Measures of emergency preparedness contributing to nursing home resilience

ABSTRACT

Resilience approaches have been successfully applied in crisis management, disaster response, and high reliability organizations and have the potential to enhance existing systems of nursing home disaster preparedness. This study’s purpose was to determine how the Center for Medicare and Medicaid Services (CMS) “Emergency Preparedness Checklist Recommended Tool for Effective Health Care Facility Planning” contributes to organizational resilience by identifying the benchmark resilience items addressed by the CMS Emergency Preparedness Checklist and items not addressed by the CMS Emergency Preparedness Checklist, and to recommend tools and processes to improve resilience for nursing homes. The CMS Emergency Preparedness Checklist items were compared to the Resilience Benchmark Tool items; similar items were considered matches. Resilience Benchmark Tool items with no CMS Emergency Preparedness Checklist item matches were considered breaches in nursing home resilience. The findings suggest that the CMS Emergency Preparedness Checklist can be used to measure some aspects of resilience, however, there were many resilience factors not addressed. For nursing homes to prepare and respond to crisis situations, organizations need to embrace a culture that promotes individual resilience-related competencies that when aggregated enable the organization to improve its resiliency. Social workers have the skills and experience to facilitate this change.     

Self-efficacy and psychological well-being of nursing home residents in China: the mediating role of social engagement

Abstract

The purpose of this study was to explore the role of self-efficacy and social engagement in psychological well-being of Chinese nursing home residents. A total of 307 residents completed the measurement of social engagement, self-efficacy and psychological well-being. The results showed that satisfaction with physical environment, social support, social activity engagement and self-efficacy were all positively correlated with psychological well-being. At the same time, social engagement partially mediated the effect of self-efficacy on psychological well-being. The results of this study should indicate additional actions for managers of nursing homes and social workers to improve the psychological well-being of older adults.     

Calling the question of "possible dying" among nursing home residents: triggers, barriers, and facilitators

Glaser and Strauss reported decades ago that in order for a person to be treated as dying, he/she must be defined as dying. Defining nursing home residents as "dying" can be complicated because most residents are in advanced old age with multiple chronic conditions. Using a social construction theoretical framework, this study looks at the step before the declaration of dying, that is, the consideration of the possibility of dying. This qualitative study is a secondary analysis of prospective data collected during 16 months of fieldwork on behalf of 45 nursing home residents whose health was considered declining. The purpose of this paper is to build understanding about the social construction of "possible dying" by reporting triggers that can call the question of possible dying and stimulate a discussion about the nursing home resident's status, prognosis, care options, and preferences. These triggers include: Health status decline; noncompliance with diet or medications; available medical interventions not being well suited for the residents; and family consideration of an out-of-town trip. The paper also reports barriers (family, staff, and disease process) and facilitators to calling the question of possible dying, including families having a sense of treatments they would like to avoid and having the opportunity to talk through options. Findings are discussed in light of basic assumptions of social construction. Implications for social workers include helping residents, families, and staff anticipate and address the possibility of dying, and to reflect these discussion in care plans, as well as the need to be available to help residents and family members with psychosocial issues related to living and dying in the nursing home setting, including the profound issues that can be provoked or exacerbated by resident health status decline and possible dying.     

Understanding the impact of early-life trauma in nursing home residents

Reactions to early life trauma can reemerge or be exacerbated in later life as coping resources and abilities are compromised by age-related changes and declines in health. For newly admitted nursing home residents, this can impact their receptiveness to assistance with care and elicit challenging reactions to environmental and situational triggers. Unfortunately, current assessment tools fail to account for reactions to early-life trauma. In this article, we review existing literature on early-life trauma and aging and introduce a hypothetical case to illustrate the importance of identifying nursing home residents with past trauma experiences.     

The probability of nursing home use over a lifetime in Australia

This article further develops the life table models used in the USA by taking advantage of the superior data available in Australia. The probabilities of nursing home use over a lifetime are estimated for various ages for men and women. The results show that over one-third of the members of a female birth cohort will eventually enter nursing homes for long-term care at least once. The corresponding probability for males is one in five. A woman at age 65 faces a probability as high as 39% of using a nursing home for permanent care before her death compared with 25% for a man at age 65.     

Nursing home social services directors and elder abuse staff training

In a nationally representative study of 1,071 nursing home social services directors 80% of social services departments provided resident rights training and 60-70% were involved in abuse training. Departments headed by recent grads and in chain nursing homes or in the northeast were more likely to be involved in training. Seventy-two percent of social services directors were able to provide one-on-one training about reporting suspected abuse; education and licensure were related to ability to train.     

