Nursing Home Social Services Research Articles

Cognitive assessment of nursing home residents: Survey data on tools used and perceptions of use among social service professionals in one U.S. state.

Background: Social service professionals routinely use screening tools to assess for cognitive decline or identify suspected dementia in nursing home residents. Published literature lacks details about the specific tools used and how professionals use and perceive them in practice. The aim of this study is to better understand cognitive screening roles performed by nursing home social service professionals and how they view their use and efficacy.Methods: An online survey was administered to all 230 nursing homes in the US state of Alabama between October 2021 and March 2022. Fifty-three social service professionals who conduct resident cognitive screenings responded to the survey.Results: In addition to completing the US-mandated Brief Interview of Mental Status (BIMS) quarterly, 75% of participants reported using additional tools, most notably the Mini Mental Status Examination (MMSE). Participants reported using different tools for varied purposes. Those who used both the BIMS and MMSE rated the BIMS significantly higher on ease and time to administer while rating the MMSE higher on reliability and validity. Although most participants reported high levels of confidence using the tools, over half of participants indicated interest in further training in cognitive assessment tools.Discussion: Findings provide evidence regarding who administers nursing home cognitive screenings, which tools are used, and their experiences using those tools. Participant responses reveal the value of using multiple screening tools for improved detection of cognitive status and decline for residents as well as a need for additional training in cognitive assessment. Findings also suggest that the primary tool used for cognitive screening may be quick and easy to use at the expense of perceived reliability and validity. Further evaluation of nursing home cognitive assessment is needed.

SOCIAL SERVICE DIRECTOR PRIORITIES IN RESOLVING CONFLICTS IN NURSING HOMES

Abstract Social workers in nursing homes serve many critical roles such as assessing for residents’ unmet psychosocial needs, providing support to residents and families at end of life, and resolving conflicts between residents, families, and staff. In their roles, they often need to balance conflicting priorities and determine whose rights or needs should take priority. Little is known about how these conflicts affect the social workers in their jobs. This presentation will report the results of a content analysis of the answers to two open ended questions, “What do you like about your job?” and “What would you change about your job?” in a nationally representative sample of nursing home social service directors. The results illustrate directors’ views of what they value in terms of helping residents, families, and staff navigate change, difficult conversations, and conflicting interests. Social service directors report that their priorities are residents and their families, specifically advocating for resident needs. They also report needing to advocate for the role of social work on the interdisciplinary team. They report that family dynamics are messy, but do not discuss how they prioritize within and between residents, their family members, and nursing home staff. More research is needed to understand the decision making process that social workers employ in decision-making about priorities.

High quality resident care increases likelihood that nursing home social service directors report thriving at work

ABSTRACT Nursing homes contend with high staff turnover. Resources invested in employees are lost when an employee leaves. However, if employees are thriving in their job, turnover is less a concern. How can employers promote thriving in employees? Using an adaptation of Spreitzer et al. (2005)’s Social Embeddedness Model of Thriving at Work as a conceptual framework, we performed a logistic regression on the responses of 836 nursing home social service directors in the 2019 National Nursing Home Social Service Director Survey to determine factors that contribute to thriving. The model explained 39% of the variation. Seven variables contributed the most to distinguishing social service directors who report thriving at work from those who do not. Having greater influence on social service functions, having time to support residents, not having to do things others could do, and the facility providing quality care were all associated with greater thriving. Those who reported the administrator and/or attending physicians engage the expertise of social services were more likely to report thriving at work. Working in nursing home social services is demanding; retaining a good social worker is important. These findings suggest ways in which administrators can support social service directors thriving at work.

High Interest in Pursuing Trauma-Informed Care in Nursing Home Social Services Directors.

