Comparing Active and Resigned Volunteers - SAGE Journals

Journal et 10.1177/0733464804267581 Nelson ofal. Applied / Ombudsman Gerontology Effort and Service

Factors Effecting Volunteer Ombudsman Effort and Service Duration: Comparing Active and Resigned Volunteers H. Wayne Nelson Towson University F. Ellen Netting Virginia Commonwealth University Ruth Huber University of Louisville Kevin W. Borders University of Louisville Volunteers are key to successful ombudsmen programs. Motivating them and keeping them is difficult. The principal goal of this article is to compare active and resigned volunteer ombudsman perceptions (along with select demographic influences) of factors that either encouraged or discouraged their work. The authors find that former ombudsmen felt more role ambiguity, greater nursing facility resistance, higher boredom, and desired better supervision than active volunteer ombudsmen. They also served less time in significantly smaller facilities. Both active and resigned volunteers perceived relatively high role conflict. Implications regarding strategies to improve volunteer ombudsman work effort and retention are discussed. Keywords:

advocacy; job satisfaction; nursing homes; long-term care

Three decades ago, Congress mandated the grassroots Long Term Care Ombudsman Program (LTCOP) for institutionalized elders. Since then, the extensive use of volunteers, comprising more than 90% of program personnel, has been a key indicator of a model ombudsman operation (Department of Health and Human Services, Office of the Inspector General, 1991). An annual average of more than 9,000 citizen volunteers have stepped forward to resolve hundreds of thousands of complaints in all forms of long-stay settings. Their time and talents have filled important service gaps (Monk & Kaye, 1982; Monk, Kaye, & Litwin, 1984), producing a resident-defensive The Journal of Applied Gerontology, Vol. 23 No. 3, September 2004 309-323 DOI: 10.1177/0733464804267581 © 2004 The Southern Gerontological Society

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“sentinel effect” leading to improved routine aspects of resident life (Litwin & Monk, 1987). Their presence is associated with heightened regulatory activity (Nelson, Huber, & Walter, 1995) and improved nursing care (Cherry, 1991). They are credited with effectively challenging actions or policies injurious to residents’ interests (Harris-Wehling, Feasley, & Estes, 1995) and seem to be widely appreciated by residents (Connor, as cited in Nelson, 1995; Monk & Kaye, 1982). In this article, we provide background on what is known about ombudsman volunteers, as well as factors that encourage or discourage their continuing engagement. The study reported focuses on the Oregon Office of the Long Term Care Ombudsman, which heavily relies on volunteers to perform the same investigative responsibilities as paid staff. Study questions are as follows: (a) How do former and active volunteer ombudsmen perceive their work experiences? and (b) What factors encourage and discourage volunteer ombudsmen to continue their service?

Background and Literature Review Many challenges are revealed in the literature on the LTCOP. Volunteers face frequent opposition (Litwin & Monk, 1987), which can dull their effectiveness (Connor, as cited in Nelson, 1995). The average volunteer’s efficacy in handling difficult problems has been questioned (Cherry, 1991; Kahanna, 1994), a perspective that finds some tentative support in a recent study showing that paid staff appear to handle more complex issues than do volunteers (Netting, Huber, Borders, Kautz, & Nelson, 2000). Concern exists that volunteer ombudsmen suffer from insufficient training, inadequate supervision, and generally poor support (Harris-Wehling et al., 1995; Litwin & Monk, 1984). Some research suggests that volunteer ombudsmen are isolated and may rely too heavily on older residents for social interaction and satisfaction, making them excessively vulnerable to the “problems of the elderly and their experiences with the long term care system” (Portland Multnomah Commission on Aging, 1989, p. ES-2). Still others worry that these volunteers face the types of challenges that typically lead to “total disengagement from the helping professions, not least of which are perceptions of poor program support and lack of power to effect change” (Litwin & Monk, 1984, p. 100). This view is echoed in a government report citing job stress, strain, and frustration as causing more volunteer ombudsman turnover than anything except poor health (National Center for Long-Term Care Ombudsman Resources, National Association of State Units on Aging, 1989). Another study, however, found only modest evidence of psychological burnout among volunteer ombudsmen, reporting an important link between role exhaustion (a mani-

