National standards for the Long-Term Care Ombudsman Program and a tool to assess compliance: The Huber Badrak Borders Scales

Purpose: We propose national standards previously recommended for the Long-Term Care Ombudsman Program by an Institute of Medicine program evaluation committee, and introduce a tool to measure the compliance of local ombudsman programs to those standards: the Huber Badrak Borders Scales. Methods: The best practices for ombudsman programs detailed in the committee's report were adapted to 43 Likert-type scales that were then averaged into 10 infrastructure component scales: (a) program structure, (b) qualifications of local ombudsmen, (c) legal authority, (d) financial resources, (e) management information systems, (f) legal resources, (g) human resources, (h) resident advocacy services, (i) systemic advocacy, and (l) educational services. The scales were pilot-tested in 1996 and 1999 with Kentucky ombudsmen. Results: The means of 9 of these 10 scales were higher in 1999 than in 1996, suggesting that local ombudsman programs were more in compliance with the proposed standards in 1999 than three years earlier. Implications: The development process consisted of 10 adopt-test-revise-retest steps that can be replicated by other types of programs to develop program compliance tools.