Dr. El

The top recommendation in the April 9 McKnight’s article “Researchers share 6 tips to improve nursing home care for blacks and Latinos” was to include a social worker on staff in the facility. “Great,” a reader commented, but “ask CMS … if they will pay for it.”

Perhaps, though better yet, social workers will pay for themselves.

A study published in March discussed the role and value of social work staff, with the surprising finding that deficiency scores are reduced twice as much when there’s an increase in social service staffing as compared to an increase in nursing staff. Lower deficiency scores can translate into better CMS star ratings and increased admissions, as well as reduced liability risk, creating a financial savings worth the price of a social worker salary.

The research brief goes on to report that while there’s been an increase in staffing in many other departments over time, the number of social workers remains low. The authors also note that there are no mandated qualifications for social work staff but that when social workers have higher qualifications such as a master’s degree, resident outcomes improve.

Interestingly, the other department that had almost as much effect on improving deficiency scores was the activities department, another psychosocially focused part of the team. (They didn’t study consulting psychologists, but I’d like to think we would have helped as well!)

I’m heartened but not surprised by these results. I consider long-term care to be its own world, populated by people in crisis and those who care for them. When people are sick and stressed, they don’t necessarily want the fanciest lobby or the most cutting-edge rehab equipment. They want caregivers who will treat them like individuals and provide comfort along with care.

Residents who are in the facility for long-term stays desire days filled with personal connections and meaningful activities. Dying elders and their families need realistic advice about prognoses and assistance navigating end-of-life care and decisions. If seniors have, in addition, the opportunity to share their wisdom and mend broken relationships before they leave this world, the facility will have offered immeasurable assistance beyond healing broken bones.

All of these essential life tasks are addressed through social work, therapeutic recreation and psychology services.

The vast majority of my nursing colleagues want to be able to offer comfort along with their medication distribution and personal care duties. Unfortunately, operating short-staffed or with a continual stream of new workers makes that almost impossible. There’s not enough time to establish the types of relationships with residents that lead to good clinical care, let alone a comforting, healing connection.

As facilities strive to stabilize nursing turnover, having a solid social work department and an active therapeutic recreation staff can allay some of the negative effects of a rotating nursing department. Rather than renovating the lobby or adding additional nursing staff, this study suggests that the biggest bang for the buck is to focus resources on the psychosocial aspects of care.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition andGold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her award-winning website at MyBetterNursingHome.com.