Ombudsmen play an important role in helping to ensure that the elderly are properly cared for and protected from abuse in long term care facilities. In Maryland's Montgomery County, however, we found that the review and reporting network did not provide reasonable assurance that instances of abuse occurring in long term care facilities were properly reported and resolved. Similar deficiencies were found in other counties but to a lesser degree. We also found that the State Ombudsman had not conducted annual monitoring reviews of local Ombudsman programs. Finally, we found that the Geriatric Nurse Aide (GNA) Registry, which is supposed to record the history of nurse aide abuses, did not always record such information on individuals who were found to have abused residents of nursing homes. Among other things, we recommended that Maryland's Office on Aging (OoA) take action to: (1) improve the GNA Registry to include information on findings of abuse, neglect, or misappropriation of property by a GNA, (2) improve procedures used to receive, investigate and resolve complaints timely, and (3) make the required annual monitoring visits of local Ombudsman programs. The OoA agreed with our recommendations and stated they will work diligently to implement them.