Who Hires Social Workers? Structural and Contextual Determinants of Social Service Staffing in Nursing Homes

Caregiver interactions, perceived control, and meaning in life of elderly: the moderating effect of the elderly-to-social worker ratio

BACKGROUND

Meaning in life is a widely accepted aim in promoting psychosocial health in institutional care. However, how caregiver interaction and perceived control impact meaning in life among the elderly remains unclear. This study explores the effect of institutional caregiver interaction, family caregiver interaction, and perceived control on meaning in life among elderly residents in China, and the potential moderating effect of elderly-to-social worker ratio in these associations.

METHODS

Multistage random sampling was used to recruit a sample of 452 elderly residents from 4 elderly care homes in urban China. A structural equation model was used to test the study hypothesis.

RESULTS

Institutional caregiver interaction is positively related to meaning in life, and perceived control among elderly residents has a positive impact on meaning in life. Moreover, the elderly-to-social worker ratio moderated the relationship between institutional caregiver interaction and meaning in life, as well as between family caregiver interaction and meaning in life.

CONCLUSIONS

Increase elderly's meaning in life is an important service target for the caring professions in institutional care. Social workers affect the effectiveness of interventions on elderly's meaning in life in institutional care. A higher elderly-to-social worker ratio could improve the effectiveness of interventions on meaning in life for elderly residents.

Social Workers Critical to Honoring Commitments to Residents and Families in Long-Term Care

Social workers have been at the forefront of research and advocacy to improve nursing home care for several decades. However, United States (U.S.) regulations have not kept pace with professional standards, as nursing home social services workers are still not required to have a degree in social work and many are assigned caseloads that are untenable for providing quality psychosocial and behavioral health care. The National Academies of Sciences, Engineering, and Medicine (NASEM)'s recently published interdisciplinary consensus report, The National Imperative to Improve Nursing Home Quality: Honoring our Commitment to Residents, Families, and Staff (NASEM, 2022) makes recommendations for changing these regulations, reflecting years of social work scholarship and policy advocacy. In this commentary, we highlight the NASEM report recommendations for social work and chart a course for continuing scholarship and policy advocacy to improve resident outcomes.

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.

Therapy-based allied health delivery in residential aged care, trends, factors, and outcomes: a systematic review

Background

Allied health professionals in residential aged care facilities (RACFs) make important contributions to the physical and mental wellbeing of residents. Yet to date, health services research in RACFs has focused almost exclusively on nursing disciplines. This review aims to synthesise the current evidence on allied health services in RACF; specifically, how therapy-based allied health is delivered, what factors impact the quantity delivered, and the impact of services on resident outcomes and care quality.

Methods

Empirical peer-reviewed and grey literature focusing on allied health service delivery in RACFs from the past decade was identified through systematic searches of four databases and over 200 targeted website searches. Information on how allied health delivered, factors impacting service delivery, and impact on resident outcomes were extracted. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT) and the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) checklist.

Results

Twenty-eight unique studies were included in this review; 26 peer-reviewed and two grey literature studies. Sixteen studies discussed occupational therapy and 15 discussed physiotherapy, less commonly studied professional groups included dieticians (n = 9), allied health assistants (n = 9), and social workers (n = 6). Thirteen studies were assigned a 100% quality rating. Levels of allied health service provision were generally low and varied. Five studies examined the association between system level factors and allied health service provision, and seven studies examined facility level factors and service provision. Higher levels of allied health provision or access to allied health services, specifically physiotherapy, occupational therapy, and nutrition, were associated with reduced falls with injury, improved care quality, activities of daily living scores, nutritional status, and meal satisfaction in five studies.

Conclusion

Evidence on how allied health is delivered in RACFs, and its impact on resident health outcomes, is lacking globally. While there are some indications of positive associations between allied health staffing and resident outcomes and experiences, health systems and researchers will need commitment to consistent allied health data collection and health services research funding in the future to accurately determine how allied health is delivered in RACFs and its impact on resident wellbeing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03386-9.

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

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

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.

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

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.

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

OBJECTIVES

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.

METHODS

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 technique.

RESULTS

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.

DISCUSSION

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.

Concept Development of Identification of Discomfort for Nursing Home Patients With Advanced Dementia

PURPOSE

The aim of this study is to clarify the concept of discomfort identification by concept development in the nursing home.

METHODS

The Schwartz-Barcott and Kim's hybrid model was used.

FINDINGS

The identification of discomfort can be explained as an interactive and confirmative process of sympathetically responding to patients with dementia's problem behavior expressions that communicate unmet needs.

CONCLUSIONS

The identification of discomfort has the potential to improve the detection of multidimensional discomfort related to nursing diagnosis as a holistic and patient-centered approach.

IMPLICATION FOR NURSING PRACTICE

The findings could help nursing home nurses have a better understanding of identification of discomfort and can improve nurses and interdisciplinary caregivers' knowledge for developing appropriate comfort caring activities.

How Does Rurality Influence the Staffing of Social Service Departments in Nursing Homes?

Purpose of the Study

Social service departments in nursing homes (NHs) are staffed by qualified social workers (QSWs) and paraprofessionals. Due to greater workforce challenges in rural areas, this article aims to describe the staffing levels and composition of these departments by rurality.

Design and Methods

Certification and Survey Provider Enhanced Reports data from 2009 to 2015 are used to examine the effect of rurality on social service staffing using random-effects linear panel regressions.

Results

The average NH employed 1.8 full-time equivalents (FTEs), with approximately two thirds of social services staffed by QSWs. Large NHs had more staff, but employed fewer staff hours per resident day. Staffing levels were lower and QSWs made up a smaller percentage of staff in rural areas.

Implications

National trends indicate variability in staffing by NH size and degree of rurality. Very low staffing within rural NHs is a concern, as staff may have less time to respond to residents' needs and these NHs may utilize fewer QSWs.