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.     

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.     

Expanding the Role of Long-Term Care Social Workers: Assessment and Intervention Related to Urinary Incontinence

Urinary incontinence (UI) is a common and stigmatizing problem faced by long-term care (LTC) residents. It is typically addressed by medical professionals, with social work rarely involved. The purpose of this article is to illustrate how social workers can address the psychosocial implications of UI while working with residents and their family members as part of an interdisciplinary team. Using a case example and the NASW objectives for LTC, recommendations on how the role of the LTC social workers can be expanded to better address both the needs of residents, families, and the larger LTC system are provided.     

Planning end-of-life care for patients with dementia: roles of families and health professionals

We examined families' end-of-life decision making and their interactions with health professionals. Twenty-eight family members of institutionalized dementia patients participated in four focus groups. We found that participating family members were not well prepared for their decision-making roles, and that they: 1) experienced substantial burdens and loss in caring for institutionalized elders; 2) had limited understanding of the natural progression of dementing conditions; 3) were uncomfortable in setting goals for their relatives' end-of-life care; 4) had little experience with death, and were ambivalent about the anticipated death of their relative; and (5) reported that they had little substantive communication with health professionals regarding end-of-life care planning. We concluded that many of the needs of such families could be addressed through improved application of the principles of advance care planning, including regular structured discussions, involvement of surrogate decision-makers, and anticipation of clinical decisions. Health professionals should take the lead in 'normalizing' the discussion of death.     

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.     

Nursing Home Social Services Directors Who Report Thriving at Work

Nationally representative data from a sample (n?=?928) of full-time nursing home social services directors were used to investigate whether knowing characteristics of the social environment at work can help to explain which directors report job thriving. Two-thirds of directors reported they were thriving in their jobs. Multiple regression results show that thriving is increased by job autonomy, being treated like an important part of the team, having enough time to identify and meet resident psychosocial needs, not having to do things that others could do, and being clear what the social services role is. Findings suggest that addressing these aspects of the social environment and social services role will likely contribute to increasing a sense of thriving at work among social services staff members.     

Psychosocial Care in Nursing Homes in the Era of the MDS 3.0: Perspectives of the Experts

Meeting psychosocial needs of nursing home residents is increasingly regarded as a critical component of care, and the nationally-mandated nursing home care screening instrument— the Minimum Data Set (MDS) 3.0—was modified and implemented in 2010 to promote better assessment of psychosocial needs and health. Recognizing the importance of psychosocial well-being among nursing home residents, and the promise of MDS 3.0 for improving psychosocial care, this article reports recommendations derived from a conference of stakeholders representing diverse disciplines and organizations regarding next steps following MDS 3.0 screening. Results relate to seven areas of psychosocial care and address cross-cutting recommendations to improve psychosocial care.