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

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

Background

Nursing home (NH) social workers face many challenges in meeting the psychosocial needs of residents while balancing their own well-being needs.

Methods

This 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).

Results

The 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.

Conclusion

These 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.

What information about choosing a nursing home is available on YouTube?

This study aimed to identify YouTube videos focused on choosing a nursing home. The contents of the videos were analyzed using 19 items from the guidelines proposed by the Donabedian model. An analysis of 57 videos showed that informal presentations for format (54.39%), laypersons for speaker (36.84%), and personal channel for uploader (61.40%) exhibited the highest frequency. According to the analysis of video content, most videos included the environment (49.12%), programs (38.63%), and cost (35.09%). However, fewer videos focused on care protocols (5.26%), participation (5.26%) and health outcomes (5.26%). More informal presentations, laypersons, and personal channels than health providers, professional groups, and mass media were included in videos focused on choosing nursing homes. It is necessary to provide information regarding the philosophy, care, and health outcomes of residents in addition to the information regarding environment and cost provided by reliable suppliers, such as health professionals, the government, and mass media.

Abuse and Neglect in Nursing Homes: The Role of Serious Mental Illness

BACKGROUND AND OBJECTIVES

Nursing homes (NH) are serving a large number of residents with serious mental illness (SMI). We analyze the highest ("High-SMI") quartile of NHs based on the proportion of residents with SMI and compare NHs on health deficiencies and the incidence of deficiencies given for resident abuse, neglect, and involuntary seclusion.

RESEARCH DESIGN AND METHODS

We used national Certification and Survey Provider Enhanced Reports (CASPER) data for all freestanding certified NHs in the continental United States from 2014 to 2017 (14,698 NHs; 41,717 recertification inspections; 246,528 deficiencies). Differences in the number of deficiencies, a weighted deficiency score, the deficiency grade, and the facility characteristics associated with deficiencies for abuse, neglect, and involuntary seclusion were examined in High-SMI. Incidence rate ratios (IRR) and odds ratios (OR) were reported with 95% confidence intervals.

RESULTS

High-SMI NHs did not receive more deficiencies or a greater weighted deficiency score per recertification inspection. Deficiencies given to High-SMI NHs were associated with a wider scope, especially Pattern (IRR:1.03;[1.00, 1.07]) and Widespread (IRR:1.07;[1.02, 1.11]). High-SMI NHs were more likely to be cited for resident abuse and neglect (OR:1.49;[1.23, 1.81]) and the policies to prohibit and monitor for abuse and neglect (OR:1.18;[1.08, 1.30]) in comparison to all other NHs.

DISCUSSION AND IMPLICATIONS

Although resident abuse, neglect, and involuntary seclusion are rarely cited, these deficiencies are disproportionately found in High-SMI NHs. Further work is needed to disentangle the antecedents to potential resident abuse and neglect in those with mental healthcare needs.

A Call to Address RN, Social Work, and Advanced Practice Registered Nurses in Nursing Homes: Solutions From the Missouri Quality Initiative

BACKGROUND

US nursing homes (NHs) have struggled to overcome a historic pandemic that laid bare limitations in the number and clinical expertise of NH staff.

PROBLEM

For nurse staffing, current regulations require only one registered nurse (RN) on duty 8 consecutive hours per day, 7 days per week, and one RN on call when a licensed practical/vocational nurse is on duty. There is no requirement for a degreed or licensed social worker, and advanced practice registered nurses (APRNs) in NHs cannot bill for services.

APPROACH

It is time to establish regulation that mandates a 24-hour, 7-day-a-week, on-site RN presence at a minimum requirement of 1 hour per resident-day that is adjusted upward for greater resident acuity and complexity. Skilled social workers are needed to improve the quality of care, and barriers for APRN billing for services in NHs need to be removed.

CONCLUSIONS

Coupling enhanced RN and social work requirements with access to APRNs can support staff and residents in NHs.

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

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.

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

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.