Contact in Emergency:
Name / Relationship:
1. Volunteer Experience:
2. Interests, Special Skills, Hobbies:
3. Work Experience:
4. Education Background:
5. Current Occupation:
6. Have you ever been convicted of a crime:
7. Why do you want to be a Volunteer Ombudsman?
8. Is there a group with whom you are particularly interested in working? (check all that apply):
People with mental disability
People with Alzheimer's/dementia
9. Is there any group you would not feel comfortable working with?
Yes (which groups):
10. What kind of volunteer work interests you? We provide the training and supervision. (check all that apply) You can change your choices at any time.
Observe for Advocacy: Be assigned to make regular visits to residents in a long-term care facility.
Monitoring visits: Visit a number of facilities in your area.
Complaint Investigation: We will train Volunteer Ombudsmen to do complex complaint investigations. When the Ombudsman office receives a complaint, the Volunteer will go to the facility to gather information by talking to the residents, and staff. With LTCOP supervision, the Volunteer will work toward resolution of the problem.
Be a Resident Rights Educator: Lead a group presentation on the rights of residents for facility staff, family members, or residents. We provide all needed material and help you prepare for the presentation.
Contact home care consumers who are on a waiting list to receive Independent Support Services (homemaker services) to find out how they are getting by, provide information and referral and discuss whether their needs have changed.
Be an advocate in your community. We are training bilingual individuals to reach out to the elderly and people with disabilities who need assistance in resolving problems around the quality of, and access to long-term care services. We are looking for volunteers to work within Maine's growing ethnic and minority communities.The volunteer will help the Ombudsman staff to understand cultural differences and assist the home care consumer to have a better understanding of the questions being asked through the interpreter as well as providing a comfort level for the consumer.
11. Will you be able to attend quarterly meetings? We ask all Volunteer Ombudsman to attend a minimum of two quarterly meetings/trainings each year. We schedule enough trainings throughout the state so that you can choose the sessions you want to attend.
12. Will you be able to spend a minimum of 4 hours a month on your Ombudsman duties?
13. Will you be able to keep simple records and complete regular reports to our office about your Ombudsman work? We provide a form for you to use.
14. Do you have available transportation? You will need this to complete your Ombudsman work, visiting residents and attending trainings.
15. How did you hear about our program?
16. List the names and phone numbers of two personal references (not a relative, Please):
"All long-term care consumers have the right to be treated with dignity and respect."
61 Winthrop St. l Augusta, Maine 04330
Voice/TTY: 1-800-499-0229 l Augusta Area: (207) 621-1079 l Fax: (207) 621-0509