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A “booming” assisted living industry is placing a burden on state long-term care ombudsman programs, which are stretching their resources to cover those extra units without any additional staffing or assistance, according to a new report from the US Government Accountability Office.

State long-term care ombudsman programs served more than 3 million residents across 76,000 residential care communities in fiscal year 2022, including 60,325 assisted living facilities serving 1.6 million residents, and 15,734 nursing homes with 1.7 million residents, according to the GAO. 

In FY22, the programs spent $140 million, including $68.4 million from federal sources (49%) including Older Americans Act funds; $63.4 million in state funds; and $7.8 million in local funds.

For the report, the GAO reviewed federal and state data and interviewed officials from the federal Administration for Community Living, representatives from four national stakeholder organizations, and state ombudsman program officials in five states — Arkansas, Connecticut, Montana, Ohio and Oregon — between December 2023 and May 2024. Interviewees described challenges that make it difficult to provide services, including the growing number of assisted living communities, increasingly complex cases and limitations on staffing and funding.

The more and more complex needs of long-term care residents are making it more difficult for ombudsmen to provide services, according to interviewees. Surveyed participants said that their programs now handle complicated cases such as those involving evictions, sexual assaults, mental health, cognitive impairment and substance misuse. 

Officials from four states also said that the proliferation of assisted living communities is a challenge in that the rapid increase has resulted in swelling workloads for ombudsmen without additional resources. 

An Ohio official said that the “booming” assisted living industry in that state is stretching its ombudsman staff resources. The Buckeye State official said that the office felt an “increased burden” to reach out to assisted living residents because assisted living communities have less oversight compared with nursing homes.

The 12-page GAO report cited an example from “one national stakeholder representing ombudsmen” who said that assisted living had grown “exponentially” over the past 15 years. The official said that the country is at a “crossover point,” where the number of assisted living beds is exceeding the number of nursing home beds, but resources have not increased to cover those extra beds.

On a national level, the workload of state ombudsman programs declined during the first year of the pandemic and partially rebounded to pre-pandemic levels in FY 22, according to the report. And although staffing levels are rebounding quickly, the number of volunteers has consistently declined since FY 2019.  

In FY 22, most state long-term care ombudsman programs used a combination of paid staff members and volunteers to perform their duties, with volunteers averaging one hour per week, the GAO found.

And although the COVID-19 pandemic introduced challenges to ombudsman programs, it also provided opportunities, the agency found. Officials from three states said that the pandemic forced programs to use virtual tools to connect with residents and to enhance communication. Pandemic relief funds also allowed one program to hire more staff members.