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From January 2001 NASW NEWS There are no "designees" in nursing homes practicing medicine or nursing. By John V. O'Neill, MSW, NEWS Staff NASW in November signed a formal complaint to the inspector general of the Department of Health and Human Services asserting that nursing homes nationwide are violating federal laws, state laws and federal regulations by allowing "social services designees" to perform professional social work services in many of the nation's 17,000 nursing homes. The complaint asks the Office of Inspector General (OIG) to audit the practice by the Health Care Financing Administration (HCFA) of allowing nursing homes and state inspectors to permit social services "designees" without social work education or training to be in charge of providing psychosocial and mental health services, a practice it says is in stark conflict with the intent of Congress, laws and regulations. Further, the complaint asks the OIG to investigate the nursing home industry practice of billing Medicaid and Medicare "as if these professional services are being delivered." The tasks of nursing home social workers are difficult for those with education, training and experience, the complaint says. "Without training, they are impossible, and residents suffer needlessly." The complaint says that HCFA and the nursing home industry have never complied with the Nursing Home Reform Act of 1986 and HCFA regulations that require a broad array of professional psychosocial and mental health services for the 1.6 million residents of America's nursing homes. There are no other designees in nursing homes except those for social workers. No untrained, unlicensed designees act as physicians, nurses or occupational therapists. Renewed attention to the issue followed actions by the Idaho legislature to repeal sections of the state's social work licensing act after a state agency wrote an opinion saying that the state was operating outside the law by allowing designees to practice social work in nursing homes. The Idaho action was based a complaint by Frank Olander, who felt he and his mother, then a nursing home resident, were harmed by the actions of a social services designee. After the state agency's opinion affirming his complaint, Olander and his attorneys expected the state to come into compliance with federal and state laws requiring professional social workers in the state's nursing homes. Instead, the state legislature, at the behest of the nursing home industry, passed emergency legislation repealing parts of the state's social work practice act, a move that would allow designees to practice social work in nursing homes and hospitals. The "egregious situation in Idaho this year threw a spotlight on the inadequacy of psychosocial and mental health services in many nursing homes and the unwillingness of the nursing home industry to comply with federal and state laws in the absence of rigorous enforcement," says the complaint. The complaint to the OIG was assembled by an informal coalition of social workers, coordinated by Ruth Knee, and the National Citizens' Coalition for Nursing Home Reform (NCCNHR). Groups signing the complaint, in addition to NASW and NCCNHR, include the Council on Social Work Education and the Association of State Ombudsmen. The complaint addresses more than just the qualifications of those providing social work services. Signers request that the OIG:
They also request corrective actions to:
Federal laws require that all state laws governing social work practice and nursing home staffing be complied with. The Omnibus Budget Reconciliation Act of 1986 (P.L. 100-203) which contains the landmark Nursing Home Reform Act, requires skilled nursing facilities to provide "medically related social services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident." Some of the functions of nursing home social workers that the complaint says would be beyond the skills of those without social work education and training include:
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