Local Ombudsman Questionnaire

12/10/2010


This instrument was developed for the National Board and Care Survey project. This project was conducted by the Bureau of the Census under contract for the Department of Health and Human Services (HHS) Office of Disability, Aging and Long-Term Care Policy. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The DALTCP Project Officer was Robert Clark.


NOTE: This is a recreation of this form. See the PDF version for a scanned version of the actual form.

 

QUESTIONNAIRE 5
LOCAL OMBUDSMAN

 

STATE: _________________________
AGENCY: _________________________
CONTACT: _________________________  
POSITION: _________________________
DATE: _________________________
INTERVIEWER: _________________________  

 

START TIME: _________________________    

1. Does the ombudsman program in this state require visits to board and care homes at regular intervals?

_____ No
_____ Yes
SPECIFY INTERVALS _________________________

2. How many staff does your ombudsman program have who deal with B&C issues?

Enter number of full time equivalent: _____

3. How does your program provide information to the public and others about board and care homes and issues? (CHECK ALL THAT APPLY)

_____A. Making B&C home survey reports available
_____B. Making ombudsman program information available
_____C. Providing training on B&C regulations and problems
_____D. Providing B&C consumer guides
_____E. Other: (SPECIFY)

1. _________________________
2. _________________________
3. _________________________
4. _________________________

4. Are there unlicensed board and care homes in your state?

_____ Yes
_____ No (IF NO, SKIP TO QUESTION 8.)

5. Can you estimate the number of unlicensed homes in your state?

Enter number of homes: _____

6. In your opinion how effective is your state in identifying unlicensed board and care homes?

7. In your opinion how effective is your state in closing unlicensed homes?

8. Are you satisfied with the current division of responsibility for board and care homes within your state?

_____ Yes
_____ No

Comments:


NATIONAL BOARD AND CARE SURVEY DESIGN REPORTS AVAILABLE

Searching for a Needle in a Haystack: Creative Use of the Decennial Census Dress Rehearsal Data to Find Board and Care Places in Central Missouri

Executive Summary   http://aspe.hhs.gov/daltcp/reports/1992/haystkes.htm

HTML   http://aspe.hhs.gov/daltcp/reports/1992/haystk.htm

PDF   http://aspe.hhs.gov/daltcp/reports/1992/haystk.pdf

INSTRUMENTS AVAILABLE

All Respondents Questionnaire

HTML   http://aspe.hhs.gov/daltcp/instruments/AllResp.htm

PDF   http://aspe.hhs.gov/daltcp/instruments/AllResp.pdf

Interagency Councils Questionnaire

HTML   http://aspe.hhs.gov/daltcp/instruments/IntCoun.htm

PDF   http://aspe.hhs.gov/daltcp/instruments/IntCoun.pdf

Licensure Questionnaire

HTML   http://aspe.hhs.gov/daltcp/instruments/Licensure.htm

PDF   http://aspe.hhs.gov/daltcp/instruments/Licensure.pdf

Local Agency Questionnaire

HTML   http://aspe.hhs.gov/daltcp/instruments/LocalAg.htm

PDF   http://aspe.hhs.gov/daltcp/instruments/LocalAg.pdf

Local Ombudsman Questionnaire

HTML   http://aspe.hhs.gov/daltcp/instruments/LocalOm.htm

PDF   http://aspe.hhs.gov/daltcp/instruments/LocalOm.pdf

Payment/Eligibility Questionnaire

HTML   http://aspe.hhs.gov/daltcp/instruments/PayElig.htm

PDF   http://aspe.hhs.gov/daltcp/instruments/PayElig.pdf


To obtain a printed copy of this report, send the full report title and your mailing information to:

U.S. Department of Health and Human Services
Office of Disability, Aging and Long-Term Care Policy
Room 424E, H.H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201
FAX:  202-401-7733
Email:  webmaster.DALTCP@hhs.gov


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