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Administration for Community Living/Administration on Aging- Office of Long-Term Care Ombudsman ProgramsNational Ombudsman Reporting System (NORS)Table 1: NORS Parts A, B and C - Case and complaint codes, values and definitionsOMB Control Number 0985-XXXXExpiration Date: XX/XX/XXXXTable 1: Part A-Case Data ComponentsEach case must contain a complainant, complaint code (s), a setting, verification, resolution, and information regarding whether a complaint wasreferred to another agency. Case and complaint data reported is only for those cases and complaints which were closed within the fiscal year.ElementNumberDataElementDefinitionQuantifier TypeCA-01CaseNumberThe uniqueidentifier used foreach case.SingleAlphaNot Applicable (NA )numeric(not a coded element)This is auto-created by the state softwareprogram.CA-02Date CaseOpenedMonth, day, andyear that the casewas opened.SingleDateEach case must have a minimum of onecomplaint.Codes and ValuesNA (not a codedelement)Examples and Reporting TipsEach case must have only one case opendate.The case opened date must be on or beforethe case closed date.CA-03Date CaseClosedMonth, day, andyear that the casewas closed.SingleDateNA (not a codedelement)The year of case closure must be in theassociated reporting period.Each case must have only one case closeddate.The case closed date must be on or after thecase open date.

ElementNumberDataElementDefinitionQuantifier TypeCA-04Facility orSettingType of facility orsetting for thecase.SingleCodes and ValuesAlpha01-Nursing Facilitynumeric02-Residential CareCodeCommunityExamples and Reporting TipsOnly one setting is allowed for each case. SeePart C definitions (Element Number CA-04,Data Elements 01, 02 & 99).99-OtherCA-05ComplainantComplainant: anindividual (i.e.,resident, residentrepresentative,family) ervices regardingone or morecomplaints madeby, or on behalf esidentRepresentative, Friend,Family03-OmbudsmanSee Part C definitions (Element Number CA05, Data Elements 01-08).Only one complainant per case is allowed.Select the complainant type that bestrepresents the complainant(s) for the case.04-Facility Staff05-Representative ofother agency orprogram06-Other: a neighborto the facility, familymember of anotherresident, visiting clergy,bank teller, etc.07-Resident or familycouncil08-Unknown2

Table 1: Part B - Complaint Data ComponentsElement DataNumber s and ValuesExamples and Reporting TipsComplaintnumberThe uniqueidentifier used foreach complaint.SingleAlphanumericNot Applicable (NA )This is auto-created by the state softwareprogram.DateComplaintOpenedMonth, day andyear the complaintwas opened.SingleDateComplaintClosedMonth, day andyear the complaintwas closed.Single(not a coded element)NA (not a codedelement)Each complaint must have only one complaintopened date.The complaint opened date must be on or afterthe case opened date and on or before the caseclosed date.NA (not a codedelement)Each complaint must have only one complaintclosed date.The complaint closed date must be on or afterthe case opened date and on or before the caseclosed date.3

Element DataNumber ElementDefinitionQuantifierCD-04An expression ofdissatisfaction orconcern broughtto, or initiated by,the Ombudsmanprogram whichrequiresOmbudsmanprograminvestigation andresolution onbehalf of one ormore residents ofa long-term carefacility.SingleComplaintTypeCodes and ValuesExamples and Reporting TipsA- Abuse, Gross Neglect,ExploitationFor the full list of codes and values, see Table 2.B-Access to InformationC-Admission, Transfer,EvictionD-Autonomy, ChoiceE-Financial, PropertyF- CareG-Activities and SocialServicesH- DietaryI-EnvironmentJ-Policies, ProceduresK- Complaints about anOutside AgencyL-System/Others (nonfacility)CD-05Perpetrator Person(s) whoappears to havecaused the abuseor neglect orexploitation.Multiple01-Facility Staff,02-Another ResidentOnly used for Abuse, Gross Neglect, andExploitation complaints A01 to A05.03-Family, ResidentRepresentative, FriendThere can be multiple perpetrators for eachcomplaint.04-Other4

Element DataNumber ElementCD-06ReferralAgencyDefinitionQuantifierThe agency oragencies to whicha complaint wasreferred to as partof theOmbudsmanprogram’s plan ofaction forcomplaintresolution.MultipleTypeCodes and ValuesExamples and Reporting Tips01-Licensing, regulatory,or certification agencySee definitions in Part C.02-Adult protectiveservices03-Law enforcement orprosecutorThere can be multiple referrals to agencies inone complaint.A code of 06 (None) cannot be combined withother codes for a complaint.04-Protection andadvocacy05-Legal services06-No referral was made99-OtherCD-07ComplaintVerificationA confirmationthat most or allfacts alleged bythe complainantare likely to betrue.SingleNumeric Code01-VerifiedEach complaint must have a verification status(verified or not verified.)02-Not verified5

Element DataNumber ElementDefinitionQuantifierCD-08Final resolution oroutcome of thecomplaint.SingleComplaintdispositionTypeCodes and ValuesExamples and Reporting TipsNumeric CodeEach complaint can have only one dispositioncode.01-Partially or fullyresolved to thesatisfaction of theresident, residentrepresentative orcomplainant.02- Withdrawn or noaction needed by theresident, residentrepresentative orcomplainant.03- Not resolved to thesatisfaction of theresident, residentrepresentative orcomplainant.6

