Nursing Home Social Workers Research Articles

ENGAGING WITH NURSING HOME SOCIAL WORKERS TO DEVELOP AND IMPLEMENT CLINICAL INTERVENTION TRAINING

Abstract PreLoss Group Support (PLGS) is a 10-session multi-modal therapeutic group intervention for dementia family care partners administered by nursing home social workers (NHSWs) to facilitate healthy death preparedness and eventual bereavement. In prior work, we used empirically validated procedures for developing psychosocial interventions, created PLGS participant and facilitator manuals, and implemented and evaluated PLGS in three cohorts of nursing home family care partners using research team LCSWs as facilitators and NHSWs as co-facilitator-trainees. Our present pragmatic trial will determine if telehealth-delivered PLGS reduces risk of poor bereavement outcome in family care partners, when delivered by NHSWs trained in PLGS via telehealth. We systematically engaged with nursing home stakeholders; administrators and NHSWs in rural, urban, and Veteran nursing homes to identify their perceptions of family care partner needs with respect to end-of-life care in residents living with dementia.NHSWs collaborated with our team to develop a full-day clinical education program. We incorporated their suggestions of family “characters” to script into our video modules using professional actors, addressed potential concerns with telehealth delivery of the training and intervention, participant identification and recruitment procedures, and requests for didactic content and interactive case examples of treatment element application. Current NHSWs who attended the full day training completed a 7-item satisfaction scale yielding a satisfaction rate of 95% (highly valuable), with 100% indicating they would recommend training to SWs in other facilities. Sustained collaboration with NH stakeholders optimizes commitment of NHSWs to PLGS participants, intervention delivery and informs later implementation strategies for translation and dissemination.

WE CAN WORK IT OUT: NURSING HOME SOCIAL WORK AND CONFLICT MEDIATION

Abstract Drawing from a nationally representative survey of social service directors (N=922), this presentation will provide an overview of nursing home staffing trends and describe the ways in which social service staff routinely interact with residents, families, and staff. Social workers are involved in many aspects of care, including the admissions process, planning and providing care, care transitions, and general supportive services. As members of the interdisciplinary team, social workers advocate for resident rights, and support decision-making and care planning in times of family crisis and high conflict situations. Summary statistics will be presented to identify the directors’ frustrations with the role – including their perceptions of major barriers to care, and draw attention to the changes that would improve job satisfaction (e.g., higher salary/wage, 51%; lower staff turnover among direct care staff, 47%; and more time to focus on the social and emotional concerns of residents, 45%). The presentation will conclude with an overview of directors’ interest in training topics that may help to mediate conflicts among residents, families, and staff. Specifically, we will share how prepared directors feel to train other staff in conflict-resolution skills (e.g., working with the resident/family and team to balance resident self-determination with the nursing home’s responsibility to minimize risk), and the use of an ethical framework to guide action.

USING COMMUNITY ENGAGEMENT TO DEVELOP, TEST, AND IMPLEMENT INTERVENTIONS FOR DEMENTIA CARE PARTNERS

Abstract Interventions for caregivers to persons living with dementia are numerous and target a wide array of outcomes. One challenge limiting the dissemination of research-based interventions is the complexity of translating the intervention models for a variety of community environments and situations. Interventions that plan for future translation and scalability during the development stages have a better chance of quickly and efficiently being adopted by community partners. This symposium describes the methods used and the lessons learned from five research projects that used various forms of community engagement to develop, adapt, and assess feasibility of caregiver interventions, while simultaneously preparing for their translation and scalability: 1) Eaton et al., present the process and benefits gained from partnering with dementia caregivers to iteratively develop the Enhancing Active Caregiver Training (EnACT) intervention. 2) Utz et al., discuss ways to use the RE-AIM implementation framework to guide the development and pilot-testing of the Time for Living and Caring (TLC) respite intervention. 3) Dassel et al., explore the use of community-based participatory methods to adapt a paper-based advance care planning guide to an interactive web-based LEAD (Life-Planning in Early Alzheimer’s and other Dementias) intervention. 4) Cotton et al., report on the lessons learned from a formative analysis of their processes used to culturally adapt an intergenerational respite program for older adults within the Latine community. 5) Supiano et al., describe how they engaged and trained nursing home social workers to develop and implement the PreLoss Group Support intervention for dementia family care partners.

