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Study: Standards Needed for Nursing Home Social Workers

Jan 8, 2009 | Parker Waichman Alonso LLP

Low federal standards and inconsistent state laws have caused lapses in nursing home social workers’ qualifications.  Although social workers are integral to nursing home residents’ quality of care, there are vast differences among workers backgrounds based on the first national study on nursing home social workers, said The Press Citizen.  This, according to the findings of a University of Iowa study that surveyed 1,071 nursing home social service directors.

The study found only half of all nursing home social workers actually have a social work degree; unbelievably, 20 percent do not have a four-year degree of any kind; two-thirds do not belong to any professional organizations; and the vast majority—62 percent—are not licensed in social work said The Press Citizen according to the study.

UI also noted that for-profit nursing homes are 31 percent less likely to hire a degreed social worker.  Mercedes Bern-Klug, study lead and assistant professor of social work at UI’s College of Liberal Arts and Sciences expressed concern over the findings noting that nursing home social workers are responsible for a variety of critical areas of care.  "Nursing home social workers handle very serious emotional issues affecting residents, family members, and other staff members, and they deserve to be educated on how to handle these issues," Bern-Klug said. "Everyone benefits when nursing homes hire qualified social workers," she added.

UI noted that nursing home residents struggle with serious disorders such as dementia, and pointed out that the highest suicide rates are among the elderly; worse, older patients are often victimized, "Still, many people in charge of social work in nursing homes aren't social workers, and the federal government doesn't require that they be social workers," Bern-Klug said.  Bern-Klug said 10 states do not address nursing home social worker qualifications, seven state codes seem to be out of compliance with federal standards, only 21 states require a social work degree, and there are loopholes in some state laws.  For instance, in Colorado, if a rurally-located for-profit nursing homes advertises for one week in its local paper for, but is not able to find, a qualified social worker, it is not required to hired such a worker, while in Indiana, a clergy member who completes a 48-hour course and consults with a social worker can deliver social services.

Also, UI said nursing homes with over 120 beds must meet federal regulations requiring one full-time social worker be employed; however, a bachelor degree in any human service area—not specifically in social work—and a year of supervised field experience is considered sufficient.  Because most nursing homes—70 percent—do not meet the 120-bed standard, they are not required to employ a social worker and despite that most do employ one such worker, there are insufficient social workers to provide the individualized care patients need and, often, said, Bern-Klug, social workers are consumed with marketing and activity planning.  "I asked 1,000 social workers, 'How many residents can you handle?  Federal guidelines say you can do 120.’ An overwhelming majority said fewer than 60,” she said.  "We need legislation to demand well-prepared social workers and to set reasonable social worker-to-resident ratios….  Decades of research has documented the negative consequences of having too few nurses in a nursing home, and still we don't have strong laws demanding a realistic nursing ratio," Bern-Klug said.