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Preamble

We, the social workers of the nursing homes of Minnesota, in order to form a more viable framework for professional practices of ourselves and for psycho-social health of our residents  do hereby ordain and establish these Standards of Practice of Social Work in the Nursing Home  Setting.

Social work holds first and foremost the dignity and self-determinism of its residents.  It seeks to resolve the problems presented by residents by viewing them from a holistic perspective within the environmental context.  Therefore, as social workers within the nursing home settings, we seek to advocate in an institutional system.  This requires complex knowledge and skills, a strong professional commitment, and ongoing learning.

The set of skills and knowledge outlined here represents a mastery level which could only be achieved with two to five years of direct experience in long-term care, given a background of education in social work.  To maintain these standards requires personal dedication, education, and an environment of support from the employer and from regulatory bodies.  We believe these standards of practice out-line a professional competence each nursing home must foster and each social worker in that setting must strive to embody.

The framework can also serve as a guide for administrators and policy-makers to create environments in which these standards can be achieved for the ultimate benefit of nursing home residents.

I. Training

A. Initial Preparation

1. The optimal preparation is a bachelor's degree or a master's degree from an accredited School of Social Work.  The social worker should have a demonstrated interest in long term care, the elderly and disabled.

2. The Minimum preparation necessary is a bachelor's or master's degree in a related field limited to human services, social services, psychology or sociology.

3. It is recommended that the social worker be licensed in the State of Minnesota, or eligible for licensure.

4. It is suggested that for the first two years of practice, a nursing home social worker be supervised by someone meeting the requirements of number 1, 2 or 3 above who has two or more years experience in a nursing home, or as comparable to the licensure supervision standards for Minnesota.

B. Ongoing Training

1. The purpose and value of ongoing training is to keep up to date with regulations, skills, issues, theories, and ethics.

2. A nursing home social worker should participate in not less than 30 hours of training every two years (as consistent with every Minnesota licensure standards) provided by a variety of sources or settings, including the following:

1. MNHWSA workshops, retreats, seminars and meetings.

2. Care Providers, MAHA or other State offered programs.

3. Programs offered by other associations or service groups.

4. In-house inservice training (but this should account for not more than half of training hours).

5. College coursework, either at the bachelor or graduate level.

6. Newsletters and journals on long term care, social work, aging and related fields.

7. Seminars enhancing professional stress management, supervision, etc.

3. By Networking with other social work professionals reviewing and sharing theories and techniques, the social worker gains updated perspectives which benefit the nursing home social work setting.  Because nursing home social work departments tend to be small and located within the larger institutional settings surrounded by other disciplines, it is vital that social workers regularly attend meetings and training sessions outside the nursing home.

II. Professionalism

A. Performance

1. The nursing home social worker must display appearance, language, and style of interaction, a level of professionalism which fosters trust in the social worker's ability to emphasize with and advocate for the resident/family system.

1. In validating an advocacy role, display a dedication which instills confidence in the people one serves and works with.

2. Convey both self-confidence and empathy to build relationships.

2. Each social worker must recognize and enact the role as resident advocate above all else.

1. Uphold residents rights, dignity and respect.

2. Promote self-determination.

3. Ensure least restrictive environment including chemical and physical restraint reduction.

4. Advocate and assist with planning for a discharge/transfer and the utilization of community resources.

3. A social worker should act as a role model for all staff and families in advocating resident autonomy.  Show willingness to promote social work values, ethics and resident rights even when challenged by difficult situations.

4. The nursing home social worker must maintain a clear identification with the philosophies and goals of social work. 

1. Educate others regarding the professional role and identity of social work.

2. Share knowledge base with colleagues.

3. Be aware of and follow National Association of Social Workers Code of ethics.

5. The social worker has an important role in documentation and shall establish and follow systems which enable sharing of information with the professional team.  Documentation (i.e., assessments, histories, plans, goals, and progress reports) is one of the visible and permanent reflections of the social worker's professional capabilities and of accomplishments toward resident goals.

6. The social worker must be aware of limits, both professional and personal.

1. Recognize legal limits and boundaries of the practice.

2. Identify when a case requires professional knowledge or skills beyond one's current capacity.  Seek additional information or refer the issue to another practitioner.

3. Be aware of personal biases in specific cases.  Seek consultation from a colleague or supervisor, or refer the case elsewhere.

7. A social worker must respect other disciplines, giving value to their positions and contributions.

8. The social worker would enhance professionalism through an active role in MNHSWA and other national, state and local associations.

B. Caseload and Additional Duties

Based on a 1992 survey conducted by the MNHSWA, a caseload of not more than 50 residents per full time social worker would be necessary to allow adequate time in which to perform advocacy, counseling and documentation functions.  Additional duties such as management, supervision and admission coordination would require an increase in social work staff for the facility.  The inclusion of social workers in these functions is valid and important to maintaining a resident-centered perspective in the operation of the facility.  This may vary depending on the type with which the social worker is employed.

The MNHSWA recommends a salary range as recognized be the National Association of social Workers.  Salary ranges may vary according to size, location and ownership of individual facilities along with the experience and education of the individual social worker.

III. Skills

A. Assessing, Planning, & Documentation

1. To be an effective case manager, a nursing home social worker must possess skills to acquire the information necessary to provide appropriate service to each resident.

