National Ombudsman Reporting System (NORS) 10/31/2024 Or If No Referral .

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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 0985-0005Expiration Date: 10/31/2024Table 1: Part A-Case Data ComponentsEach case must contain a complainant, complaint code (s), a setting, verification, resolution, and information regarding whether a complaintwas referred to another agency or if no referral was made. Case and complaint data reported is only for those cases and complaints that wereclosed within the fiscal year.ElementNumberDataElementDefinitionQuantifier TypeCodes and ValuesCA-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.NA (not a coded element)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 coded element)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 afterthe case 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.See Part C definitions (Element Number CA04, Data Elements 01, 02 & 99).99-Other settingCA-05ComplainantComplainant: anindividual (i.e.,resident, residentrepresentative,family) ervices regardingone or morecomplaints madeby, or on behalfof, residents.SingleAlphanumericCode01. Resident02. Residentrepresentative,friend, family03. Ombudsmanprogram04. Facility staff05. Representative ofother agency orprogram06. Concerned person07. Resident or familycouncil08. UnknownSee 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.2

Table 1: Part B - Complaint Data ComponentsElement DataNumber ElementDefinitionQuantifierTypeCodes and ValuesExamples and Reporting TipsCD-01ComplaintnumberThe uniqueidentifier used foreach complaint.SingleAlphanumericNot Applicable (NA )This is auto-created by the state softwareprogram.DateComplaintOpenedMonth, day andyear thecomplaint wasopened.SingleDateNA (not a coded element)DateComplaintClosedMonth, day andyear thecomplaint wasclosed.SingleCD-02CD-03(not a coded element)Each complaint must have only one complaintopened date.The complaint opened date must be on orafter the case opened date and on or beforethe case closed date.DateNA (not a coded element)Each complaint must have only one complaintclosed date.The complaint closed date must be on or afterthe case opened date and on or before thecase closed 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 ValuesA.B.C.D.E.F.G.H.I.J.K.L.CD-05Perpetrator Person(s) whoappears to havecaused the abuseor neglect orexploitation.MultipleAbuse, GrossNeglect,ExploitationAccess toInformationAdmission,Transfer, EvictionAutonomy, ChoiceFinancial, PropertyCareActivities andSocial aints aboutan Outside AgencySystem/Others(non-facility)01-Facility Staff,Examples and Reporting TipsFor the full list of codes and values, seeTable 2.02-Another ResidentOnly used for Abuse, Gross Neglect, andExploitation complaints A01 to A05.03-Family, ResidentRepresentative, FriendThere can be multiple perpetrators for eachcomplaint.99-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.Single01-Verified02-Not verifiedEach complaint must have a verification status(verified or not verified.)5

Element DataNumber ElementDefinitionQuantifierTypeCodes and ValuesExamples and Reporting TipsCD-08Final resolution oroutcome of thecomplaint.SingleAlphanumericcode01-Partially or fullyresolved to thesatisfaction of theresident, residentrepresentative orcomplainant.Each complaint can have only one dispositioncode.Complaintdisposition2- No action neededor withdrawn by theresident, residentrepresentative orcomplainant.3- 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-Nursing Facility(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 who bringsa complaint to the Ombudsman program regarding one or moreresidents.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-06Referral 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 serving olderadults and adults with disabilities.CD-06Do not report complainants that wish to beanonymous as “unknown,” unless thesource is not known to the Ombudsmanprogram.9

ElementNumberData ElementDefinitionCD-0602-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-0603-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-0604-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-0605-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-0606-NoneNo referral was made.CD-06.199-OtherOther: Any other entity to which a referral is made.Examples and Reporting Tips10

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 Month, day, and Single Date NA (not a coded element) The year of case closure must be in the

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