Despite Their Importance, Many Nursing Homes Lack Social Workers
These professionals play an important role in positive experiences for residents
Nursing home residents and their families rely on social workers to help navigate the maze of decisions required to meet their often-changing health needs. Social workers also provide emotional support and interventions to help residents adapt and cope with cognitive and mental health issues, such as dementia and depression.
But how likely are there to be well qualified social workers when and where they’re needed?
That’s what John Bowblis and Amy Roberts set out to assess in their study for the Scripps Gerontology Center at Miami University in Oxford, Ohio, where they are both research fellows. Bowblis also is a research fellow in the university’s school of business and Roberts is an assistant professor of family science and social work.
Staffing Level Varies Widely
About 83% of nursing homes have at least one qualified social worker (QSW) on staff on a part-time basis, but only 68% have a least one full-time qualified social worker in the facility, according to Bowblis’ and Roberts’ research.
“There is significant variation in the presence of QSWs by facility size — smaller facilities (in terms of number of beds) are less likely to have QSWs,” Bowblis says.
Well-trained social workers can be forceful advocates for both residents and family members.
The definition of a qualified social worker, according to the Centers for Medicare & Medicaid Services, is anyone with at least a bachelor’s degree in social work or related human services field who has at least one year of supervised social work experience in a health care setting working directly with individuals.
The federal government requires only nursing homes with 120-plus beds to employ one full-time social worker, and that person need not hold a social work degree.
State requirements differ. Twelve states do not address nursing home social worker qualifications. “Up to 25 states appear to be out of federal compliance,” according to 2018 research from the University of Iowa.
Only Maine appears to meet the professional standards set by the National Association of Social Workers (NASW), according to the article. An individual who meets those standards has, “at minimum, a bachelor’s degree from an accredited school or program of social work; has two years of postgraduate experience in long-term care or related programs; and meets equivalent state requirements for social work practice, or, in jurisdictions not having such legal regulation, holds certification or credentialing from the National Association of Social Workers.”
Other states approaching the NASW standards include: Alaska, Arkansas, Connecticut, Illinois, Massachusetts, Minnesota and West Virginia, the article says.
Some nursing homes “only have para-professionals who are not a hundred percent trained in this area,” Bowblis notes, because they don’t want to spend money on fully qualified social workers. And too often, the social service department is understaffed, forcing the employees to struggle with heavy caseloads.
Staffing Priorities Focused on Nurses
“Over the past twenty or so years, when it comes to nursing home quality, the federal government and states have focused on the staffing level of nurses,” Bowblis says. “But they need to look at activities and social services. That’s important, because if people are happy in their environment, they have a higher quality of life.”
Although nursing homes are associated with long-term care, “most people who go into a nursing home are short-stay residents who are there for rehab after some type of hospitalization, and the goal for most of those people is to go back home,” Bowblis says. Social workers play an important role in the transition.
“It’s a very disruptive situation,” he adds. “It’s actually two transitions — from the hospital to the nursing home, then from the nursing home to home. You want to make sure they’re ready to go home, so they don’t come back to the nursing home.”
Social Workers as Resident Advocates
Sherry Saturno, who has experience as a social worker and as a nursing home administrator, also emphasizes that well-trained social workers can be forceful advocates for both residents and family members. Saturno is licensed as a clinical social worker and nursing home administrator in New York and is certified in clinical social work.
“They support residents and families who are trying to navigate services. They provide clinical support. They put together a care plan and monitor it,” says Saturno, who is currently executive director of Gramatan Village, a Bronxville, N.Y. nonprofit that helps older adults who want to age at home.
For residents who are about the be discharged from a nursing home, social workers “make sure that the home is a safe environment, that adaptive equipment is available” if necessary, Saturno says.
For both short- and long-term residents, properly trained social workers are front-line protection against physical or emotional abuse or neglect, she adds.
When choosing a nursing home for a loved one, Saturno recommends doing research on the size and qualifications of the social services staff as well as the nursing staff.
Check family reviews of the facility and arrange for a visit. Visit on a weekend, if possible, when staffing levels may be lower, Saturno says. “When you visit, say, ‘I’d like to meet the social worker.’ Chat with that person. Don’t be afraid to ask questions,” she says.