Table 1: Part C - Case and Complaint DefinitionsElementNumberData ElementDefinitionCA-04Facility or SettingDescription of where Ombudsman services are provided.CA-0401-Skilled NursingFacility/NursingFacility(A) Any skilled nursing facility, as defined in section 1819(a) of theSocial Security Act (42 U.S.C. 1395i–3(a)); (B) any nursing facility,as defined in section 1919(a) of the Social Security Act (42 U.S.C.1396r(a)).CA-0402-Residential CareCommunityA type of long-term care facility as described in the OlderAmericans Act that, regardless of setting, provides at a minimum,room and board, around-the-clock on-site supervision, and helpwith personal care such as bathing and dressing or health-relatedservices such as medication management.Examples and Reporting TipsFacility types include but are not limited to: assisted living; boardand care home; congregate care; enriched housing programs;homes for the aged; personal care homes; adult foster/ familyhomes and shared housing establishments that are licensed,registered, listed, certified, or otherwise regulated by a state.CA-0499-Other settingA code for Ombudsman services offered as a state option, insettings beyond those defined as long-term care facilities in theOlder Americans Act.CA-05ComplainantAn individual who requests Ombudsman program complaintinvestigation services regarding one or more complaints made by,or on behalf of, residents.This code is used by Ombudsmanprograms that provide in-home careombudsman services, managed careombudsman and similar ombudsmanservices.7

ElementNumberData ElementDefinitionCA-0501-ResidentAn individual who resides in a long-term care facility.CA-0502-Residentrepresentative,friend, familyResident Representative, Friend, & Family: ResidentRepresentative as defined in 45 CFR 1324.1 (1) An individualchosen by the resident to act on behalf of the resident in order tosupport the resident in decision-making; access medical, social orother personal information of the resident; manage financialmatters; or receive notifications; (2) A person authorized by Stateor Federal law (including but not limited to agents under power ofattorney, representative payees, and other fiduciaries) to act onbehalf of the resident in order to support the resident in decisionmaking; access medical, social or other personal information ofthe resident; manage financial matters; or receive notifications;(3) Legal representative, as used in section 712 of the Act; or (4)The court-appointed guardian or conservator of a resident.Friend is a non-relative with a personal relationship with theresident as identified by the resident or complainant; family isspouse, sibling, other relative or as identified by the resident orcomplainant.CA-0503-OmbudsmanprogramOmbudsman program: the program through which the functionsand duties of the Office are carried out, consisting of theOmbudsman, the Office headed by the Ombudsman, and therepresentatives of the Office.CA-0504-Facility staffAny employee or contractor of a long-term care facility whobrings a complaint to the Ombudsman program regarding one ormore residents.Examples and Reporting Tips8

ElementNumberData ElementDefinitionExamples and Reporting TipsCA-0505-Representativeof other agency orprogramAny representative of an agency, program or organization thatrefers a complaint to the Ombudsman program regarding one ormore residents.Includes medical personnel not associatedwith the facility, adult protective services,licensing and certification, lawenforcement, other social servicesagencies, faith based communities, andbank employees.CA-0506-ConcernedpersonAny person not closely associated to a resident that refers acomplaint to the Ombudsman program regarding one or moreresidents.Includes neighbor to the facility, familymember of another resident, persondelivering supplies, barista, etc.CA-0507-Resident orfamily councilOrganized, self-governing, decision-making groups of long-termcare residents (resident council) or families (family council) whomeet regularly to voice their needs and concerns and to haveinput into the activities, policies, and issues affecting the facility.CA-0508-UnknownThe source of the complaint or the type of complainant is notknown to the Ombudsman program.CD-05Referral AgencyThe agency or agencies to which a complaint was referred to aspart of the Ombudsman program’s plan of action for complaintresolution.01-Licensing,regulatory orcertification agencyLicensing or Regulatory or Certification Agency: Government unitsresponsible for the licensing of facilities and agencies servingolder adults and adults with disabilities.CD-05Do not report complainants that wish tobe anonymous as “unknown,” unless thesource is not known to the Ombudsmanprogram.9

ElementNumberData ElementDefinitionCD-0502-Adult ProtectiveServicesAdult Protective Services: A social services program provided bystate and/or local governments serving older adults and adultswith disabilities who are in need of assistance because of abuse,neglect, self-neglect, or financial exploitation.CD-0503-Lawenforcement orprosecutorLaw Enforcement or Prosecutor: People employed by a local,state, tribal, or federal justice agency. This includes police, courts,district attorney's office, probation or other communitycorrections agency, and correctional facilities; including the StateMedicaid Fraud Control Unit, as defined in section 1903(q) of theSocial Security Act (42 U.S.C. 1396b(q))CD-0504-Protection &AdvocacyProtection & Advocacy Systems: A system to protect and advocatethe rights of individuals with developmental disabilities; asdesignated by the State, and as established under theDevelopmental Disabilities Assistance and Bill of Rights Act of2000 (42 U.S.C. 15001 et seq.)CD-0505-Legal servicesLegal services: Entity or individual attorney providing legalrepresentation and/or consultation to residents including but notlimited to legal services funded through Older Americans Act orLegal Services Corporation funds, Ombudsman legal counsel orany other attorney.CD-0506-NoneNo referral was made.CD-05.199-OtherOther: Any other entity to which a referral is made.Examples and Reporting TipsInclude a brief description, up to 500characters.10

This is auto-created by the state software program. CA-02 Date Case Opened Month, day, and year that the case was opened . Single Date NA (not a coded element) Each case must have a minimum of one complaint. Each case must have only one case open date. The case opened date must be on or before the case closed date. CA-03 Date Case Closed