What Is an Ombudsman and Why Do Notaries Public Need to Know About Them?
Written by Beth Hathoot
Edited & Updated 09/2026
What does an Ombudsman have to do with notarizing an Advance Directive? For Notaries working in hospitals, nursing homes, and other care facilities, the answer may be more important than you think. Learn why certain documents can have special witness requirements—and why Notaries should know when an Ombudsman or patient advocate may be involved.
An Ombudsman is essentially a patient advocate for residents in healthcare settings. When asking for assistance in a facility, you may also hear terms such as social worker, patient representative, patient liaison, patient relations counselor, crisis resolution specialist, and other names or titles used for individuals who assist patients or residents. However, these positions are not necessarily the same as an Ombudsman. Ombudsmen and representatives of the Long-Term Care Ombudsman Program must meet specific program requirements and operate under state and federal regulations.
The Ombudsman Program grew out of efforts by both state and federal governments to respond to widely reported concerns that vulnerable peoples living in long-term care facilities were subject to abuse, neglect and substandard care. The program is made up of many volunteers and some employee staff. Their job it is to identify, investigate, and resolve complaints made by or on behalf of residents of nursing homes, assisted living facilities, adult foster care or long-term care homes, skilled nursing centers and even hospitals. They are trained to resolve problems and are a liaison between the patient and the facility. This service is generally free to the patient.
Under the federal Older Americans Act, every state is required to have an Ombudsman Program. Most state programs are run by the state's Counsel on Aging.
So, what does that have to do with Notaries?
Oftentimes, as a Notary who does ‘General Notary Work’ and not just loan signings, we will be called to notarize Powers of Attorney, Advance Directives, and other health-care planning documents. Doing that all by itself does not ring any bells except for three particular situations:
1- the POA is part of a Living Will or Health Directive and/or
2- the signer is in one of the types of facilities listed above and/or
3- you and the signer are in the state of California, Delaware, District of Columbia, or South Carolina. These states have specific requirements that involve an Ombudsman or Patient Advocate.
Some states have specific requirements for certain Advance Directives and health-care documents when the signer is in one of these facilities. Depending on the state and the document, those requirements may involve an Ombudsman, patient advocate, or another designated individual. For instance:
California - If you are a patient in a skilled nursing facility, the ‘Advanced Directive for Healthcare’ document must be witnessed by a patient advocate or ombudsman as required by California law.
Delaware - If you are a resident of a sanitarium, rest home, nursing home, boarding home or related institution, the ‘Advance Healthcare Directive’ document will require one of the witnesses to be a patient advocate or ombudsman designated by the Division of Services for Aging and Adults with Physical Disabilities or the Public Guardian.
District of Columbia - If you are a patient in a skilled care facility, one witness must be a patient advocate or ombudsman when signing the ‘Declaration’.
South Carolina - If you are a patient in a hospital or skilled care facility, one witness must be a patient advocate or ombudsman when signing the ‘Declaration of a Desire for Natural Death’.
In addition to these states, there is Vermont that has an additional special requirement. If you are a patient in a hospital, nursing home or residential care facility, an authorized individual must explain the nature and effect of the 'Advanced Directive' and sign a statement confirming that the explanation was provided. An Ombudsman is one of several individuals authorized to provide this explanation.
Each of our 50-states have their own requirements for who can be the witness on these documents, how many witnesses are needed, if you need it notarized and witnessed, or just notarized, or just witnessed. The rules are exhausting.
I have included a view-only spreadsheet covering all 50 states for your reference below.
Please Note: This spreadsheet is provided as a view-only educational reference. Laws and requirements can change, so always verify current information with the appropriate state government source.
This applies to the types of documents we would typically see in a Living Will. Living Wills are the persons statement of how they want their care orchestrated when they are no longer able to voice that for themselves.
Living Wills can go by different names in different states. That would include terms like:
Health care Directive
Medical Directive
Advanced Directive for Health care
Durable Power of Attorney for Health Care
Declaration to Physician
Declaration of Living Will
Declaration
Advanced Directive
Health Care Proxy
Medical Power of Attorney
These regulations are not something you would normally find in your state notary handbook. Rather, they are a set of regulations set forth by your state governor. In addition to that, you can find your state specific Living Will (or whatever the term is for your state) document sets on your states .gov website.
Sources & References
Written by Beth Hathoot for Notary Stars
Originally Published: 10/19/2022
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