Ombudsman program characteristics related to nursing home abuse reporting

The purpose of this research is to determine if there is an association between ombudsman report rates of abuse, gross neglect, and exploitation from 1997 through 2002 and ombudsmen's public and staff education, investigative process, program expenditures, and census demographics. Data were obtained from the National Ombudsman Reporting System. Ombudsman annual reports of nursing home abuse, neglect, and exploitation are representative of that state's individual program. These reports should not be construed to represent all abuse in nursing homes. Physical abuse and resident-to-resident abuse were the highest rates of abuse reported. Census demographics and ombudsman program characteristics were associated with rates of abuse.     

Two-sided intergenerational moral hazard,long-term care insurance,and nursing home use

Two-sided intergenerational moral hazard occurs (i) if the parent’s decision to purchase long-term care (LTC) coverage undermines the child’s incentive to exert effort because the insurance protects the bequest from the cost of nursing home care, and (ii) when the parent purchases less LTC coverage, relying on child’s effort to keep him out of the nursing home. However, a “net” moral hazard effect obtains only if the two players’ responses to exogenous shocks fail to neutralize each other, entailing a negative relationship between child’s effort and parental LTC coverage. We focus on outcomes out of equilibrium, interpreting them as a break in the relationship resulting in no informal care provided and hence high probability nursing home admission. Changes in the parent’s initial wealth, LTC subsidy received, and child’s expected inheritance are shown to induce “net” moral hazard, in contradistinction to changes in child’s opportunity cost and share in the bequest.     

The home visit in child protection social work: Emotion as resource and risk for professional judgement and practice

This article conceptualises the role of emotion in social work home visits. It draws on findings from a qualitative study of initial child protection home visits in the United Kingdom. The research used narrative interviews and focus groups to examine how emotions arising from visits were registered in social workers' narratives. These visits were often challenging; social workers needed to manage their own emotions and those of the family, while at the same time investigating concerns and assessing need. This article identifies seven key emotional experiences associated with the home visit from the perspective of the social worker: going into the unknown; being intrusive; being disliked; fear of harm to self; fear of causing or allowing harm; pain, disgust, and distress; and “absorbing” emotion. It is argued that emotion plays a central role in home visiting and that professionals' emotional responses have important implications for the way they make sense of, and manage, home visits. Emotion is therefore conceptualized as both a potential resource and risk for social workers' professional judgement and practice.     

Current Realities

This article reports survey data from nursing home professional social workers on their practice circumstances, prior education and training, and current training needs. This data supports the growing body of evidence that a significant portion of social work practitioners are unlikely to have received the depth of information and the specialized skills required to work with the aged and their families during their formal education. Assuming limited personnel and time, and the responsibility of many different persons for psychosocial care -the practice reality in nursing homes today-- this data can guide education and training efforts.     

The living-dying interval in nursing home-based end-of-life care: family caregivers' experiences

Guided by concepts from the living-dying interval ( Pattison, 1977 ) this study sought to explore family members' experiences with a dying nursing home resident. In-depth interviews were conducted with 31 caregivers of residents who had died. Interviews were audiotaped and transcribed. Themes that illuminated families' experiences on the living-dying interval were: an acute medical crisis (trigger events, accumulation of stressors, level of care crisis); the living-dying phase (advance care planning, hospitalization, end-stage decisions); and the terminal phase (beginning of the end, awareness of dying). The results illustrate critical periods for social work intervention with families of dying nursing home residents.     

Performing child protection: home visiting, movement and the struggle to reach the abused child

Social work and child protection literature, policy and practice discussions largely ignore the core experience of doing the work. Little attention is given to where it is performed, and in particular, the practice of home visiting and the emotions and challenges of accessing children it gives rise to. Although it is the methodology through which most child protection goes on, the home visit is virtually ignored, as the emphasis in policy and practice texts is increasingly on what happens in the office, at the computer and in inter-agency collaboration. Examining scenes from home visiting practices and child death inquiry reports – Baby Peter, Victoria Climbié and Jasmine Beckford – the paper identifies the core problem of contemporary child protection as being social workers (and other professionals) not moving in rooms or around houses to meaningfully engage with, touch or examine children. Analysing practice through the sociology of 'mobilities' and psychodynamic social work theory, the paper provides new ways of understanding social work experience as forms of embodied movement. It uses the concept of 'containment' to suggest ways in which practitioners can be supported to use their bodies to move more and better in performing child protection to the benefit of children, other service users and themselves.     

