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From January 2002 NASW NEWS The review is called a unique opportunity to review nursing home social work practice. By John V. O'Neill, MSW, NEWS Staff The Department of Health and Human Services' Office of Inspector General (OIG) has undertaken an investigation of whether the nursing home industry is in compliance with laws and regulations that require a broad array of psychosocial services to their patients. A major part of the investigation will be the legality and health consequences of hiring social work "designees." Designees usually have little or no training and sometimes have no more than a high school education when hired to perform social services functions in the challenging environment of skilled nursing facilities (SNFs). The investigation resulted from a complaint put together by an informal coalition of social workers in Washington, D.C., in conjunction with the National Citizens' Coalition for Nursing Home Reform (NCCNHR). NASW was one of 14 organizations that signed the complaint. The evaluation is being conducted by the OIG's Office of Evaluation and Inspections out of its New York office. By November, the OIG team that will conduct the investigation was developing a methodology and had met with the informal coalition in Washington. OIG investigations typically take a year or sometimes considerably longer to complete, and no timetable has been established. "This is a unique opportunity for a review of social work practice in important and critical health care institutions to determine the extent to which regulations have had an impact on the level and quality of service," said Ruth Knee, a social worker who coordinates the informal coalition. "Even regulatory surveys are very thin on data they produce about social work compliance and resources. I don't know of any other study that has been done that provided even the preliminary data that this study will produce." "For many years, NCCNHR has joined other advocates and social workers in their concern about the lack of qualified social services in nursing homes," said Elma Holder, who founded NCCNHR more than 25 years ago. "Although many nursing homes do strive to provide qualified social services, in the typical nursing home the emotional and mental health needs of residents are seriously neglected. This study should lead to important changes that will benefit residents." The complaint on which the OIG investigation is based cited the Omnibus Budget Reconciliation Act of 1987, which contains the landmark Nursing Home Reform Act. The law 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." It also requires that "the services provided or arranged by the facility must meet professional standards of quality." "Despite strong legal and regulatory requirements about the provision of social work services in nursing homes, HCFA (Health Care Financing Administration, now Centers for Medicare and Medicaid Services), and its state contractors, have — for the most part — ignored, misinterpreted and failed to enforce these requirements, allowing SNFs to provide inadequate services while billing the federal government for comprehensive services," the complaint asserted. Because of weak enforcement of federal law and regulations, psychosocial services for nursing home residents are minimal, it said. The complaint asked the OIG to conduct an investigation that will:
The complaint listed functions that professional social workers are trained to perform, which it said are far beyond the reach of those without professional education and training:
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