Improving Psychosocial Care in Nursing Home Settings: The Next Challenge

Abstract

Imagine the nursing home setting in the United States as a place in which stronger research and connections are tested in a social laboratory-type setting, where strategies to improve the psychosocial well-being of nursing home residents are implemented, and social work's contributions to resident quality of life and quality of care are better articulated and actualized. The creation of this type of setting has the potential to encourage the highest quality of social work practice. The research implemented in these types of settings has the promise to better inform health care policy debate, improve the quality of care for nursing home residents, and support the development of more effective and efficient monitoring and quality improvement strategies in our nation's 17,000 nursing facilities. nursing home care is an issue for public concern as about 5 percent of elderly people live in these facilities, including a higher percentage of the oldest old (85 years and older), as well as an increasing number of patients who cycle through nursing facilities, which are increasingly providing subacute care. Decent and responsive nursing home care is an emerged issue for the 21st century. Multifaceted strategies are required to improve resident outcomes, enhance the quality of nursing home care, persuade more social workers to seek nursing home jobs, and encourage more social work researchers to examine psychosocial care in nursing facilities. These strategies should include the development and testing of effective psychosocial interventions for our burgeoning aging population. The first facet to examine is the weak federal requirement for social services in nursing homes. Federal regulations regarding Quality of Life in nursing homes and other long-term care facilities (42 C.ER. 483.15) specify that all facilities must provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. Nursing home reform legislation passed in 1987 had sought to meet these needs by requiring that all nursing facilities provide social services and that those with more than 120 beds have at least one full-time social worker with at least a bachelor's degree in social work or another human service field and one year of supervised social work experience in a health care setting working directly with individuals. Since the passage of the 1987 Nursing Home Reform Act (as part of the Omnibus Budget Reconciliation Act, P.L. 100-203), however, social work and nursing home advocates have worked to strengthen the staffing standards without success. Continuing concerns led social work groups, including the Institute for the Advancement of Social Work Research (IASWR), the National Association of Social Workers (NASW), and nursing home advocates to request that the Inspector General of the Department of Health and Human Services examine psychosocial care in nursing homes. In 2003 the Office of the Inspector General (OIG) released a report,Psychosocial Services in Skilled Nursing Facilities, documenting gaps in the delivery of psychosocial care in Medicare-supported nursing facilities. The findings indicated that all residents had at least one psychosocial need, but 39 percent of residents' charts had inadequate psychosocial care plans and 46 percent with care plans did not receive all of the planned services (OIG, 2003). The OIG report also highlighted the absence of a comprehensive approach to monitoring and measuring psychosocial care and quality of life. Furthermore, the report noted that many social workers interviewed indicated that they encounter barriers in trying to meet those needs. The OIG report served as a catalyst for further exploration and the development of an action plan that would support service delivery improvements and more focused research and evaluation efforts. There was a need to better describe what best practice social work services in nursing homes look like and what mechanisms exist to better monitor psychosocial care. …