New Practice Updates Address Aging, Health

NASW emphasizes the critical role of professional nursing home social work in a new practice update concerning the Centers for Medicare & Medicaid Services’ rollout of its revised assessment instrument, the Minimum Data Set version 3.0, or MDS 3.0.

The update is one of four recently released by NASW. Of the other three, one is related to prescription assistance programs and two others are specific to social workers involved in child welfare.

CMS-certified nursing facilities, skilled nursing facilities (SNF), swing bed hospitals (small, rural hospitals approved by CMS to provide post-acute SNF care) and nursing homes operated by the Veterans Administration must begin using the MDS 3.0 beginning Oct. 1.

According to CMS, the primary purpose of the MDS, which must be completed for all residents, is to use individualized care planning to identify and address residents’ strengths, preferences, needs and concerns. The agency also uses MDS data to determine Medicare and Medicaid reimbursements and to monitor the quality of care provided to nursing home residents.

“The implementation of the MDS 3.0 underscores the importance of the professional social work role in assessment and care planning for nursing home residents,” NASW’s practice update says. It asserts that nursing home staffers with degrees in social work are uniquely qualified to conduct direct resident interviews — new to the assessment tool — and to determine when residents’ responses warrant additional evaluation and services.

In addition, many nursing home social services staffers are overburdened by high caseloads, the association points out, further highlighting the need for more social workers. According to a 2003 Department of Health and Human Services Office of the Inspector General investigation of nursing homes, nearly half of social services staff reported an inability to provide comprehensive psychosocial services due to lack of time, burdensome paperwork and insufficient staffing.

Chris Herman, the NASW senior practice associate who authored the practice update, said much of the information the MDS 3.0 attempts to capture should be familiar to social workers.

“Four sections of the MDS 3.0 directly address residents’ psychosocial well-being,” said Herman. “Assessing residents’ cognitive patterns and mood, ascertaining their preferences for daily routine and activities and ensuring their participation in assessment and goal-setting — these are all things social workers in nursing homes are trained to do.”

Prescription assistance programs. Pharmaceutical Industry Prescription Assistance Programs: Benefits and Challenges is a primer on pharmaceutical companies’ prescription assistance programs for the poor and uninsured.

“Invariably, social workers are working or will work with clients who have a chronic illness treatable with medication, considering that one in five American adults has a chronic illness such as diabetes or heart disease,” said Stacy Collins, the NASW senior practice associate who wrote the update. “So, it’s important to know who is or isn’t eligible for PAPs.”

In general, those eligible for PAPs do not have health insurance, either through a private insurance company or public programs such as Medicare and Medicaid, and have household incomes below 300 percent of the federal poverty level — or less than $66,150 for a family of four in 2010. Each program has its own rules and restrictions, however.

According to the update, while many people stand to benefit from PAPs, there are a number of drawbacks that social workers should know about.

For starters, filling out the applications for assistance can be a daunting task, with each medication requiring its own application, and eligibility criteria is subject to change. Also, the accompanying fee can be cost-prohibitive for people with low incomes.

“Social workers and other providers who have experienced the labor intensiveness of PAP applications have advocated for a universal application and enrollment process,” the update says.

In addition, the update noted that PAPs may contribute to health disparities. “For example, a health care provider working with an uninsured patient will often prescribe a medication that is available through a PAP, although the medication may not be the first drug of choice for that particular patient. ... There is also concern that providers who prescribe PAP-accessible drugs without discussing fee-based alternatives with patients may be compromising their patients’ rights to informed consent.”

Social workers also should be aware that most PAPs only are available to legal U.S. residents. “Social workers often work with undocumented people in dire need, and the legal status requirement causes problems,” Collins said.

She added that a big unknown is what will happen to PAPs once the recently passed health care reforms are implemented.

On Sept. 14, NASW hosted a Lunchtime Series webinar, Helping Uninsured Individuals Save on their Prescription Medicines, in which participants learned about one such PAP, the Together Rx Access Card. Audio and transcripts of this and other Lunchtime Series webinars.

Child welfare

In Meeting the Needs of Immigrant Children and Youth in Child Welfare, Roxana Torrico-Meruvia, an NASW senior practice associate, wrote that social workers should apprise themselves of the myriad challenges faced by immigrants involved in the child welfare system. Those challenges include navigating complicated laws governing immigration and child welfare to the more obvious differences in language and culture.

The practice update recommends that social workers do the following to ensure that immigrant families and children receive the services necessary to stay together, reunite as soon as possible and/or access immigration relief options:

  • Participate in cultural competency trainings;
  • Participate in trainings focused on immigrant issues;
  • Develop professional relationships with their local U.S. Citizenship and Immigration Services agency staff to ensure that they understand immigration application processes;
  • Establish partnerships with experienced community-based agencies such as domestic violence shelters, family courts and immigration specialists;
  • Help eligible families tap into a range of resources such as the federal Supplemental Nutrition Assistance Program and Temporary Assistance to Needy Families; and
  • Participate in task forces and collaborations dedicated to immigrant issues.

The other practice update, also written by Torrico-Meruvia, examines the issue of youth aging out of foster care. According to the U.S. Department of Health and Human Services, approximately 29,500 youth, ages 18 and older, transition out of foster care with limited independent living skills and without a permanent family — all critical factors to a successful transition into adulthood, the update says.

“Unfortunately, research shows that youth who have exited foster care without a family to turn to are more likely to experience unhealthy outcomes including, homelessness, poverty, incarceration and/or poor health,” the update says.

Nevertheless, the NASW-supported Fostering Connections to Success and Increasing Adoption Act of 2008, signed into law Oct. 7, 2008, contains a number of provisions designed to promote the well-being of older youth in foster care.

Beginning this month, federal funding to states for foster care, adoption and guardian assistance is extended to cover youth up to the age of 21.

The law also extends eligibility for the Chafee Foster Care Independent Living Program and for education and training vouchers to youth who exit foster care through kinship care or adoption after age 16.

It also mandates that states develop transition plans that address future housing, education, employment and health care for each youth aging out of foster care no later than 90 days prior to their 18th birthday, or older if states choose to extend care beyond age 18.

Torrico-Meruvia says in the update that social workers can work with the young person to develop a solid transition plan prior to discharge.

“Young people leaving foster care have many more obstacles to overcome before achieving their goals,” the update concludes. “However, with support and opportunities they too, can realize their strengths and abilities to reach their goals.”