This study explored nursing home social services directors' interest in pursuing trauma-informed care (TIC) training, and individual and organizational characteristics associated with their interest. Data from the 2019 National Nursing Home Social Services Directors Survey, a national cross-sectional survey, were used. Measures sought information on participants' interest in TIC training, sociodemographic characteristics, and characteristics of employing nursing homes. Descriptive statistics and multivariate binary logistic regression analyses were used. Of the 924 respondents, 880 (95.2%) were included in the analysis. Most (71.7%) expressed high interest in TIC training. Younger age, fewer years of nursing home social services experience, being degreed and licensed in social work, and being a person of color were associated with greater odds of high interest in TIC training. Neither nursing home ownership nor social services staffing ratio was significantly associated with interest in TIC training. As policy requires TIC in nursing homes, these findings present a first step towards understanding implementation.

ELDER ABUSE TRAINING NEEDS AMONG NURSING HOME SOCIAL SERVICES DIRECTORS

Abstract This study aims to identify elder abuse training needs among social services directors. Using nationally representative data from the 2019 National Nursing Home Social Services Directors Survey, we found that approximately three-quarters of directors reported either a moderate or strong interest in receiving training in the following areas: (1) the types of abuse, neglect, and/or exploitation by staff, residents, family and/or other visitors…; (2) establishing trust with a resident and/or family member who feels mistreated by the nursing home or a staff member…; and (3) interacting with visitors whose behaviors are perceived as threatening to residents or staff. Hierarchical logistic regressions found significant associations between strong interest in each training topic and facility, department, and director characteristics. Additional training may enhance directors’ skills in explaining basic information about elder abuse and supporting other staff with strategies to address elder abuse and difficult interpersonal dynamics among staff, residents, families, and visitors.

NURSING HOME SOCIAL SERVICES DIRECTORS' ROLE AND RESPONSIBILITIES

Abstract While most of the nursing home literature focuses on residents and nurses, there is a growing literature on social services staff and family members of nursing home residents. Social services staff include social workers as well as non-social workers with responsibility for assessing and care planning for resident psychosocial issues, as well as a host of other responsibilities including working with families. This symposium presents findings from the National Nursing Home Social Services Directors Survey (NNHSSDS), a cross-sectional (2019) nationally representative study (n=924) that collected data on social services staff characteristics, departmental role responsibilities, and training needs. In this session three papers developed from these data are presented to document the extent to which social services staff are involved with family members, their interest in receiving training on how they can support other staff in understanding resident abuse and exploitation (at the hands of family, fellow residents, or staff), and neglect. As demanding as the social services role is, many holding the position of social services director report they are thriving (not just surviving) in the role. A final paper describes which variables help to distinguish those who report they are thriving versus those who do not. Implications to be discussed include what administrators could do to make the social services director’s job more attractive. The RRF Foundation for Aging provided data collection support for the NNHSSDS.

Nursing Home Social Work With Residents With Severe Mental Illness, Thoughts of Suicide, or Dementia

Many of the close to 3 million persons who receive care in a U.S. nursing home in any given year face mental-health-related challenges that range from minor to severe. One of the core professionals involved with care planning for the psychosocial needs of nursing home residents with mental health concerns is the social worker. Reporting data from a 2019 nationally representative survey of nursing home social services directors, this session provides information about the training needs of nursing home social workers in terms of their work with residents diagnosed with a severe mental illness such as schizophrenia or severe depression, residents who are suicidal, and residents with dementia.

Nursing Home Social Services Directors' Roles and Self-Efficacy in Suicide Risk Management

Nursing home (NH) residents face many risk factors for late life suicide, and transitions into and out of NHs represent risk periods for suicide. Based on data from the 2019 National Nursing Home Social Services Directors survey (n = 924), this presentation describes NH social services directors (SSDs) roles in managing suicide risk and factors that influence self-efficacy in this area. Nearly one-fifth (19.7%) of SSDs lack of self-efficacy in suicide risk management, reporting needing significant preparation time or being not able to train others on this topic. Results of ordinal logistic regression indicate that SSDs who consider insufficient social services staffing as a minor barrier (comparing with a major barrier) to psychosocial care, those who report greater involvement in safety planning for suicide risk, and those with Master’s degree, are more likely to perceive greater self-efficacy in suicide risk management. Implications for training and staffing will be discussed.