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festation of burnout) and poor job clarity and lower job involvement, especially among younger volunteers (Nelson, Pratt, Carpenter, & Walter, 1995). An Institute of Medicine study warns that the ombudsman’s job may become even more challenging in the future as volunteers will face more medically complex and technology-driven systems that will only increase the knowledge gap between themselves and the experts they monitor (HarrisWehling et al., 1995). Recruitment may also become more difficult as competition for volunteers increases in the social services and volunteers continue to increasingly engage in more episodic, short-term volunteer opportunities. Therefore, attracting responsible volunteers who are willing to undertake the ardor and long-term commitment required of elder care ombudsmen may be even more challenging.

Potential Encouraging or Discouraging Factors Several studies have examined encouraging and discouraging factors related to ombudsman volunteer motivation. Litwin and Monk (1984) found that volunteer ombudsman perceived four power factors as corroding their motivation and effectiveness. These were (a) the ombudsman’s role’s weak legal clout, (b) the role’s nonpaid status, (c) opposition by facility staff, and (d) resistance by nursing home administrators (Litwin & Monk, 1984, p. 101). They also found that ombudsmen were disheartened by poor training and inadequate supervision and by the nursing home residents’ extreme fragility (Litwin & Monk, 1984, p. 101). Keith (2000) found that younger volunteers who, as a group, tended toward a stronger advocacy orientation, perceived more work-role barriers and inequities than did older volunteers, who leaned toward more neutral laytherapy roles. Dehart (1999) linked higher volunteer organizational loyalty, which arises when volunteers share their parent organization’s core advocacy values, to longer job tenure, more frequent facility visits, increased case reporting, and higher satisfaction. The ombudsman’s multifaceted job (advocate, educator, resource broker, friendly visitor, and so forth) is an especially rich source of role conflict, which is classically defined as a clash of inconsistent role expectations between the role holder and an external contact (Kahn, Wolfe, Quinn, Snowe, & Rosenthal, 1964). Providers, family members, and nursing facility surveyors, for example, differ in their expectations about the ombudsman’s responsibilities. Providers (mistakenly) tend to accord legitimacy to the ombudsman friendly visitor role (Lusky, Friedsam, & Ingman 1994; Monk et al., 1984) and may resent ombudsmen who (correctly) see themselves as patient advocates (Connor & Winkelpleck, 1990). On the other hand, ombudsmen

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who assume a neutral stance risk experiencing role conflict with their own paid supervisors, who are more likely to be partisan watchdogs. Roleconflicted ombudsmen have been linked to diminished organizational loyalty, to lower psychological identification with their jobs, to more burnout, and to lower felt role self-efficacy (Nelson, Pratt, et al., 1995). A closely related concept is role ambiguity. It manifests as confusion about appropriate work behaviors and responsibilities and is linked to many work related problems. Role-ambiguous ombudsmen, for example, are less likely to assume an advocacy role; they feel less organizational loyalty, are less psychologically identified with their job, and feel less effective in their work (Nelson, Pratt, et al., 1995). The literature leaves many questions unanswered about the challenges and motivations impacting the ombudsman’s multifaceted role. Therefore, this Oregon-based study was designed to build on the foregoing research specific to ombudsmen volunteers, as well as the work of others on role conflict and ambiguity (Rizzo, House, & Lirtzman, 1970), work-role loyalty (Mowday, Steers, & Porter, 1979), and perceived work-role self-efficacy (Maslach & Jackson, 1981). All these concepts are closely linked to work motivation and overall job satisfaction (Nelson, Pratt, et al., 1995), which are, in turn, correlated, in both paid and volunteer work literature, to improved indices of job performance and role longevity (Dehart, 1999).

