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Systems Advocacy Tip Sheet

Definition: Systems advocacy is advocacy aimed at making a change in the more global issues impacting the consumers
we serve. This type of advocacy is directed towards concerns that are not within the scope of facility policy or practice
and require action by legislators, regulators or government officials. Examples of systems advocacy include: in increase
in staffing ratios required by state and federal regulations, an increase in the resident’s monthly personal needs
allowance (PNA), securing an increase in SSI-designated bed reimbursements in personal care homes or training
requirements for facility staff.

The Final Federal Rule, enacted in 2016, mandates that all ombudsmen engage in systems advocacy.

Here in Pennsylvania, systems advocacy is directed by the residents we serve. Through our large network of PEERs, our
program has regular dialogue with our PEERs and residents. During these conversations, ombudsmen are made aware
of priority issues that require attention. Based on the concerns brought forth by the residents, research is conducted
and options are presented for action. With the guidance of our State Ombudsman and the direction of our residents,
local ombudsmen are then asked to assist in the effort to effect change.

Provided to: Residents residing in nursing homes, assisted living facilities, personal care homes, older adult daily living
centers (OADLC) and domiciliary care homes

When/How: Because legislative or regulatory change is often required to achieve the preferred resolution, systems
advocacy is often a complex and lengthy process. In Pennsylvania, resident surveys/interviews are often used to obtain
the information and details needed to compel change. In a simplified explanation, the “steps” of systems advocacy are
as follows:

1) Gathering resident information and direction via conference calls, personal interviews, surveys (conducted by
both state office staff and local ombudsmen)
2) Compiling local data/details into a statewide profile or impact statement (completed by state office staff)
3) Exploring the systems structure that needs to be engaged in discussions
4) Connecting with the people identified to be influencers in that systems structure
5) Educating those influencers on the concerns of the residents and the issues created by the current “system”
6) Delivering the “ask” – i.e. explaining the change needed/resolution requested
7) Follow-up as needed with more information, answers to questions, thank-you’s, etc.
8) Continue to repeat the process until success is achieved.

Systems advocacy is usually a statewide effort with instructions and technical assistance being routinely provided by
your regional ombudsman specialist. Each year, our program conducts a statewide resident survey in conjunction with
resident rights month. Each local program is then asked to implement the survey during facility visits and send
information obtained back to the state office designee. This information is used to direct our program and to help us
create training modules for use with facility staff. The survey provides the resident’s perspective and preferences in
regards to the message the staff need to hear.

Sometimes, systems advocacy can have a local component. A facility in the northwest region had a main access road
that wasn’t paved. The residents found it difficult to walk or use their wheelchair out front because of the lack of

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