Nursing Home Social Services Directors Caring for Residents With Serious Mental Illness

Psychosocial care for residents with serious mental illness (SMI) requires understanding of co-morbidities and careful attention to needs, rights, and preferences. Analyses of social services directors (SSDs) responses (n=924) to the National Nursing Home Social Service Director Survey considered perceived roles and competence to provide care stratified by the percentage of NH residents with SMI. Depression screenings and biopsychosocial assessments were common roles regardless of the percentage of residents with SMI. About one-quarter lacked confidence to train colleagues in recognizing distinctions between depression, delirium and depression (23.4% unable) or to develop care plans for residents with SMI (26% unable). A bachelor’s degree (OR=0.64, 95% CI:0.43, 0.97) or less (OR= 0.47, 95% CI:0.25, 0.89) was associated with less perceived competence in care planning compared to those with a master’s degree. SSDs reported less involvement in referrals or interventions for resident aggression in homes with a high proportion of residents with SMI.

Social Service Directors’ Roles and Self-Efficacy in Suicide Risk Management in US Nursing Homes

ABSTRACT Nursing home (NH) residents have many risk factors for suicide in later life and transitions into and out of NHs are periods of increased suicide risk. The purpose of this study was to describe NH social service directors (SSDs) roles in managing suicide risk and to identify factors that influence self-efficacy in this area. This study used data from the 2019 National Nursing Home Social Services Directors survey (n = 924). One-fifth (19.7%) of SSDs reported a lack of self-efficacy in suicide risk management, as indicated by either needing significant preparation time or being unable to train others on intervening with residents at risk for suicide. Ordinal logistic regression identified SSDs who were master’s prepared, reported insufficient social service staffing as a minor barrier (versus a major barrier) to psychosocial care, and those most involved in safety planning for suicide risk were more likely to report self-efficacy for training others. Implications include the need for targeted training of NH social service staff on suicide prevention, such as safety planning as an evidence-based practice. Likewise, sufficient staffing of qualified NH social service providers is critically important given the acute and chronic mental health needs of NH residents.

Barriers to Psychosocial Care in Nursing Homes as Reported by Social Services Directors

ABSTRACT This study identifies social services directors’ perceptions of major barriers to psychosocial care and examines the structural factors associated with these barriers. Data were merged from the 2019 National Nursing Home Social Services Directors Survey and CMS’s Nursing Home Compare. A hierarchical linear regression predicts overall barriers. Nine binary logistic regressions predict specific barriers. Common major barriers include “insufficient number of nurse aide staff” (31%), and “having to do things other people could do” (30%). Overall barriers to psychosocial care decreased as directors’ years of experience increased, the number of staff members in social services increased, and less time was spent on short-stay residents. Departments with one staff member (compared to 3+) have a 300% greater likelihood of perceiving a major barrier in social services staffing, pressured discharge of short-stay residents, and residents’ socioemotional needs are treated as less important than medical/nursing needs. Directors had a 59%-239% greater likelihood of perceiving a major barrier across six of the nine barriers when 50% or more of social services staffing is devoted to short-stay residents. To improve psychosocial care, federal guidelines should ensure adequate staffing levels differentiated by resident needs across short- and long-term care.

More Evidence that Federal Regulations Perpetuate Unrealistic Nursing Home Social Services Staffing Ratios

What guides quality psychosocial care in nursing homes? By law, people receiving care in Medicare or Medicaid certified nursing facilities (in this manuscript referred to as nursing homes) are requ...