Study Methods Our analysis focuses on the Oregon State LTCOP, which relies heavily on volunteers (315 active and backup) to perform the same investigative responsibilities as the agency’s tiny paid staff (N = 8). Oregon is 1 of 34 states using trained and certified volunteers to investigate complaints ranging from minor food and grooming complaints to abuse, gross neglect, and even wrongful death. During the period under review, Oregon volunteers investigated 5,437 complaints and reported a 75% resolution rate. Oregon volunteers are assigned to specific facilities where they work independently, relying largely on a toll-free telephone number to keep in contact with their paid supervisors, who are centrally housed in the state capital. Volunteer ombudsmen are obliged to serve an average of 4 hours a week in their assigned facilities and are expected to complete an average of 8 hours continuing education per year. Despite this record of success, program leaders recognized that the severe shortage of paid staff seriously undermined the agency’s effectiveness.


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Of the 315 ombudsmen recorded on agency roles in 1995, 136 (43%) were telephoned by specially trained (nonombudsman) volunteers and asked to respond to a survey. Of those not contacted, 28 (9%) were unreachable because of being on leave; 113 (36%) were not contacted because they were on backup status, constituting a sort of inactive reserve; and 38 (12%) were not contacted because they had less than 4 months of service and were deemed as too inexperienced to provide meaningful responses. Of the 136 active, facility-assigned ombudsmen targeted for contact, 96 (71%) responded to the questionnaire. The callers were unable to contact 19 volunteers (14%), and 21 either refused to participate for various reasons or repeatedly deferred. The trained callers also randomly contacted 170 former volunteers from an estimated pool of at least 350 individuals who had officially resigned from the program during the previous 5 years. Of these, 147 (85%) responded to the survey. Many could not be reached because of having changed their telephone numbers. Completed telephone surveys were given to a data entry person employed by the ombudsman program.

Questionnaire Construction Having identified both encouraging and discouraging factors in the literature, a 27-item instrument was constructed by the chief investigator and program staff to use with volunteer ombudsmen. The first 2 items (1 and 2) under Discouraging Factors (see Table 1) constituted Rizzo et al.’s (1970) widely used Role Ambiguity and Role Conflict Questionnaire. Role ambiguity is assessed by six positively phrased statements such as “I felt certain about how much authority I had” and “I knew what my responsibilities were” (p. 156). Questions were arranged along a 7-point Likert-type scale ranging from strongly agree (1) to strongly disagree (7). Reliability analysis for role ambiguity in this study revealed an overall alpha coefficient of .88. Role conflict, the second half of Rizzo et al.’s scale (1970), was assessed with six negatively worded questions such as “I worked with two or more groups who operated quite differently” or “I received incompatible requests from two or more people” (p. 156). The strength of the role conflict instrument was supported by an overall alpha of .77. Factor analysis using the principle components extraction method with an orthogonal varimax rotation confirmed the role conflict and ambiguity instrument’s two dimensions and accounted for 56% of the variance in the data. The eigenvalues for role conflict and role ambiguity were 4.4 and 2.3, respectively. Each of the six scale items loaded highly on its anticipated

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Discouraging factors General factors 1. Role ambiguity 2. Role conflict 3. Boredom Resistance factors 4. Facility staff resistance 5. Government resistance Power factors 6. Insufficient legal authority 7. Low volunteer role status Program factors 8. Inadequate training 9. Inadequate supervision

Item

7 1 9 2 3 6 8 4 5

3.40 3.60 3.80 4.01 3.66 3.70

Rank

5.30 4.43 4.60

M

a

1.27 1.29

1.42 1.22

1.50 1.50

1.13 1.21 0.73

SD

Current Ombudsmen (N = 98)

4.08 3.20

4.00 4.04

2.99 3.40

4.90 4.60 4.33

M

8 2

6 7

1 4

5 3 9

Rank

1.13 1.48

1.32 1.40

1.55 1.60

1.50 1.30 0.94

SD

Resigned Ombudsmen (N = 142)

