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Elder Abuse pp 317–342Cite as

Adult Protective Services and the Long-Term Care Ombudsman Program


Adult Protective Services (APS) and the Long-term Care Ombudsman Program (LTCOP) are present in every American community to respond to allegations or complaints related to elder abuse, neglect and exploitation. Yet, the two programs have very different and distinct purposes, roles, and structures. For the most part they can collaborate and complement each other. But in some circumstances they can be at odds with each other. APS is the single, dedicated authorized victim service system for elder and vulnerable adult abuse victims who live in community settings (in about half the states, APS also investigates abuse in facility settings). The LTCOP provides long-term care residents with an independent advocate to help them resolve complaints, protect their rights, and seek policy changes to improve systemic problems. This chapter details APS and LTCOP structure and functions, their similarities and differences, and the key issues, recent developments and future directions facing both programs.


  • Adult protective services
  • Long-term care ombudsman
  • Elder abuse
  • Advocacy
  • Nursing home
  • Financial exploitation
  • Neglect

Several Long-Term Care Leaders were consulted for this chapter. Among those who must be singled out with gratitude for their contributions are Louise Ryan, Ombudsman Program Specialist, U.S. Administration for Community Living; Lori Smetenka, former Director of the National Ombudsman Resource Center (NORC) and now Executive Director, Consumer Voice (host organization for NORC); Deanna Clingan-Fischer, J.D., State Long-Term Care Ombudsman, Iowa Department of Aging; and Cindy Englert, Regional Ombudsman Director, Centralina Area Agency on Aging, NC and President, National Association of Local Long-Term Care Ombudsmen.

The authors express their gratitude to Kelli White of Philadelphia APS and Kendra Kuehn of Health Benefits ABCs for their technical know-how and assistance in preparing this chapter.

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  1. 1.

    As of this writing FY 17 appropriations have not yet been finalized.

  2. 2.

    LTCOP Representatives are individuals who work on behalf of the State Long-Term Care Ombudsman and have been recognized by the State Ombudsman to serve as her or his representative. Representatives can be employees of the State Ombudsman or be employed by other organizations that are designated to serve as local or “substate” ombudsman programs, or may be volunteers in such programs. Representatives have no authority to act as ombudsman representatives without the express recognition of the State LTC Ombudsman.

  3. 3.

    Assistant Secretary for Aging at the Administration for Community Living, USDHHS.

  4. 4.

    Immunity for good faith performance of duties, unlawful to willfully interfere with the duties of an ombudsman, strict confidentiality requirements, access to facilities, residents and resident’s records, engage in legislative and regulatory advocacy, to name some.

  5. 5.

    Ombudsmen may also initiate complaints on behalf of facility residents when they identify a problem that affects multiple residents or is systemic, or when they witness or have independent knowledge of a matter that falls within their purview. The program’s strict confidentiality and disclosure requirements limit the capacity of ombudsmen to share information that would reveal the identity of individual residents except under certain circumstances when a resident is unable (not unwilling) to provide consent. The AoA’s final rule (effective July 1, 2016) goes into considerable detail about exception circumstances and requirements.

  6. 6.

    This case occurred during the tenure as a State LTC Ombudsman of one of this chapter’s coauthors.

  7. 7.

    The landmark 1995 Institute of Medicine report on the LTCOP (Real People Real Problems) noted, “The regular presence of persons from outside of facilities has been identified as an important factor in improving quality of care and quality of life in facilities,” cited numerous studies supporting this.


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Snyder, J., Benson, W.F. (2017). Adult Protective Services and the Long-Term Care Ombudsman Program. In: Dong, X. (eds) Elder Abuse. Springer, Cham.

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