Structural Characteristics of Nursing Homes and Social Service Directors that Influence Their Engagement in Disaster Preparedness Processes

ABSTRACT Nursing home residents are an at-risk population during disaster situations, and nursing homes face unique challenges in managing disasters. Nursing home social service departments can support their nursing homes in meeting the needs of residents during disasters, yet there is little research exploring their involvement. To address this gap, we use secondary data from the 2019 National Nursing Home Social Service Directors’ study to explore social service directors’ and their departments’ involvement in disaster preparedness and response, and personal- and nursing home-level characteristics that predict involvement. Results show that nursing home social service directors and their staffs are predominantly involved; 61.9% (n = 562) of respondents stated always participating, and an additional 20.3% (n = 184) usually participating in disaster planning. The age of the director significantly predicted involvement, with older directors being most likely to always be involved. Further research is needed to understand why some nursing homes involve their social service directors in disaster planning and others do not, what roles those directors play, and to identify strategies to increase involvement within this role.

About a Third of Nursing Home Social Services Directors Have Earned a Social Work Degree and License

ABSTRACT Nursing home (NH) residents have high psychosocial needs related to illness, disability, and changing life circumstances. The staff member with the most expertise in addressing psychosocial needs is the social worker. However, federal regulations indicate that only NHs with 120+ beds need hire a social services staff member and that a “qualified social worker” need not have a social work degree. Therefore, two-thirds of NHs are not required to employ a social services staff member and none are required to hire a degreed social worker. This is in stark contrast to NASW professional standards. Reporting findings from this nationally representative sample of 924 social services directors, we describe the NH social services workforce and document that most NHs do hire social services staff, although 42% of social services directors are not social work educated. 37% of NHs have a degreed and licensed social worker at the helm of social services. The odds of hiring a degreed and licensed social workers are higher for larger NHs, especially if not-for-profit and not part of a chain. NH residents deserve psychosocial care planned by staff with such expertise. Quality of psychosocial care impacts quality of life.

Factors Related to the Depression Score in the Elderly at the Social Service of the Dharma Asri Binjai Nursing Home

BACKGROUND: Depression is the most common psychiatric problem in the elderly. Suicidal thoughts or recurring thoughts of death are common in people suffering from depression. Depression in the elderly has a very poor prognosis compared to people in other age groups because they have a relatively higher risk of suicide and death. Elderly people in nursing homes is a condition that significantly affects the quality of life and survival and harms the psychology of the elderly, cause stress is due to elderly people in nursing homes associated with medical and psychosocial problems such as divorce/widows, poverty, and social isolation. AIM: We aimed to find out the factors that affect the Geriatric Depression Scale (GDS 15) score in elderly people at the Social Service of the Dharma Asri Binjai Nursing Home. METHODS: This study used a cross-sectional approach to 91 subjects at the Dharma Asri Binjai Nursing Home Social Service starting from June to July 2020 utilizing sampling, namely, simple random sampling. The tests conducted in this study consisted of a bivariate test and a multivariate linear regression test to determine which factors are associated with depression. The measuring instrument used was the GDS 15. RESULTS: After the multivariate test was carried out, the variables that were statistically significant to the total score of depression in the elderly at the Binjai Dharma Asri nursing home were Gender (p < 0.001) and activity of daily living (ADL) Score (p < 0.001). CONCLUSION: The factors associated with the GDS score of 15 and the occurrence of depression in the elderly were found in the gender variable and the ADL score variable.

Dementia Tops Training Needs of Nursing Home Social Services Directors; Discharge Responsibilities Are Common Core Functions of the Department

ABSTRACT This report address two key questions: what are common core functions of nursing home social services departments and what are top training needs. Cross-sectional survey data collected in 2019 from a nationally representative sample of 924 social services directors reveal 33 responsibilities that at least two-thirds of respondents reported their department was usually or always involved in. We document strong and consistent interest in more training related to dementia and in common mental health and psychosocial challenges residents face. Findings reveal that training specific to social services is difficult to find. Online training opportunities were endorsed and 96% felt training targeted to new social services directors would be useful.