Training nursing home social workers in the Pre‐loss Group Support intervention

AbstractBackgroundPre‐loss Group Support (PLGS) is a 10‐session multi‐modal, psychotherapy group intervention administered by nursing home social workers (NH‐SWs) for dementia family care partners (CPs) whose PLWD resides in a nursing home.1 While the overarching purpose of this project is to determine if telehealth‐delivered PLGS reduces risk of poor bereavement outcome in family CPs of PLWD when delivered by NH‐SWs, in this presentation we describe developing and applying the PLGS clinical training for NH‐SWs in this phase of our NIH‐Stage 52 implementation and dissemination study.MethodUsing professional actors, we created a simulated PLGS 10‐session group as a series of training videos. Training utilized our Stage‐3 PLGS Facilitator manual.3 We developed a training curriculum incorporating these video vignettes, didactic content, interactive case examples and pragmatic application concepts of PLGS for telehealth delivery to CPs by NH‐SWs. The full training is deliverable in one full day or two half day sessions and is provided on an interactive distance platform. Training was delivered to two cohorts of NH‐SWs in a stepped‐wedge design.ResultWe are evaluating this implementation study using the RE‐AIM measures.4 In this training phase, we have successfully achieved Reach—defined as buy‐in and training of NH SWs, Adoption—defined as uptake by NHs and SWs, and the first phase of Implementation—Defined as training completion. Trained NH‐SWs were assessed for satisfaction with the training. On a 7‐item satisfaction scale with a range of 3‐21, satisfaction rate was 95% (highly valuable), with 100% indicating they would recommend training to SWs in other facilities. In this session, we will share PLGS training content and procedures.ConclusionNursing home SWs are the last clinicians with opportunity to support CPs as they approach the death of their PLWD in the facility. NH‐SWs have clinical expertise to learn and implement PLGS, allowing us to simultaneously evaluate telehealth SW training acceptability, telehealth delivered PLGS outcomes. Carefully tailoring PLGS training content and delivery for NH‐SWs to equip them for telehealth implementation, engagement to recruit and retain enthusiastic SWs, and available consultation have contributed to the success of this phase in the project.

The Influence of Spirituality on Professional Identity, Role Performance, and Career Resilience among Nursing Home Social Workers

ABSTRACT This paper explores how social workers integrate personal spirituality within nursing homes, where a highly regulated, stressful environment marginalizes professional identity and challenges retention. Researchers offer new evidence of how spirituality informs professional identity, ethical practice, and continuation in the role. Twenty BSW/MSW licensed nursing home social workers (NHSWs) reported how they daily navigate the personal spirituality-at-work opportunity and challenge. Qualitative analysis of in-depth interviews resulted in three primary codes and related subcodes: Spirituality-Integrated Professional Identity (Vocational Affirmation and Value Alignment), Spirituality-Informed Practice (Intervention Asset, Relational Affinity, and Ambiguous Boundaries), and Spiritually-Sustained Career Resilience. Respondents reported how spirituality animated professional identity, informed daily role enactment, and sustained role involvement. Recommendations are provided for normalizing ethical spirituality-at-work through social work education and practical guidance in navigating the spirituality and practice space.

The Preservation of Spousal and Partner Relationships Among Nursing Home Residents

ABSTRACT Deciding to seek placement in a nursing home can be difficult for both older adults and their families, but especially so for spouses or partners of potential nursing home residents. Disruption of the attachment relationship following placement is likely to influence the psychosocial well-being of nursing home residents. This mixed-method study explored services and activities offered that emphasize the preservation of spousal and partner relationships among nursing home residents. A survey was administered to nursing home social workers in the states of Alabama, Georgia, Mississippi, and Tennessee. Survey results reveal that approximately 49% of respondents reported having a written policy to preserve these relationships, however, only 22% reported having a program to carry out the facility’s written policy. Both survey respondents and interview participants highlighted privacy and outings as ideal relationship-preserving practices. Nursing home social workers can utilize the study results in the design and implementation of specific services to preserve relationships between residents and their spouses/partners.

