                          which should be coded in
                                          category I.66. (For example, a
                                          confused resident who strikes
                                          out is categorized at I.66 and
                                          an alert resident who strikes
                                          out is A.6.)
                                         Add to the instructions that
                                          resident requests for
                                          assistance in moving out of
                                          the facility should be coded
                                          under P. (System/Others) 128
Part I E.2.(a) under ``Disposition''     Change the verb tense so it
 reads (number of complaints) ``for       reads ``for which government
 which government policy or regulatory    policy or regulatory change or
 change or legislative action was         legislative action is required
 required to resolve * * *''.             to resolve * * *''.
                                         For Part III F. ``Other
                                          Ombudsman Activities,'' item
                                          6, the instructions define
                                          more prominently and
                                          specifically that resident
                                          visitation on a ``regular
                                          basis'' means no less
                                          frequently than quarterly.
                                          (Note: ``Regular visitation''
                                          is not a federal ombudsman
                                          program requirement, but it is
                                          an activity in the NORS which
                                          requires definition.)
                                         The instructions clarify Part
                                          III F.7., ``Participation in
                                          Facility Surveys,'' means
                                          participating in any aspect of
                                          both regular surveys and
                                          surveys held in response to
                                          complaints. This may include
                                          conferring with the
                                          certification agency prior to
                                          or following a survey. It is
                                          not limited to actually going
                                          with the team on the survey.
                                         The instructions emphasize that
                                          under Part I A and B, a
                                          ``case'' means ``opening of a
                                          case file and includes
                                          ombudsman investigation, fact
                                          gathering, setting of
                                          objectives and/or strategy to
                                          resolve, and follow-up''
                                          (which is the definition of
                                          ``case'' on the NORS form).
                                          Other calls reporting
                                          incidents or seeking advice
                                          but not requiring ombudsman
                                          involvement to the degree
                                          specified in this definition
                                          should be counted as
                                          consultations to individuals
                                          or facilities in Part III F.4.
                                          or documented in some way
                                          specific to the state's needs
                                          but not included in the NORS
                                          system. For example, in those
                                          few states where state law
                                          requires reporting instances
                                          of nursing home abuse to the
                                          ombudsman program, the reports
                                          should not be counted as a
                                          case and as an abuse complaint
                                          unless the ombudsman program
                                          investigates and is actively
                                          involved in working out a
                                          resolution. Unless the
                                          ombudsman program is actively
                                          engaged in investigating and
                                          working to resolve the
                                          problems reported, the program
                                          should keep its own list of
                                          such reports and not include
                                          them in the data submitted in
                                          the NORS system.
The instructions, at the bottom of page  This direction is deleted from
 3, direct ombudsmen to document          the instructions. (The effect
 primary complaints in Part I D but not   will be to leave such
 to document problems which are           documenting decisions up to
 incidental to, or even causal to, the    the states. One state
 primary complaint.                       ombudsman staff member
                                          strongly objected to this
                                          change because it could lead
                                          to inconsistent documentation
                                          among the states, but the
                                          majority of those on the task
                                          force thought the directive
                                          should be deleted because it
                                          causes confusion and
                                          inaccuracies in reporting
                                          complaints and problems
                                          experienced by residents.)

[[Page 9281]]

                                         The instructions clarify the
                                          distinctions between complaint
                                          categories B.14, D.29, and
                                          M.96, all of which involve
                                          barriers and yet are different
                                          types of problems (as
                                          explained. in the ``Complaint
                                          Codes'' attachment to the
                                         The instructions emphasize that
                                          supplies not provided as part
                                          of the daily rate should be
                                          coded under E.36, ``Billing,
                                         The instructions as well as the
                                          form emphasize that problems
                                          with a referral agency failing
                                          to substantiate a complaint
                                          should be coded under the Part
                                          III E.2.d.2) disposition
                                         The instructions emphasize in
                                          that complaints about
                                          ``nutrients out-of-date''
                                          should be categorized under
                                          J.71 dealing with food
                                         The instructions clarify that
                                          ``percentage of staff time
                                          spent on technical assistance
                                          for volunteers'' under ``other
                                          ombudsman activities''
                                          includes staff resources
                                          devoted to the management and
                                          administration of the
                                          volunteer program as a whole.
                                         Add the following to the
                                          narrative issues section, Part
                                         B. Facility Closures: If your
                                          program has worked on facility
                                          closures, please include a
                                          description of these
                                          activities, including reasons
                                          for the closure(s) and
                                          outcomes of ombudsman
                                         C. Alternative Care Systems: If
                                          your program has been involved
                                          in planning for alternatives
                                          to institutional care and/or
                                          has assisted individual
                                          residents to move to less
                                          restrictive settings of their
                                          choice, please describe these
                                          activities and provide an
                                          approximate number of the
                                          individuals who have been
OMB-approved form for certifying         Add a form for state
 compliance with minimum funding          certification of compliance
 requirement expired in FY 1997.          with the ombudsman minimum
                                          funding and non-supplantation
                                          provisions in the Act and to
                                          confirm expenditures reported
                                          in the NORS.

[FR Doc. 02-4800 Filed 2-27-02; 8:45 am]