Image of male nurse pushing senior woman in a wheelchair in nursing facility

Long-term care ombudsmen in some states are unable to effectively advocate for residents due to a lack of independence from government interests, according to a report published Monday.

Ombudsmen programs are not all run the same way, points out the report by Kaiser Health News, in collaboration with USA Today and the SCAN Foundation. Most are state government programs, and in five states, long-term care ombudsman is a governor-appointed post. However, in seven states, the ombudsman program is run through a nongovernmental organization such as a nonprofit.

While it may seem obvious that ombudsmen can function most effectively with maximum autonomy from government officials who may have competing interests, some argue that maximizing access to policymakers and legislators is valuable — as long as the state gives appropriate freedom to ombudsman. However, some cases seem to illustrate an “awkward fit” with regard to state control of the ombudsmen, said Office of Long-Term Care Ombudsman Programs Director Becky Kurtz in the report.

The high-profile departure of Florida ombudsman Brian Lee in 2011 sparked a federal inquiry amid allegations Lee was ousted for being too aggressive. Yet, states such as Iowa and California have faced and managed similar situations, the report pointed out.

A variety of factors, including state policies and personality clashes, can hamper ombudsmen, Lori Smetanka, director of the National Long-Term Care Ombudsman Resource Center, told Kaiser. But whatever their cause, she said if these issues are not resolved “there is no one speaking out for nursing home residents or … their voice is not being carried to that higher level.”