The ombudsman and the case manager.

Abstract

THE ADVOCACY ROLE The movement toward citizen's participato investigate complaints, initiate general designee, is assigned to coordinate com tion and recognition of client's rights in inquiries, recommend program improveprehensive, community-oriented plan of 1960s and early 1970s encouraged dements, and intercede to make sure modiflservices and informal supports for an in velopment of strategies designed to safecations occur when necessary.6 Most often dividual or family.11 More specifically, case guard human service consumer from ombudsman is appointed to particular management is recognized as providing five bureaucratic obstruction, coercion, and institution (such as prison system), inbasic services: (1) assessment, (2) planning, paternalism. The strategies included develdustry (for example, nursing homes), or (3) linking, (4) monitoring, and (5) ad opment of citizens'review boards, recognigovernment level (such as city governvocacy.12 tion of patient and consumer rights, and ment or state bureaucracy) with aim of In practice, case management models client participation on agency boards. The ensuring the proper functioning of an invary on continuum from information and more enduring roles to originate from this stitution delivery service, given its referral agents to administrators and pro movement have been ombudsman, designated or professed objective.7 viders of capitated services.13 Regardless of patient representative (a derivation), and Although in some models ombudsthe model, case managers have viewed case manager. Although these roles man functions as an active advocate or themselves consistently as client represen share common concerns, they remain investigator, most often, however, omtatives instrumental in keeping individuals distinct in purpose, scope, and degree of budsman serves as nonpartisan arbitrator from fall[ing] through cracks.14 One adoption and acceptance by human service of specific complaints.8 Also in health care, of goals of case management is to providers, businesses, and state and local many patient representatives serve as assure consumer satisfaction in making governments in United States. public relations agents for their institutions, system work for client in consis thus decreasing litigation while promoting tent and coherent manner.15 To accom r»mriJTTr»CM i*t patient satisfaction with hospital services.9 plish this goal, assessing and monitoring clients' needs are of primary importance for The concept of ombudsman origi_ . __ « at case manager and serve as tools for nated in Scandinavia. At time, an omLUE UAah M effective advocacy and brokering, budsman denoted neutral, independent ofThe concept of case management evolved fleer of legislature who was empowered in 1960s from concerns with service in to investigate citizen complaints about tegration and coordination. The prolifera governmental agencies and to recommend tion of categorical social programs during Traditionally, advocacy has been viewed corrective actions where indicated.1 By this era had resulted in fragmented and as an important social work role. In prac 1960s this concept had become increasingly inefficient service delivery system. Conselice, however, social workers rarely have popular in United States with number quently, service integration was designated time, resources, or institutional support of states creating ombudsman-like roles.2 In as priority by Secretary Elliot Richardson to exercise fully an advocacy role—one 1971, ombudsmen were included in seven of U.S. Department of Health, Educareason ombudsman and case mana demonstration projects as part of tion. and Welfare (HEW). Under Allied ger roles evolved. Accordingly, these role Presidential Initiatives in Nursing Home ImServices Act of 1972. 45 Services Integrastrategies can be viewed as complements provement Program. Later, Administration Targets for Opportunity (SITO) demonto social work advocacy efforts, tion on Aging provided limited funds for stration projects were created to improve Initially, advocacy appears to be straight ombudsmen activities, and in 1978, amendlinkages and coordination at state and forward approach to addressing perceived ments to Older Americans Acts required local level. In 1974, HEW expanded wrongs. The practice of advocacy, however, all states to have an ombudsman for their SITO concept with Partnership Grants involves many complex tactical and ethical nursing home and long-term care facilities.3 Program, which focused on identifying issues; some of which are clearly manifested Currently, ombudsmen work in higher those elements essential for securing coorin ombudsman and case manager education, business, corrections, and health dinated delivery of services, including case roles.16 Moreover, survey of how case care, particularly long-term care where management. These and other initiatives, managers and ombudsmen approach these role has been adopted widely.4 In health along with passage of Community issues can clarify how they complement care, adoption of an ombudsman like Mental Health Centers legislation of 1975 social work activity and highlight ad role led to creation of patient (P.L. 94-63) and 1981 Omnibus Budget vantages and limitations of each, representative. In 1971. Society of PaReconciliation Act (OBRA) fostered case The practice of advocacy may be differen tient Representatives was formed under management programs and mental health tiated along four basic dimensions: ( 1 ) role auspices of American Hospital Associalong-term care, aging services, programs for specificity, (2) client orientation, (3) prob tion, and by early 1980s more than developmentally disabled, and child lem-solving mode, and (4) resources and 1,400 hospitals in United States welfare agencies.10 constraints. For purpose of this article, employed patient representative.5 Case management has been defined as these four dimensions will be examined in Generally, ombudsman is viewed as a system of locating, coordinating, and relation to ombudsman and case man an independent, impartial arbiter who inmonitoring defined group of services for ager roles. vestigates problems and complaints but is defined group of people and as a proRole Specificity. Functionally, om not involved in making administrative decicess whereby fixed point of responsibilibudsmen tend to be more role-specific than sions. The ombudsman can be empowered ty within governmental agency, or its case managers. The ombudsman focuses