Add to ORKGThis paper reports the results of a national comparative study of nursing home ombudsman programs for the institution-alized elderly. Of recent origin, patient representative programs have received little critical assessment as to their success in improving the quality of life of America's most vulnerable aged. At the same time, anticipated increases in the number of institutionalized aged coupled with current austerity measures in the health and human services underscores the present and future need to design effective and efficient monitoring/advocacy mechan-isms to prevent abuses in long stay institutions. The paper focuses on a de--56-scription of the current configuration of state and local sector roles and re-sponsibilities in ca...