Who the Ombudsman Serves
Anyone may contact the Long-Term Care Ombudsman Program to raise a concern about the care, services, or rights of someone receiving long-term care. This includes individuals receiving care (consumers), their family members, friends, facility staff or management, and community or government agencies.
When a concern is brought to the Ombudsman Program, the consumer receiving long-term care services is the Ombudsman's client.
For purposes of the Ombudsman Program, the term “consumer" refers to individuals receiving long-term care services, including:
- Individuals age 60 and older living in nursing homes and assisted living facilities, also referred to as residents
- Individuals age 60 and older receiving services through home and community-based waiver programs (Family Care, PACE, Partnership, and IRIS), also referred to as members or participants
The Ombudsman works to understand the concerns raised and speaks directly with the consumer to learn their perspective and determine whether they would like assistance.
Consumer-Directed Advocacy
Ombudsman advocacy is consumer-directed. Regardless of who raises the concern, the Ombudsman works to understand the situation from the consumer's perspective and supports the consumer in understanding their rights, exploring options, and working toward outcomes that reflect their wishes and goals.
The Ombudsman will always seek to involve the consumer to the fullest extent possible. In situations a consumer has a legally authorized decision-maker, the Ombudsman will still make every effort to communicate directly with the consumer and include them in the process.
Legal Advice
The Ombudsman is not an attorney and cannot provide legal advice. If you need legal advice, you should talk with an attorney.
Confidentiality
Individuals who contact the Ombudsman Program may request confidentiality or anonymmity when making a complaint.
Because the Ombudsman Program's client is the consumer receiving long-term care services, the Ombudsman must follow strict confidentiality requirements. Information about a complaint or investigation may only be shared with others when the consumer, or their legally authorized representative, provides consent, or when disclosure is otherwise authorized by law. While anyone may raise a concern with our office, there may be limits on the information the Ombudsman can share with individuals who are not the consumer.
How to Raise a Concern or File a Complaint
Complaints may be made via phone, fax, letter, or via the online complaint form. Please provide a detailed description of your complaint and complete contact information.
By mail:
1402 Pankratz Street, Suite 111
Madison, WI 53704-4001
By fax:
608-246-7001
Online:
File an online concern or complaint
Complaint Prioritization
Calls and complaints may be prioritized based on the nature and urgency of the concern. While the Ombudsman Program makes every effort to respond as promptly as possible, response times may vary depending on the nature of the concern and current caseloads.
Steps Toward Resolving a Complaint
The Ombudsman Program works to resolve concerns through a process that is guided by the consumer's wishes and preferences. Depending on the situation, this process may include:
- Listening to the concern and gathering information
- Speaking directly with the consumer to understand their perspective
- Reviewing relevant laws, policies, or records
- Working with facility staff, service providers, or other involved parties to address the concern
- Providing information about rights, options, and available resources
Concerns may be resolved informally or formally.
Informal Resolution
Many times complaints can be resolved through informal resolution. Ombudsmen often serve as mediators, negotiators and consultants. When communication has broken down between consumers and their families, or consumers and providers, the Ombudsman is frequently called upon to help mediate a resolution in which the clients voice is heard above all others.
Increasingly, the providers of long term care services have come to rely on the consultation of the Ombudsman to resolve issues which are not addressed by administrative rules. By involving the Ombudsman in a dispute before it becomes a grievance or a crisis, the Ombudsman can explore options and resolutions from a rights perspective and can offer staff and/or consumer education on specific topics.
Formal Resolution
When complaints cannot be resolved through informal resolution, a formal resolution might be necessary. Ombudsman offer assistance and represenation to consumers through the formal complaint process. This may include internal appeals, grievances, and State Fair Hearings. An Ombudsman provides help and representation only at the request of the consumer.