–2.60 2.68

–0.79 0.91

1.99 0.92

2.43 –1.02 2.19

t Value

Statistics

.008* .007*

.360 .911

.047* .360

.016* .310 .030*

p Value

Table 1. Factors Encouraging or Discouraging Ombudsman Efforts, Service Duration, and Facility Size by Current and Resigned Volunteers

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35.10 75.02 64.55

4.56 4.50 4.40 4.40 4.23 4.01

1 2 3 3 5 6 33.13 26.26 11.70

.76 .86 .83 .73 .86 .70 26.30 56.13 63.86

4.31 4.13 3.86 3.40 3.64 3.73

a. Ranks adjusted for comparing 5- and 7-point scales. b. Lower means always indicate less desirable outcomes and greater hindrance.

Encouraging factors Perceived satisfaction 10. Work is meaningful 11. Residents influenced by effort 12. Would endorse role to others 13. Would rejoin the program 14. Job meets expectations 15. Volunteer is satisfied Other factors 16. Months served 17. Facility beds 18. Age 1 2 4 6 5 3 24.14 49.00 11.70

1.00 1.00 1.24 1.44 1.22 1.50 2.39 2.50 0.71

2.04 2.67 3.75 3.70 2.37 1.83

.018* .013* .479

.042* .008* .000* .000* .020* .070

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factor, and no role conflict or role ambiguity item loaded above .16 on the other factor. The factor loadings for each item on its predicted factor was .51 or higher. Boredom constituted a third, hitherto unexamined, general discouraging factor (Table 1, Item 3). This was included to explore the possibility that the job’s lack of amusement or challenge might lead to lower satisfaction and higher attrition. In the paid work literature, it is axiomatic that people want challenging work, and boredom is presumed to spur work-role restlessness and lack of interest. We assessed boredom by the single statement “I found the job boring,” ranked on a 5-point scale ranging from strongly agree (1) to strongly disagree (5). The next two items comprise the survey’s resistance factors (Table 1, Items 4 and 5). Litwin and Monk’s (1984) resistance factors of nursing home administrator resistance and nursing home staff resistance were combined into a more global single factor facility resistance: “I encountered resistance from care provider staff” (includes nursing home administrators, adult foster care providers, and other facility employees). A second resistance factor was assessed by the statement, “I encountered resistance by other government agency personnel.” Government resistance had not been previously examined despite the fact that ombudsmen commonly challenge government policies and administrative actions harmful to residents (HarrisWehling et al., 1995). Anecdotal evidence suggests that government resistance can be especially frustrating to volunteers. Both resistance factors were assessed on 5-point scales of significance from (1) very significant to (5) not significant at all. Litwin and Monk’s (1984) power factors—insufficient legal authority (Item 6) and low volunteer role status (Item 7)—were measured by the respective statements, “I encountered resistance because I lacked legal authority” and “I encountered resistance because I was a volunteer.” These were measured on 5-point significance scales. Two program factors, training was inadequate (Item 8) and supervisory contact and support were inadequate (Item 9) were also measured on 5-point Likert-type agreementdisagreement scales. The next six statements (Table 1, Items 10 through 15) relate to satisfaction, loyalty, effectiveness and meaningfulness and are grouped under Encouraging Factors. We used Kahn’s (1990) discussion of psychological meaningfulness as perceived competency to ask if the job was meaningful (Item 10) and drew (loosely) from Maslach and Jackson’s (1981) work-role self efficacy subscale to ask if residents were positively influenced by their work (Item 11). Two of these single-response items were broadly adapted from Mowday et al.’s Organizational Commitment (loyalty) Questionnaire


