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.     

Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.     

The Role of the Nursing Home Social Worker in Terminal Care

This study examines the role of the nursing home social worker in terminal care. Questionnaires were distributed to 60 social workers in 14 nursing homes in the greater Milwaukee area. The hypothesis was that the presence of policies/procedures governing terminal care would be related to a decreased amount of stress for social workers. This correlation was not supported by the survey results. Although 71% of respondents indicated no policies were available to them, only 32.6% of social workers reported that terminal care was a source of stress. In fact, 59% reported that the social worker's role in terminal care had not been discussed in the social services department of their facility. Comparative lack of stress for social workers may be related to the lack of perception that social workers play a significant role in the terminal care of residents.     

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.     

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.     

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.     

Practice challenges at the intersection of child protection and mental health

This paper examines the complexity of collaboration between child protection and mental health services, where a parent has a mental illness and there are protection concerns for children. The paper reports on data from focused in‐depth interviews with 36 child protection workers, adult mental health workers and child and youth mental health workers. Data were analysed thematically, using NVivo to facilitate data management and analysis. Two dimensions were identified. The first, the process of collaboration, relates to four factors that assisted the collaborative process: communication, knowledge, role clarity and resources. The second dimension considers the challenges presented to collaborative work when a parent has a mental illness and a child is in need of protection, and identifies issues that are inherent in cases of this kind. Two types of challenge were identified. The first related to characteristics of mental illness, and included the episodic and/or unpredictable nature of mental illness, incorporating information from psychiatric and parenting capacity assessments, and the provision of ongoing support. The second type of challenge concerned the tension between the conflicting needs of parents and their children, and how this was viewed from both the adult mental health and the child protection perspective. Implications for policy and practice are identified in relation to the need for service models that provide ongoing, flexible support that can be intensified or held back as needed.     

Facility Organizational and Facility Resident Characteristics in Nursing Homes Serving Residents With a Mental Health History

ABSTRACT

The prevalence of mental health disorders among nursing home residents has been noted. The purpose of this study was to identify characteristics among nursing homes serving residents with a mental health history. A retrospective, cross-sectional design was conducted using the 2003 national Online Survey, Certification, and Reporting facility data merged with the resident-level Minimum Data Set resulting in 2,499 nursing homes. Across facilities, 22% of the total residents had a diagnosis of a mental disorder not including any form of dementia. Among those with a mental health history, 53% of facility residents had depression and 37% had schizophrenia.     

An Inclusive Approach to Knowledge for Mental Health Social Work Practice and Policy

As the integration of health and social care services progressesin the mental health sector, there is concern that mental healthsocial workers are disadvantaged, relative to health professionals,because they cannot identify the knowledge base for their practice.This paper argues that this concern is partly the product ofassuming that the knowledge base has to be premised upon randomizedcontrolled trials. Instead, it proposes a non-hierarchical frameworkbased on that developed in health research in Canada by Upshurand colleagues that generates a typology of knowledge whichis congruent with the main forms of inquiry that are relevantto mental health social work practice. The framework recognizesthe contribution of randomized controlled trials to the knowledgebase but also validates knowledge drawn from qualitative, epidemiological,practitioner and user knowledge. It is argued that the frameworkprofiles a wider knowledge base than that promoted by conventionalevidence-based practice, and also could be a basis for futuredevelopment of the research agenda in mental health social work.     

Social Work Gerontological Practice: The Need for Faculty Development in the New Millennium

There is a pressing need to upgrade the gerontological knowledge and skills of practicing social workers. Geriatrics and gerontology, as specialized fields of knowledge, have not been sufficiently integrated into formal academic training programs. There are major trends in the health care environment which impact on social work education, including technological advances, a shift from inpatient to outpatient and community care settings, increasing diversity of the older population, and client and family participation in decisionmaking. These trends necessitate social work education to emphasize new content areas in gerontology and the development of new skills in clinical, case management, care coordination, and teamwork. A significant obstacle to the preparation of future social workers to deliver the complex services needed by older adults and their families is a serious shortage of social work faculty in gerontology. Sustained and broad initiatives, such as the John A. Hartford Foundation funded Geriatric Social Work Faculty Scholars Program, are needed to develop academic and practice-based faculty in gerontology. This is crucial if social work is to maintain an important service role in the new millennium.     

A Leadership Training Group for at Risk Fifth & Seventh Graders: Results from A Brief Strength-Based Group Program

ABSTRACT

An increasing number of youth are exhibiting social, emotional, and behavioral problems that hinder their ability to function at grade level. Subsequently, school mental health services have not been able to address the need for services particularly among students who are minority and poor. A mixed methodology study was conducted to determine the treatment outcomes from a brief strength-based leadership training group for primarily students who are African American and poor. Pre–post scores on three scales and focus group data revealed significant positive changes in regard to internal areas of functioning and social skills, anger management skills, and school attitude. Gender and age significantly impacted outcomes.     