Unmet patient need in home care under managed care

Social workers in home care agencies obtained through a national random sample responded to a mail questionnaire that examined the relationship between the frequency of discharge with unmet patient need and patient/family characteristics, agency auspice, and practice activities when social workers' assessment of patient needs and managed care payment limits conflict. Regression analysis found that the importance of social work financial planning with clients and intra-agency advocacy were significant negative contributors, and patient cognitive impairment, inadequate family care, and agency auspice were significant positive contributors to a regression model explaining 31 percent of the variance in the frequency of discharge with unmet need. Implications for practice, education, and research are discussed.     

Informal Caregivers of Institutionalized Dementia Residents

When older adults are placed in nursing homes, care- giving responsibility continues, despite long held beliefs to the con- trary. Although the American family is in transition, bonds of care- giving and of filial responsibility are strong and persist into old age. Knowledge about characteristics of caregivers who have actually placed their relative in a nursing home is limited. The purpose of this study is to examine whether demographic and facility-related char- acteristics as well as knowledge about dementia and participation in support groups and workshops are signif~cant predictors of burden in caregivers of institutionalized dementia residents. Sixty-seven per- cent of caregivers of residents in a dementia unit in a nursing home participated in the study. Overall, the regression explained 68% of the variance in burden and was highly simcant statistically. In- formation gained from this study will assist social workers in mak- ing referrals to nursing homes or in direct practice with cognitively impaired nursing home residents and their families.     

Mental Health Problems and Behavioral Disruptions in Nursing Homes:

This paper describes a study that examines knowledge of mental health problems and management of behavioral disruptions by social workers in nursing homes. Since a significant number of nursing home patients have mental health problems (estimates range from 50 to 80 percent) which present behavioral disruptions, this knowledge is critical. Results indicate that social workers are not prepared to provide needed services because they do not have adequate knowledge about the management of behavioral disruptions or the identification of mental health problems of nursing home patients. Recommendations are that social workers employed in nursing homes should have gerontological training and that national policy changes are needed to develop guidelines for qualifications of nursing home social workers. Nursing homes are not meeting the needs of older adults with mental health problems when social workers do not have the knowledge needed to provide nursing home services.     

State Variations in Nursing Home Social Worker Qualifications

ABSTRACT

This is the first published account of state administrative code variations in nursing home social worker qualifications. It is important to review state codes because the majority of nursing homes in the U.S. have fewer than 121 beds and therefore are not required by the federal government to employ at least one full-time qualified social worker. States have the option of extending the federal regulations to homes with 120 or fewer beds, or strengthening the federal requirements in other ways. Findings indicate enormous variation in state requirements for qualifications of nursing home social workers, and even when states define a qualified nursing home social worker (not all do), they often exempt facilities from employing one. Seven states were found to be out of federal compliance. Research describing the qualifications of people employed in nursing home social services is called for, as well as research documenting effective psychosocial interventions, especially as they relate to resident quality of life. Ten recommendations for enhancing nursing home social work services are included.     

社会工作理论视角下农村养老机构建设研究——以荥阳市五保供养幸福园为例

目前解决农村养老问题的一个重要政策就是建设农村五保老人养老院。然而在实践中,农村养老院的运营仍存在着诸多的问题,如何建设物质保障与精神支撑并重的专业养老机构成为重中之重。本文试从社会工作专业视角来介入农村养老机构的建设中,从农村养老的主体——养老机构的角度出发来培养其优势视角的理念,引入增权和抗逆力的积极概念来增强老年人的生活幸福感。     

Social Worker as Client: My Education as a Family Member in a Nursing Home

A social worker's professional experience in providing a service does not necessarily ease her own personal stress when she is the recipient of that same service. The author is a nursing home social worker whose own mother was a resident in the facility where she works. Her first-hand experience with the "system" and with her emotions brought new enlightenment to the practice of her profession.     

Responding to the 2015 CMS Proposed Rule Changes for LTC Facilities: A Call to Redouble Efforts to Prepare Students and Practitioners for Nursing Homes

In July of 2015, the Federal Register published for public comment proposed rule changes for nursing homes certified to receive Medicare and/or Medicaid. If the final rules are similar to the proposed rules, they will represent the largest change in federal rules governing nursing homes since the Nursing Home Reform Act which was part of OBRA 1987. The proposed changes have the potential to enhance the quality of care and quality of life of nursing home residents. Many of the proposed changes would directly affect the practice of social work and would likely expand the role for nursing home social workers. This article discusses the role that members of the National Nursing Home Social Work Network (NNHSW Network) played in developing and submitting a response to CMS. The article provides the context for the publication of the proposed rules, describes the process used by the NNHSW Network to develop and build support for comments on these rules, and also includes the actual comments submitted to CMS. Social work education programs and continuing education programs throughout the country will continue to have an important role to play in helping to prepare social work students and practitioners for a career in long-term care.