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(1979): “would endorse the ombudsman job to others” (Item 12) and “would rejoin program” (Item 13). Each of these constructs has been closely linked to job satisfaction, which represents a person’s positive affect toward his or her work. Nevertheless, they are still considered to be different traits, although the nature of their relationship is perennially debated—a discussion not pursued here. Finally, to assess satisfaction straightforwardly, we asked the subjects if the “job met expectations” (Item 14) and how “satisfied they were with their work” (Item 15). All six items were measured on 5-point Likert-type scales. Length of service and bed capacity of facility served in were determined by program rosters (Items 16 and 17, Table 1). Finally, the last question concerned the respondents’ age (Item 18, Table 1). Two separate versions of the questionnaire were developed to reflect wording and tense appropriate to active and resigned ombudsmen respectively. Higher scores are always positive, representing, for example, both low role conflict and low government resistance and high satisfaction and job is more meaningful.

Data Analysis We used t tests to compare the perceptions of active (N = 96) and former (N = 147) volunteer ombudsmen regarding their respective experiences of the model’s encouraging and discouraging factors. Mean scores were adjusted to compare 5- and 7-point scale items, which were used to rank the order of importance for items in each of these two groupings (Table 1). Unpaired t tests were also used to compare active and resigned ombudsmen by age and months served and also to assess any differences in the bed size of assigned service facilities.

Results The mean age for both retired and active groups was 64 years, with a range of 27 to 87 years. Men (N = 80), who comprised about one third of the total group, averaged age 68, women (N = 240) averaged 61 years. The combined average job tenure for both groups was about 30 months, with men serving a longer average of 32 months, versus a 28-month average logged by women. Men tended to serve in larger facilities (bed capacity M = 74) than women (M = 59). These data are consistent with other program reports indicating that volunteer ombudsmen are overwhelmingly retired, older, and female (Dehart, 1999; Nelson, Huber, et al., 1995).

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Discouraging Factors Statistically significant differences between current and past volunteers were found in five areas of role discouragement, including resistance by facility staff, inadequate training and supervision, boredom, and role ambiguity. Former ombudsmen felt worse about each factor except training, which, although generally well regarded by both groups, is less valued by current ombudsmen. Resistance by facility staff is the most important resistance factor for past ombudsmen and second for active volunteers. There were only two blatant ranking discrepancies between the two groups. Former volunteers ranked training as better than current ombudsmen and supervision as the second most important problem, as opposed to its placement of fifth among current ombudsmen. There were no between-group differences in the four remaining discouraging factors: role conflict, government resistance, insufficient legal authority, and resistance owing to volunteer status. Of these, role conflict emerged as the most important discouraging factor for both active and former volunteer ombudsmen, although it was deemed the most significant problem by active ombudsmen as opposed to past volunteers, who ranked it third among discouraging factors. Relative ratings for government resistance, insufficient legal authority, and volunteer status show descending rates of only minor importance.

Encouraging Factors Significant between-group differences exist for five of the six satisfaction items, including meaningful work, residents affected by job, would recommend job, would rejoin (or continue with) the program, and job meets expectations. Former volunteers feel less strongly about each of these factors than do active ombudsmen. Rank-order discrepancies are minor, with both active and former ombudsmen ranking meaningful work and residents affected by job as the first and second most important motivators respectfully and job meets expectations as fifth in encouraging factor precedence. The most glaring rank discrepancy concerns the intent to rejoin (or stay with) the program, which ranks sixth among former volunteers and third among current ombudsmen.

Other Factors Significant between-group differences exist for months served (Table 1, Item 16) and facility beds (Table 1, Item 17), with former volunteers having


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served fewer months in smaller facilities. There were no significant age differences between active and resigned ombudsmen (Table 1, Item 18).

