In addition to the survey and inspection activities of the state licensing agency, additional monitoring is possible through the state ombudsman program and home and community based case management agencies. Thirty-four states indicated that the ombudsman program monitors care in assisted living and board-and-care facilities. The role is similar to that performed in nursing homes and focuses on receiving and investigating complaints.
Nineteen states indicated that case managers monitor Medicaid beneficiaries receiving services in these facilities. The role of case managers was described in various terms and included observing and monitoring care, ensuring that services were delivered in accordance with a negotiated service agreement, and monitoring the assessment process. Quality of care problems are reported to the licensing agency in several states. Case managers are mandatory reporters of abuse and neglect in Alabama.