Nursing Home Social Work During COVID-19: Lessons Learned

Nursing Home Social Work During COVID-19: Lessons Learned

“Knowing when it's time to take a break”: Nursing home social workers’ coping during COVID-19

BackgroundNursing home (NH) social workers face many challenges in meeting the psychosocial needs of residents while balancing their own well-being needs. MethodsThis study employed a cross-sectional survey of NH social workers via social media and professional networks about their coping strategies during COVID-19. Open-ended responses were analyzed qualitatively using the rigorous and accelerated data reduction technique (RADaR). ResultsThe study included a sample of 63 (N = 63) NH social workers. Four themes defined ways the in which NH social workers coped with stress during COVID-19, including relying on friends and family, mindfulness and spirituality/religion, self-care strategies, and setting boundaries at work. ConclusionThese techniques appear to be effective; however there remains a need for institutional programs and policies to provide the time and space to holistically support coping in NH social workers and to prevent burnout and turnover, particularly during times of crisis.

Nursing Home Residents’ Relocation to Another Facility: an Exploratory Study of Family Caregiver Experiences

ABSTRACT Over time, family caregivers for older adults may face care transitions for their loved ones. The move from home to residential care facility is a much-studied transition. Yet we know little of family caregiver experiences when their loved ones move from one facility to another. We interviewed family caregivers of nursing home residents and inquired about caregiver experiences in prior facilities and factors that prompted moving to another facility. Our analysis identified three themes: 1) A precursor of moving to another facility was caregivers’ assessment of poor fit between their family member and the facility; 2) Executing a move was demanding for the caregiver in instrumental and emotional ways; 3) Once in the new facility, caregivers adapted their caregiving to the capacity of the new facility and fostered resident-facility fit (not interfering with good care and supplementing facility care). Findings suggest that family caregivers continually assess and respond to emerging problems with resident-facility fit, which sometimes escalate and necessitate a move to another facility. Nursing home social workers are well-positioned to help families address emerging care problems, so they do not escalate. Doing so can promote care continuity, which benefits both the resident and the family caregiver.

No Visitors Allowed! The Impact of Covid-19 Restrictions on the Psychosocial Well-being of Nursing Home Residents

The COVID-19 coronavirus pandemic changed life for everyone, but especially for nursing home residents. In March 2020, the Centers for Medicare and Medicaid Services enacted nursing home restrictions in response to the pandemic regarding visitation from outside family/friends and changes to facility activity programs. Despite the public health concern prompting these restrictions to prevent virus spread, these sudden changes affected nursing home residents’ relationships with their spouses/partners. As part of a larger study to identify the nursing home policies and practices that preserve relationships among nursing home residents with spouses/partners, participants shared facilities’ restrictions, social connection practices, and effect of coronavirus restrictions on residents’ relationships with spouses/partners. The study utilized both an online survey (81 respondents) and ten telephone interviews with nursing home social workers in four Southern states. Twenty-eight percent of participants reported that no visitors were allowed; while 25% allowed couples to visit with one another as usual was reported by 25%. The most noted practices to maintain social connections were phone calls, video calls, and ‘window’ visits between residents and families/friends; however, “it’s just not the same. It’s affected them greatly”. The interviews revealed further details about the detrimental effect of the COVID-19 restrictions on nursing home residents’ overall mental health and attachment relationships with spouses/partners. These results highlight the importance of maintaining social connections between residents and spouses/partners. Nursing home social workers can develop policies and practices that enhance relationships and connections under all circumstances and work with other health care team members to ensure implementation.

The Preservation of Spousal and Partner Relationships Among Nursing Home Residents