Discussion and Implications This study is one of two attempting to assess what encourages or discourages volunteer action in a legally empowered, post-1987, Older American’s Act reauthorized ombudsman program (Nelson, 1995). We found, as did Litwin and Monk 2 decades earlier (1984), that there were important differences between currently active ombudsmen and those who had resigned from the program. Former ombudsmen were more confused about their roles (role ambiguity), experienced more resistance by facility staff, desired more supportive supervision, and experienced greater boredom. As an apparent consequence, they tended to see ombudsman work as failing to meet their expectations, found it less meaningful, and as having less impact on the residents. They were also less likely than active ombudsmen to recommend the job to others or to consider rejoining the program. Surprisingly, former ombudsmen felt better about training than did current ombudsmen, although both groups rated training fairly high (3.66 and 4.08, respectively, on 5-point scales). This was in marked contrast to the low scores training received in the Litwin and Monk study (1984), where current and former ombudsmen rated training a respectively low 2.36 and 1.19 on 5point scales. One possible explanation for this is that the Oregon program simply provided better training than the program analyzed by Litwin and Monk in 1984. This is certainly plausible as the Oregon program has been nationally recognized for its innovative, multimethod, skills-based training approaches. It may also be that an added decade of experience and improved funding better positioned Oregon program leaders to instill skill, drive, and competence in their volunteers. This may also be reflected in the relatively high ratings that active and past Oregon ombudsmen accord their supervisory support (3.7 and 3.2, respectively) as compared to the much lower respective scores (2.84 and 1.28) reported by both active and former volunteers in Litwin and Monk’s 1984 study. Although the Oregon program seems better situated to cope with external resistance than did the program examined by Litwin and Monk (1984), resistance by facility staff was still ranked as the top obstacle by Oregon volunteers, as it had been in the earlier study. However, it was felt less intensely (active and past means: 3.4 and 2.99, respectively) than it was by their earlier counterparts (active and past means: 1.8 and 1.32, respectively). One obvious

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explanation for this is that the pioneering ombudsmen examined by Litwin and Monk in 1984 lacked legal access authority and other investigative powers and protections that were accorded Oregon ombudsmen in subsequent reauthorizations of the Older Americans Act. Supporting this notion is the fact that weak legal authority was a major concern for both active and resigned ombudsmen in the earlier study but not in the current analysis. Perhaps the industry has simply grown more accustomed to volunteer ombudsmen. This might be suggested in one study showing that providers prefer volunteer ombudsmen, who are typically assigned to specific facilities and hence work more closely with staff, more than paid advocates (Lusky et al., 1994), who tend to show up only when there is trouble. This may account for the virtual elimination of volunteer status as a concern to second generation ombudsmen, whereas it was once a point of considerable annoyance (Litwin & Monk, 1984). Given the widely reported complexity and role disorientation associated with the ombudsman’s complex and multifaceted job, it is surprising that role ambiguity was not of greater concern to both active and former ombudsmen. In fact, active ombudsmen in this study felt pretty clear about their role. This may have been the result of their values-based training, which strongly emphasized compliance with a partisan resident defense role (Nelson, 1995). But if this is true, why, then, do resigned ombudsmen, who feel better trained than active ombudsmen, express greater role confusion? The answer may lie in their lower evaluation of supervisory support, which ranked as their second most discouraging factor. It is axiomatic that good supervision promotes role clarity (that is what supervisors are supposed to do) and may arguably be more important in this respect than the initial 48 hours of certification training provided by the ombudsman program. Regardless, the ombudsman’s job’s multiple role dimensions and informal processes are likely to assure that even under near ideal circumstances, role ambiguity will invariably take some toll among part-time volunteers who will have fewer opportunities to be habituated to follow the job’s best practices. This study confirms earlier research indicating that ombudsmen feel more role conflict than ambiguity (Nelson, Pratt, et al., 1995). Moreover, role conflict may be even harder to ameliorate because it depends on two resource-intensive factors. First, it requires effective internal organizational socialization mechanisms (training, supervision, policies, and communication generally) that inure all organizational participants to the program’s guiding values. Second, it also requires that extraorganizational parties, including families, facility staff, regulators, and others understand the ombudsman’s lawfully mandated role—a requirement that is not being met (Connor & Winkelpleck, 1990; Harris-Wehling et al., 1995; Keith, 2000).


