Psychosocial Care of Residents at Nursing Homes Examined

Improving delivery of psychosocial services for nursing home residents was the focus of the “Psychosocial Care in Nursing Homes” conference in Washington.

The event was funded by The Commonwealth Fund and supported by NASW, LeadingAge (formerly the American Association of Homes and Services for the Aging) and the American Health Care Association.

Greater attention is being given to psychosocial care of nursing home residents in response to the Minimum Data Set 3.0, the latest tool issued by the Centers for Medicare & Medicaid Services to implement standardized assessment and facilitate care in nursing homes and non-critical access hospital swing beds.

Conference organizers said the psychosocial assessment component of the MDS 3.0 was significantly expanded as compared to the MDS 2.0. Attendees, representing various health institutions, federal agencies, national organizations and nonprofit advocacy groups, were urged to identify further guidance needed to effectively implement the new psychosocial assessment mandate.

Conference organizer Sheryl Zimmerman, professor and director of aging research at the University of North Carolina’s School of Social Work, said: “Our task was to identify clinical practice guidelines and related care planning materials that could be used by different types of nursing home staff, and to establish plans to disseminate those materials.”

Zimmerman said attendees were asked to offer “how-to” information that can be implemented in a timely fashion.

“Good psychosocial care need not be challenging nor time-consuming,” she said.

Another conference leader, Mercedes Bern-Klug, associate professor of social work and director of aging studies at the University of Iowa, said it was important to include representatives from the various disciplines involved with nursing home care. In order to have nursing home residents’ psychosocial social needs properly addressed, the entire staff requires some level of skill in assessment and follow-up planning, Bern-Klug said.

“Social workers have an important role to play, but they are not the only providers of care in nursing homes,” she said.

Another organizer, Robert Connolly, an NASW Social Work Pioneerw and CMS consultant, has years of experience helping social work and nursing home leaders improve policies and practices regarding nursing home regulations.

He said social workers need to assist others, from nurses to doctors to direct care workers, with tools that can aid them in completing the federal forms.

Conference attendees broke into seven workgroups, each focusing on a different psychosocial element outlined in the screening portion of the MDS 3.0.

For example, conference organizer Joan Levy Zlotnik, executive director of the NASW Foundation Social Work Policy Institute, served on the “return to the community” workgroup. Participants noted that states differ in fulfilling nursing home residents’ requests to return to the community.

“Among the questions raised was who is responsible for assessing availability of community resources for a nursing home resident who wants to return to the community,” Zlotnik said. “One of our recommendations is that social workers need to be involved with this process.”

Chris Herman, an NASW senior practice associate, served on a workgroup on pain issues. “Our workgroup noted that pain is not just a physical issue; it also has psychosocial aspects,” she said. “The entire interdisciplinary team needs to respond to residents’ pain, and it may be appropriate and useful to involve the residents’ family members as well.”

Zimmerman said the input from the conference will be used to aid interdisciplinary groups in nursing home care.

She said, “We hope the entire long-term care community of providers, advocates, regulators, educators, researchers and others will disseminate the materials we develop and will continue to work together now that we recognize how much can be done.”