The Alzheimer’s Association (AA) Dementia Care Practice Recommendations (DCPR) outline ten recommendations to achieve quality care with a person-centered focus. The AA has developed tools to assist care communities (CC) to evaluate their status within the recommendations by working with a trained coach to maximize adoption and implementation of these recommendations. The purpose of this pilot was to evaluate the acceptability and feasibility of pairing trained DCPR coaches with CC teams to implement the DCPR tools. Seven CCs were recruited and four received the DCPR overview and self-assessment. Of the four CC, one withdrew and did not receive the intervention. The remaining three were located in a suburban area, nonprofit, and with memory care units. Data was collected from November 2019 through March 2020. Nine CC staff participated with a mean age 35.8 years and had worked for 11.8 years. Baseline mean scores on the Organizational Readiness to Implementing Change (ORIC) scale were 4.6 for the commitment domain and 4.4 for the efficacy domain. Mean scores on the Nursing Home Employee Satisfaction Survey were high. Sixty-nine percent of CC participants were satisfied with their jobs (greater than 4). Findings from mid-project interviews with the coaches revealed difficulty with scheduling appointments, significant efforts needed to get the “right” people at the table and need for the DCPR tools to be more user-friendly. No post-intervention results were collected due to closing of the CCs to visitors due to COVID. The DCPR tools shows promise and are being evaluated in additional CCs.

Work Does Not End When You Leave: Concerns and Coping Strategies Among Nursing Home Social Workers During COVID-19

Nursing home social workers (NH SW) at the frontline during COVID-19 are faced with many challenges in meeting the psychosocial needs of residents while balancing their own well-being needs. In order to explore the experiences of NH SW during COVID-19, the study utilized a cross-sectional survey distributed to social media sites (e.g., Reddit, Facebook) and professional networks. The survey asked participants (N = 63) open-ended questions which were analyzed using the rigorous and accelerated data reduction (RADaR) method. Themes suggested that fear for self, lack of administrative support, and overall stress were notable concerns among NH SW. Findings also suggested that support from family/friends and self-care were most personally helpful to NH SW. Lastly, themes related to coping strategies included talking with co-workers, mindfulness, and boundary setting. Findings suggest the need for increased supports for NH SW. Implications related to stress and coping during COVID-19 are offered.

The Experience of Health Care Workers Caring for Older Adults During the COVID-19 Pandemic

Older adults are at increased risk for COVID-19 illness, hospitalization, and mortality. Essential health care workers became the backbone of their care during the pandemic, and their experiences are worthy of discussion. This symposium will highlight the emotional impact of COVID-19 on health care workers, and their scope of practice in various health settings. Using data from a cross-sectional survey, presenter one will describe concerns and coping strategies among nursing home social workers during COVID-19. Next, presenter two will present findings on the emotional health and wellbeing of home care workers. Then, presenter three will describe the experience of the VA’s strike teams sent into 82 Florida nursing homes most impacted by COVID. Presenter four will describe findings from a qualitative study on emotional distress experienced by hospital-based medical directors, nurse practitioners, and other health care workers. Finally, presenter five will describe findings from a scope of practice among health care social workers study, with an emphasis on how policies in their respective settings impacted their work. Taken together, the presenters’ findings in this symposium have implications for practice and policy recommendations to improve the experience of health care workers during pandemics.

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.

“Please Don’t Let Academia Forget about Us:” An Exploration of Nursing Home Social Work Experiences during COVID-19

ABSTRACT Nursing home social workers are on the frontlines during COVID-19 responding to individual resident needs, the needs of staff, and larger health needs of the nursing home. However, it is unclear whether nursing home social workers feel adequately trained and prepared in responding to disasters, such as COVID-19. To explore this, we used a study cross-sectional survey distributed via social media focusing on 1) prior training on disaster preparedness, 2) any content social workers wish had been a part of their education, and 3) suggestions for educators/academics to serve social workers on the frontlines. Data in this study are based on a sample of 63 (N=63) nursing home social workers. Demographic data were analyzed using SPSS and qualitative data were analyzed using the RaDar (rigorous and accelerated data reduction) technique. Findings revealed that most social workers had little to no training in disaster preparedness, and shared areas of future education initiatives. Participants also shared the need for bridging the research to practice gap through open access articles and support from academics. Findings from the present study reveal areas social work programs can expand gerontology-focused course offerings. Additionally, developments promoting practitioner support from academics is worth consideration.

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.