Stress and Pressures in Mental Health Social Work: The Worker Speaks

Two-thirds of councils with social services responsibilities(CSSRs) took part in a UK survey of mental health social workers.A one in five sample of front line workers was drawn, and 237respondents completed a questionnaire and diary about theirwork context and content, and their attitudes to their work,their employer, mental health policy and the place of mentalhealth social work in modernized mental health services. Thequestions, that called for free-text responses, were completedin detail and at length. This paper reports the results of aqualitative analysis of these responses using NVIVO software.The paper is structured around the themes emerging from theanalysis: pressure of work; staffing matters; job satisfactionand well-being; recruitment and retention issues; and beingvalued. The conclusions are that the social workers value faceto face contact with service users, and that their commitmentto service users is an important factor in staff retention.The most unsatisfactory aspects of their work context arisefrom not feeling valued by their employers and wider society,and some of the most satisfactory from the support of colleaguesand supervisors. Without attention to these factors, recruitmentand retention problems will remain an unresolved issue.     

Medicalization of Social Workers in Mental Health Services in Hong Kong

Correspondence to Dr Kam-shing Yip, Associate Professor, Department of Applied Social Studies, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong. E-mail: ssksyip{at}polyu.edu.hk Summary Medical dominance is a crucial problem in social work practicein mental health services. This paper is an examination of theresponse of social workers to medical dominance in mental healthservices in Hong Kong. To explore the process and the effectsof medicalization of social workers, sixty-three social workersin various areas of mental health service settings were interviewed.Their reaction and daily performance in facing medical dominancewere analysed and evaluated. The findings show that facing medicaldominance was a common occurrence for social workers in variousmental health services in Hong Kong. Conflict existed betweenthe rationalization of medical knowledge by medical professionals,and social work rationalization of social work knowledge bysocial workers. The process of medicalization consisted of fivestages: ignorance of medical dominance, confronting medicaldominance, compromise with medical dominance, acceptance ofmedical dominance and internalization of medical dominance.The findings also show that medicalization was influenced bythe organizational and team context.     

BJ Spitler: geriatric care management pioneer

The late BJ Curry Spitler pioneered a new geriatric care management business model that combined care management with home health services and emphasized high levels of training and professionalism for all members of the caregiving team. After working with BJ to write a marketing plan emphasizing quality, I learned to appreciate what she did when my mother needed "assisted living at home" services from the firm. Thanks to BJ Curry Spitler and her vision of helping seniors age in place, more elders are able to remain independent in their own homes with dignity and safety, and peace of mind for their families.     

THE ELDERLY BLIND IN NURSING HOMES

This article addresses a number of issues surrounding the problem of delivering services to elderly blind residents in nursing homes. It is pointed out that general public misunderstanding, blind service agencies' lack of resources and general nuising home problems like high staff turnover rates make it difficult to establish ongoing effective training programs. It is argued that rigorously evaluated trainings could solve some of the problems involved in coordinating the blind service system and nursing home network to establish a national in-service training policy on blindness for staff who work with elderly blind in nursing homes.     

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.     

Deregulation,workplace, and women: Nurses in private health care in India

The paper examines the growth of private health care in India in the context of its regulatory provisions and questions the work and employment conditions of female care workers (nurses) employed there. Nurses constitute 80% of the total workers in each nursing home/hospital. In the wake of increased demand for private health care since mid‐1990s, insertion of technology and investment is inducing transformation of nursing homes into multi‐ and super‐speciality hospitals resulting in changes in work organization of nurses. This has led to demand for larger numbers of workers. Employers gain by the segmentation in the nursing labor market, paying low wages. Workers face widespread social discrimination, long working hours, and high work intensity. The deplorable situation of a significant section of workers employed in this sector indicates state failure to control the private health sector. Lack of effective standards of work impacts nature of work of the workforce employed in various levels in the healthcare system.     

Pathways to Service for Older Persons

Abstract

As services for older persons continue to shift from hospital and nursing home care to greater reliance on support for care at home, the need to understand the ways older persons obtain services becomes more important. This study examines the use of home-delivered meals as a case study to gain insight into the process of service use from the recipients' point of view. It explores the research question: What are the pathways by which older persons acquire home delivered meals? Narrative analyses of structured and unstructured questions asked of thirty frail older persons suggested that the process of acquiring home delivered meals was accompanied by patterns of adjustment in shifting between independence and dependence in managing loss of physical function, and themes of isolation, loss, and abandonment. The results provide insights for social workers in providing the support needed for the role transition that service acceptance symbolizes for older adults.     

A Model for Community-Based Mental Health Services for Older Adults:

The mental health needs of older adults have historically been underserved by existing mental health service delivery systems. This paper presents a model for the delivery of comprehensive mental health services to older adults in their own homes, based on sound clinical practice, and incorporating a cross-cultural perspective coupled with a strong social and community support base.