Two kinds of free help exist for older adults facing problems with long-term care or the legal side of aging, and both are consistently underused: the long-term care ombudsman, and legal services funded under the Older Americans Act.
What the Long-Term Care Ombudsman does
Every state has a Long-Term Care Ombudsman Program, required under the Older Americans Act. Regional ombudsmen, many of them based at Area Agencies on Aging, advocate for residents of nursing homes, assisted living, and board and care homes.
The service is free, available to any resident regardless of income, and independent of the facility. Ombudsmen are not regulators and do not issue fines; their job is to resolve the problem on behalf of the resident.
What they handle
- Quality of care complaints, call lights unanswered, missed care, poor hygiene, inadequate help at meals
- Discharge and eviction notices, including the common case of a facility trying to refuse readmission after a hospital stay
- Billing and contract disputes
- Dignity and rights issues, privacy, visitors, restraints, retaliation after a complaint
- Help with care plan meetings, including attending the meeting with the family
Two rules worth knowing
- The resident directs the case. An ombudsman acts on the resident’s wishes, not the family’s. If a competent resident does not want a complaint filed, it will not be filed.
- Consent and confidentiality are required. Nothing is disclosed without permission, which is what makes it safe for residents to raise problems they are afraid to raise directly.
How to file a complaint
- Write down what happened: dates, times, names, and what was said. Specifics matter far more than general dissatisfaction.
- Raise it with the facility first if it is safe to do so, charge nurse, then director of nursing, then administrator. Many issues resolve here.
- Contact the regional ombudsman. Find yours through the Eldercare Locator at 1-800-677-1116 or theconsumervoice.org.
- For immediate danger or suspected abuse, contact the state survey agency or Adult Protective Services as well. The ombudsman is an advocate, not an emergency responder.
Free legal services for older adults
The Older Americans Act funds legal assistance for people 60 and over, with priority given to those in the greatest social or economic need. There is generally no income test, though priority rules apply when demand exceeds capacity.
Typical areas covered:
- Public benefits, Medicare, Medicaid, SNAP, Social Security denials and appeals
- Housing, eviction, foreclosure, utility shutoffs, landlord disputes
- Consumer problems, debt collection, predatory lending, scams
- Long-term care access and nursing home discharge appeals
- Advance planning documents
- Elder abuse, neglect, and financial exploitation
- Guardianship, including alternatives to guardianship
Legal aid programs usually do not handle fee-generating cases such as personal injury, and most do not write complex estate plans. Your Area Agency on Aging holds the list of legal providers for your area.
Age discrimination
Federal law prohibits age discrimination in employment for workers 40 and over, and in programs receiving federal financial assistance. Complaints about employment go to the Equal Employment Opportunity Commission, and deadlines are short, often 180 days from the discriminatory act, extended to 300 days in some states. If you believe you have a claim, ask about the deadline on the first call, not the third.
Advance planning documents
These are not the same thing, and families routinely assume one covers the other:
| Document | What it does |
|---|---|
| Durable power of attorney (finances) | Names someone to handle money matters. Stays effective if the person loses capacity, which is the point of “durable”. |
| Health care power of attorney / proxy | Names someone to make medical decisions when the person cannot. |
| Living will / advance directive | States wishes about treatment in specific situations. |
| POLST or MOLST | A medical order signed by a clinician, for people who are seriously ill. Travels with the patient and is followed by emergency responders. |
| Will | Directs what happens after death. Does nothing while the person is alive. |
Forms vary by state, and a document valid in one state may need revision in another. Many states accept free statutory forms; legal aid or your Area Agency on Aging can tell you which apply.
Warning signs of financial exploitation
Reported most often by family members and bank staff, usually in this order:
- New “friend”, caregiver, or relative suddenly involved in money matters
- Changes to a will, deed, or beneficiary designation that the person cannot explain
- Unpaid bills despite adequate income
- Unusual ATM withdrawals or transfers, especially repeated and just under reporting thresholds
- Secrecy, or distress when finances are discussed
Adult Protective Services investigates in every state, and your local AAA can tell you how to reach it.
This page explains what programs exist. It is not legal advice, and laws differ by state. For advice about a specific situation, contact a legal services program or a licensed attorney in your state.