Take it to the resident: A model for engaging long-term stay residents in advance care planning

ABSTRACT Advance care planning involves a meaningful conversation about residents’ end of life goals with the health-care team and documenting these wishes in advance directives; however, these conversations are not taking place early enough or with strategies that allow nursing home residents’ preferences to be meaningfully integrated into care plans. This article outlines a new model that nursing home social workers can use to initiate advance care planning discussions called Take it to the Resident. This model was tested with 11 long-term stay nursing home residents. Data were collected through structured memos and field notes. Summative content analysis was utilized to analyze the data. Take it to the Resident facilitated a discussion about advance care planning and allowed residents to consider their wishes before engaging family members. Although discussions took place, some residents were hesitant to document their wishes formally through advance directives. The results of this study support the utility of continued testing of this model. Having empirically supported tools for nursing home social workers is critical to increasing advance care planning conversations and empowering residents to document their wishes.

Nursing Home Social Workers Perceptions of Preparedness and Coping for COVID-19

Social work has a long history of responding to the needs of vulnerable populations during times of crisis and disaster. Social workers are working at the front lines responding to the current COVID-19 pandemic in a variety of health care practice settings, including nursing homes, however it is unclear how social workers perceive their preparedness during this time. This study employed a cross-sectional survey to nursing home social workers via social media on feelings of preparedness for COVID-19, what has been most professionally helpful for social workers during these times in their role in COVID-19, as well as demographic questions. Demographic data were analyzed using SPSS and qualitative data were analyzed using the rigorous and accelerated data reduction (RADaR) technique. Data are based on a sample of 63 (N=63) nursing home social workers. Findings revealed that while some social workers felt prepared for the coronavirus, many respondents stated that they were unprepared to meet the demands and challenges they were facing. Moreover, participants shared that professional support was critically important to get through COVID-19. These findings are important, as social workers are tasked with ensuring each resident attains their highest level of psychosocial well-being, which can be achieved only when nursing home staff are supported. Findings from the present study suggest that additional support for nursing home staff ought to include peer mentoring and mutual support. Additionally, improved leadership across health care settings is worth assessing.

The Social Worker in the Nursing Home: A Systematic Review of the Literature from 2010 to 2020

Social workers have an integral role in health care and a long-standing history in nursing homes. The novel pandemic, COVID-19, has disproportionately adversely affected nursing home residents, bringing to the fore the importance of practice in this setting. However, the role of the nursing home social worker is often ambiguous. The objective of this study is to (1) identify existing research studies that discuss the role of social work and nursing facilities, (2) synthesize findings to determine what is most often reported in the literature, (3) present recommendations for practice and implications for research and policy change. This rapid review 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 met inclusion criteria. Relevant details were extracted from these articles, and the following 3 categories emerged as broadly describing the literature: (1) elements of social work practice in NHs, (2) social worker responsibilities, (3) policy impacts on practice. Findings highlight that the literature on NH social workers is limited and outdated, despite the 2016 federal rule requiring increased consideration for resident quality of life, quality of care, and behavioral health, all features of social work practice. The nursing home social work role warrants greater attention, with an emphasis on how to support residents during the current pandemic to ensure the development and implementation of person-centered care. The literature points to research priorities including involving families and residents in data collection efforts.

Nursing Home Social Workers Perceptions of Preparedness and Coping for COVID-19

ObjectivesSocial work has a long history of responding to the needs of vulnerable populations during times of crisis and disaster. Social workers are working at the front lines responding to the current COVID-19 pandemic in a variety of health care practice settings, including nursing homes, however it is unclear how social workers perceive their preparedness during this time.MethodsThis study employed a cross-sectional survey to nursing home social workers via social media on feelings of preparedness for COVID-19, what has been most professionally helpful for social workers during these times in their role in COVID-19, as well as demographic questions. Demographic data were analyzed using SPSS and qualitative data were analyzed using the rigorous and accelerated data reduction (RADaR) technique.ResultsData are based on a sample of 63 (N=63) nursing home social workers. Findings revealed that while some social workers felt prepared for the coronavirus, many respondents stated that they were unprepared to meet the demands and challenges they were facing. Moreover, participants shared that professional support was critically important to get through COVID-19.DiscussionThese findings are important, as social workers are tasked with ensuring each resident attains their highest level of psychosocial well-being, which can be achieved only when nursing home staff are supported. Findings from the present study suggest that additional support for nursing home staff ought to include peer mentoring and mutual support. Additionally, improved leadership across health care settings is worth assessing.