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The resulting disconnect breeds role conflict that may be the source of at least some of the resentment-bred resistance reported by ombudsmen. Regardless, the only means to reduce external role confusion is for program leaders to increase outreach efforts through joint training and other endeavors that communicate the ombudsman’s unique role, mission, and means of operation. However, this is an unlikely expedient given the severe resource constraints chronically facing the ombudsman program (Harris-Wehling et al., 1995). Finally, nothing in this study explains why ombudsmen serving in small, community-based adult foster care homes served an average of 16 months less than ombudsmen serving in larger nursing homes. Neither boredom nor provider resistance nor any other factor in the present model shed any light on this phenomenon. Perhaps ombudsmen feel less comfortable or too intrusive in these more intimate settings. Perhaps because adult foster homes are less regulated, problem solving may be more difficult because ombudsmen lack the leverage provided by comprehensive standards. This potentially important area cries out for further study, especially to determine if this pattern exists in other states.

Conclusion The salient limitation of this study is its single-state focus. Nevertheless, the factors examined here are drawn not only from the full history of ombudsman volunteer research and theory but from those that have prima-facie relevance to nonreimbursed service. Future researchers may shift from examining job content and context factors to personal factors such as ill health, family commitment, and lack of time, factors that have been cited as primary causes of ombudsman attrition (Schiman & Lordeman, 1989). Research might also assess the effect of job isolation and the theorized dependence of the volunteer on vulnerable patients for social support (Portland Multnomah Commission on Aging, 1989). Further analysis of role conflict and role ambiguity, provider resistance, satisfaction, and other job context and content variables may help ombudsman program leaders provide the tools necessary for volunteer ombudsmen to hone a meaningful experience. Training that assists with role clarity must be tempered with a recognition that volunteer recruits must be able to face at least some ambiguity, given the complex nature of ombudsman work. Within the context of rapidly mounting long-term care service needs, elder advocates have a stake in motivating and keeping volunteers, who have for

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decades played a crucial role in the ombudsman program’s efforts to improve conditions in long-term care.

References Cherry, R. (1991). Agents of nursing home quality care: Ombudsmen and staff ratios revisited. The Gerontologist, 31(3), 302-308. Connor, K. A., & Winkelpleck, J. (1990). Educating the volunteer: Issues in long-term care facilities. The Journal of Volunteer Administration, 8(3) 11-16. Dehart, K. (1999). The volunteer experience: Predictors of success in the long term care ombudsman role. Unpublished master’s thesis, Oregon State University, Corvallis, OR. Department of Health and Human Services, Office of the Inspector General. (1991). Successful ombudsman programs (Report No. OEI-02-90-02120). Washington, DC: Author. Harris-Wehling, J., Feasley, J. C., & Estes, C. L. (1995). Real people, real problems: An evaluation of the long term care ombudsman programs of the Older Americans Act. Washington, DC: Division of Health Care Services, Institute of Medicine. Kahanna, J. S. (1994). Reevaluating the nursing home ombudsman’s role with a view toward expanding the concept of dispute resolution. Journal of Dispute Resolution, 2, 218–233. Kahn, R. L. (1990). Psychological conditions of personal engagement and disengagement at work. The Academy of Management Journal, 33(4), 692-724. Kahn, R. L., Wolfe, D. M., Quinn, R. P., Snowe, J. D., & Rosenthal, R. A. (1964). Organizational stress: Studies in role conflict and ambiguity. New York: John Wiley. Keith, P. M. (2000). Correlates of primary orientations of volunteer ombudsmen in nursing facilities. Journal of Aging Studies, 14(4), 373-384. Litwin, H., & Monk, A. (1984). Volunteer ombudsman burnout in long term care services: Some causes and solutions. Administration of Social Work, 8, 99-110. Litwin, H., & Monk, A. (1987). Do nursing home patient ombudsmen make a difference? Journal of Gerontological Social Work, 2(1), 95-104. Lusky, R. A., Friedsam, S. R., & Ingman, S. R. (1994). Provider attitudes towards the nursing home ombudsman program. Denton, TX: Center for Studies on Aging, University of North Texas. Maslach, C., & Jackson, S. E. (1981). Maslach burnout inventory manual. Palo Alto, CA: Consulting Psychologists. Monk, A., & Kaye, L. W. (1982). Assessing the efficacy of ombudsman services for the aged in long term care institutions. Evaluation and Program Planning, 5, 363-370. Monk, A., Kaye, L. W., & Litwin, H. (1984). Resolving grievances in the nursing home. New York: Columbia University Press. Mowday, R. T., Steers, R. M., & Porter, L. W. (1979). The measurement of organizational commitment. Journal of Vocational Behavior, 14, 234-247. National Center for State Long-Term Care Ombudsman Resources, The National Association of State Units on Aging. (1989). A study of the use of volunteers by state long term care ombudsman programs: The effectiveness of recruitment, supervision and retention (DHHS-AOA No. 90-AT0401). Washington, DC: Author. Nelson, H. W. (1995). Long-term care volunteer roles on trial: Ombudsman effectiveness revisited. Journal of Gerontological Social Work, 23(3-4), 25-46.


