Academic journal article Health and Social Work

Organizational Characteristics Influencing Nursing Home Social Service Directors' Qualifications: A National Study

Academic journal article Health and Social Work

Organizational Characteristics Influencing Nursing Home Social Service Directors' Qualifications: A National Study

Article excerpt

This research sought to identify organizational characteristics associated with the amount of professional qualifications among a nationally representative sample of nursing home social service directors. A self-administered survey was sent to directors in 675 facilities randomly sampled from a federal database, excluding facilities with fewer than 120 beds that are not required to staff a full-time social worker. The response rate was 45 percent (N = 299). Univariate results showed that most respondents possessed a social work degree, most lacked licensure, and few were clinically supervised. A multiple regression analysis found that nonprofit, independently owned facilities in rural areas staffed social service directors who were significantly more qualified than directors in for-profit, chain-affiliated facilities in urban and suburban areas. Facilities with fewer psychosocial deficiencies and higher occupancy rates employed social service directors with greater qualifications. The implications of these findings for social work education, practice, policy, and research are discussed.

KEY WORDS: nursing homes; professional qualifications; professionalization; social service directors

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Nursing home (NH) residents, among the most vulnerable members of our society, typically have complex, interacting psychosocial and medical needs. Most require extensive assistance with personal care, including bathing, dressing, toileting, eating, and transfers (Jones, 2002), and nearly 75 percent have cognitive impairment, often complicated by depression, agitation, or both symptoms (Bartels et al., 2003). Social workers are commonly the primary staff assigned to psychosocial services provision--assessing, monitoring, and either providing or referring residents and their families for needed clinical or support services. Therefore, they also are key providers and facilitators of mental health services in the home. Current federal regulations require the provision of medically related social services in all nursing homes certified for Medicare or Medicaid payments, although only facilities with more than 120 beds are required to employ a full-time social worker who possesses the minimum of a bachelor's degree in social work or "similar professional qualifications" (Nursing Home Reform Act, 1987).

This federal definition of a social worker varies from professional standards (National Association of Social Workers [NASW], 2003) by allowing staff who lack degrees in social work and may not have basic practice knowledge and skills to serve in this role. It also erodes social work's professional status in NHs given Greenwood's (1957) characterization of professions as possessing a body of knowledge, authority and expertise, a code of ethics, a culture that includes self-monitoring, and public sanctioning. Perhaps the most salient concern, public sanctioning allows for title protection, accreditation of educational programs, and a licensing system and requires professionals to convince their communities, and likely their employers, that their skills and performance require specialized education and lead to good outcomes for clients. Historically, the process of social work professionalization may have contributed to a deprofessionalization of the public welfare workforce, because social work failed to "define its domain of activity ... to establish and protect its border and to assert its professional authority in the context of services for the poor and dependent" (Lowe & Reid, 1999, p. 91). Although not typically viewed as part of the modern-day public welfare system, NHs might very well fit into this spectrum as most residents are frail and impoverished and must rely on Medicaid to cover the cost of their room and board.

Concerns about a perceived lack of training among social services providers and, specifically, the use of social work designees (that is, staff lacking training in social work) in NHs culminated in a formal complaint to the U. …

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