1. Interviewing skills are essential, using questions and environment in a purposeful manner to gather information.  Attention must be given to both verbal and nonverbal communication, utilizing observation and listening skills.  Techniques must include interviewing individuals as well as groups.

2. Possess research skills including the ability to gather data from any written document, particularly medical records.

2. Once adequate information is gathered, a nursing home social worker must possess the information, drawing conclusions, completing initial and drawing ongoing assessments.

1. Assessments must be comprehensive, often expanding on the State and Federal minimum standards (i.e., "Minimum Data Set").

2. A good assessment process  includes an initial assessment, the purposeful subsequent assessments, identifying residents needs, problems, goals, strengths and weaknesses, recognizing the positive and negative aspects of every situation.

3. Utilize assessment techniques to identify and evaluate cognitive, emotional, interpersonal, legal, financial, social and behavioral issues.

3. As a member of the interdisciplinary team which includes the resident, a nursing home social worker must apply the assessment to develop a useful plan of care.

1. Advocate for a resident-directed plan of care, with resident input.

2. Formulate individualized goals which are behavioral and measurable.

3. Re-evaluate interventions and goals as indicated by any changes in circumstances involving the status of the resident.

4. Continually gather new information, reassess, and update the plan of care.

4. The social worker must be intricately involved in the implementation of the plan of care, outlining specific approaches that will enable the resident to attain individual goals.

5. Nursing home social workers must document thoroughly in progress notes, assessment records and the plan of care.

1. Documentation must be clear, useful, accurate and legible.

2. The social worker must differentiate between objective and subjective statements.

3. Documentation must be individualized.

4. In coordination with other disciplines, documentation must reflect consistency in assessments, the plan of care, and progress notes.

B. Implementation

1. A nursing home social worker advocates for resident rights to ensure quality of life and access to known entitlements within the family, nursing home, and government agencies.

2. A nursing home social worker should demonstrate leadership and assertiveness.

3. In working with nursing home residents, the social worker should possess problem solving skills.  These skills include the ability to investigate, evaluate, negotiate, make recommendations and resolve the issues.

4. A social worker should have skills to disseminate information clearly through meetings and educational programs with residents, staff, families and the public.  The ability to successfully perform public speaking at the listener's level is important.

5. A social worker should possess good writing skills to inform others at a reader-friendly level.

6. It is important in completing job tasks for the social worker to prioritize and use good organizational skills.

7. Through a good social service "quality assurance" program, a nursing home social worker would critique, evaluate, and seek to improve the quality of services provided.

IV. Knowledge

A. Methods

In order to professionally serve residents, nursing home social workers need knowledge of social work methods which offers structure to the practice of this discipline.  Appropriate use of assessment tools (i.e., Minimum Data Set (MDS), Mental Status Questionnaire (MSQ), etc.) and clinical methods (i.e., crisis intervention, mediation, negotiation, facilitation, referrals, consults, etc.) assists is addressing and implementing planned change effort.

B. Knowledge Bases and Theories for practice

In order to more effectively serve the unique population in the nursing home, the social worker should have knowledge of the established theories of human development and human behavior as well as knowledge in the following areas:

1. Aging process

2. Family dynamics

3. Group process/dynamics

4. Crisis theories

5. Grief counseling

6. Interpersonal skills

7. Socio-economic conditions

8. Historical perspectives/era of development

9. Demographics

10. Disease processes

11. Medical terminology

12. Medications

C. Regulations

1. Nursing home social workers need working knowledge of federal and state regulations and interpretations as they pertain to the social work function and responsibility, especially resident rights.

2. Nursing home social workers must also possess a working knowledge of county interventions such as Pre-Admission Screening (PAS), Vulnerable Adults, etc. are also needed.

3. Nursing home social workers must have input and subsequently follow facility policies and procedures relating to their disciplines.  A general knowledge of pending legislation as it applies to nursing home social work.

D. Legal Issues

A social worker must gain familiarity with various legal issues and how they pertain to the people served.  The social worker should know the provisions of the law, any definition, how to implement it, and what role the social worker can play.

1. Financial Power of Attorney -- General of Durable; and how to revoke.

2. Power of Attorney for Health Care Decisions.

3. Living Will

4. Guardianship

5. Conservatorship

6. Commitment

7. Resuscitation guidelines

8. Disclosure of presence

E. Resources

1. Financial (i.e., RSDI, SSI, VA, Medical Assistance, General Assistance, Alternative Care Grants (ACG) Elderly Waivers and CADI.)

2. Advocacy (i.e., ombudsman, County Adult Protection, legal aid, political systems, Area Agency on Aging, Office of Health Facility Complaints (OHFC).

3. Functional Assistance (transportation, homecare, meals on wheels, social opportunities, adult day care, durable medical equipment, emergency response equipment.)

4. Alternate Placement (own home, apartments, board and lodging or board and care facilities, family homes, other nursing homes, assisted living settings, adult foster homes, subsidized housing, etc.)

5. Support/Information/Education (AARP, local volunteer groups, church efforts, family, neighbors, friends, senior centers, county human services, hospice services, veteran's administration, hospitals, Alzheimer's Association.)