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Nelson, H. W., Huber, R., & Walter, K. L. (1995). The relationship between volunteer long-term care ombudsmen and regulatory nursing home actions. The Gerontologist, 35, 509-514. Nelson, H. W., Pratt, C., Carpenter, C. E., & Walter, K. L. (1995). Factors affecting volunteer long-term care ombudsman organizational commitment and burnout. Nonprofit and Voluntary Sector Quarterly, 24(3), 213-231. Netting, F. E., Huber, R., Borders, K., Kautz, J. R., & Nelson, H. W. (2000). Volunteer and paid ombudsmen investigating complaints in six states: A natural triaging. Nonprofit Voluntary Sector Quarterly, 29(3), 419-438. Portland Multnomah Commission on Aging. (1989). In search of ombudsmen, 1988-1989: Executive summary. Portland, OR: Research for Marketing. Rizzo, J. R., House, R. J, & Lirtzman, S. (1970). Role conflict and role ambiguity in complex organizations. Administrative Science Quarterly, 15, 150-163. Schiman, C., & Lordeman, A. (1989). A study of the use of volunteers by long term care ombudsman programs: The effectiveness of recruitment, supervision, and retention (Cooperative agreement No. 90-AT0401). Washington, DC: National Center for Long Term Care Ombudsman Resources, Administration on Aging. Article accepted January 16, 2004.

H. Wayne Nelson, Ph.D., is an associate professor in the Department of Health Science at Towson University. His recent publications include “The Ombudsman Social Worker Alliance: Using a Resident Centered Model of Situational Conflict Tactics” and “The Older Volunteer Experience: Factors Important to Success in the Long-Term Care Ombudsman Program.” F. Ellen Netting, Ph.D., is a professor in the School of Social Work at Virginia Commonwealth University. Her recent publications include “Data From Long Term Care Ombudsman Programs in Six States: The Implications of Collecting Resident Demographics” and “Volunteer and Paid Ombudsmen Investigating Complaints in Six States: A Natural Triaging.” Ruth Huber, Ph.D., is a professor in the Kent School of Social Work at the University of Louisville. Her recent publications include “The Badrak-Borders Scales for Assessing Ombudsman Program Quality: Testing a New Tool to Evaluate Advocacy Programs” and “The Relation of Volunteer Long-Term Care Ombudsmen to Regulatory Nursing Home Actions.” Kevin W. Borders, Ph.D., is a member of the research faculty in the Kent School of Social Work at the University of Louisville. His recent publications include “Training Nursing Home Patients’ Rights Case Advocates Effective Conflict Skills” and “External Grievances Against Volunteer Advocates: Expecting, Investigating, and Managing Complaints.”