Nursing home social services: A systematic review of the literature from 2010 to 2020

ABSTRACT Nursing home (NH) social workers carry out person-centered care, guided by the 1987 Nursing Home Reform Act. As the projected population of individuals requiring NH care is expected to grow and become more racially and ethnically diverse, the social worker in this setting becomes increasingly important. The aims of this study are to: (1) identify existing research that discusses the role of social work and nursing facilities, (2) synthesize findings to determine what is most often reported in the literature, and (3) present recommendations for practice, research, and policy. This study used the PICO framework and PRISMA guidelines to systematically search for articles published in English between 2010 and 2020 across 11 databases. A final sample of 23 articles discussed social work in the NH organized into three categories: (1) qualifications of the NH social worker (n = 5), (2) social worker responsibilities (n = 11), and (3) policy dictates practice (n = 7). Future research ought to include primary data collection methods with NH social workers, as well as NH residents and family, as residents must be at the center of their care. Considering policy modifications to further enhance the social work role of the interdisciplinary team is warranted.

Serious Mental Illness in Nursing Homes: Roles and Perceived Competence of Social Services Directors

ABSTRACT Providing nursing home psychosocial care to persons with serious mental illnesses (SMI) requires understanding of comorbidities and attention to resident rights, needs and preferences. This quantitative study reports how 924 social service directors (SSDs) taking part in the National Nursing Home Social Service Director survey identified their roles and competence, stratified by the percentage of residents with SMI. More than 70% of SSDs, across all categories of homes, reported the social services department was “always” involved in conducting depression screening, biopsychosocial assessments and PASRR planning. SSDs in homes with lower concentrations of residents with SMI reported less involvement in anxiety screening. Those employed in homes with higher concentrations of residents with SMI reported lower involvement conducting staff interventions for resident aggression or making referrals. More than one-fifth of SSDs lacked confidence in their ability to compare/contrast dementia, depression, and delirium or to develop care plans for residents with SMI. SSDs’ perceived competence in developing care plans for residents with SMI was associated with education and involvement in care planning. About one-quarter of social services directors reported not being prepared to train a colleague on how to develop care plans for residents with SMI. Training in SMI could enhance psychosocial care.

Barriers to Meeting the Social and Emotional Needs of Nursing Home Residents

Presenters will describe barriers to psychosocial care and identify which factors increase the odds of experiencing a psychosocial care barrier. Reported major barriers include: insufficient number of nurse aide staff (31%), having to do things other people could do (29%), lack of resources to provide residents with opportunities to leave the nursing home on outings (25%), pressure to admit and discharge post/sub-acute patients takes time away from attending to the social and emotional needs of long stay residents (23%), and not enough social service staff for the number of residents (21%). With data from the 2019 National Nursing Home Social Services Directors Survey, a series of logistic regressions found that significant predictors varied by specific barrier, although devoting more time to short-term residents predicted a greater likelihood of reporting a major barrier in four of the five outcomes. Strategies to address these structural and contextual factors will be discussed.

First National Data Reporting Nursing Home Social Services Directors’ Training Interests and Needs

A national sample of 924 social services directors reported training needs in three ways. First, their level of interest in 14 topics, second by how much preparation time needed to provide one-on-one training to a colleague about 27 difference issues/tasks (no time needed, up to 2 hours, up to 10 hours, not able to do), and third, by indicating their top training priority. At least 2/3s reported interest in each of the 14 topics with 86% interested in common mental health and psychosocial challenges, and 86% in the psychosocial needs of persons with dementia. Education, social work licensure, and characteristics of the nursing home explained some of the variation, e.g. respondents with a social work degree reported higher interest in more training in trauma-informed care and culturally competent care. Dementia was by far the highest training priority, followed by better understanding of regulations, behavioral health issues, and trauma-informed care.