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Social Services, Admission, and Discharge
The nature of social work in a long-term care facility brings the social worker into extensive
contact with current and poten±al clients. The prac±ce of social work requires sensi±vity to
people’s needs and an understanding of the problems and issues that people may face when
they have to live within social systems that can be large and complex. Hence, dealing with
residents’ psychosocial concerns is at the heart of good nursing home social work (Bern-Klug et
al., 2010). The term psychosocial refers to a constella±on of social and emo±onal needs and the
care provided to meet those needs (Vourlekis et al., 2005). When psychosocial issues remain
unaddressed, they can lead to depression, anxiety, and physical illness. Eventually, the person
may lose touch with reality as a means of coping and may even lessen the will to live (Bern-Klug
et al., 2010). Because many complex social issues cannot be resolved in the best interest of
everyone, the focus of social services is on suppor±ng the coping and adap±ve capaci±es of
individuals (Dubois & Miley, 1999, p. 44). Social services are an essen±al component of long-
term care from preadmission planning through a pa±ent’s stay in the nursing facility to the ±me
of discharge. The social worker performs key planning and coordina±ng func±ons through these
stages of change in a person’s life.
Social Services Department
StaFng
In an average-sized facility of 100 to 120 beds, the social services department typically consists
of one full-±me social worker, who holds the posi±on of department head and reports to the
nursing home administrator. Larger facili±es generally have a director of social services, who is
in charge of one or more assistant social workers in the department. A facility of 120 beds or
more may also have an addi±onal posi±on of director of admissions, admissions coordinator, or
director of admissions and marke±ng, who may report to the administrator or to the director of
social services.
²ederal regula±ons mandate a full-±me social worker for facili±es that have more than 120
beds. ²acili±es with 120 or fewer beds must s±ll provide social services, even though a full-±me
social worker is not required by regula±ons. Apart from these minimum requirements, however,
staFng considera±ons should be based on the overall scope of responsibili±es assigned to the
social services department. A na±onal study found that a full-±me social worker was typically
employed to serve 80 to 90 residents, but there were considerable varia±ons among facili±es.
Social services directors, on the other hand, indicated that a full-±me social worker could
address the needs of 60 or fewer long-stay residents or 20 or fewer subacute care residents
(Bern-Klug et al., 2010).
Quali³ca±ons
Qualifcatons oF social workers are specifed by sTaTe nursing home licensure regulatons.
Depending on whaT a sTaTe requires, social workers may or may noT have To be licensed
proFessionals. ±ypically, a bachelor’s degree in social work (BSW) is The minimum academic
preparaton necessary. In additon To The bachelor’s degree, individuals who have less Than a
specifed amounT oF experience—Typically 1 year—musT receive regular consulTaton From
someone who holds a masTer’s degree in social work (MSW). NoT all sTaTes require educaton in
The social work feld. Some sTaTes allow Facilites To have The positon oF social work designee,
someone who has a relaTed degree buT noT a BSW, in which case consulTaton From someone
wiTh an MSW is required. Evidence, however, suggesTs ThaT be²er qualifed social workers are
be²er prepared To meeT The residenTs’ psychosocial needs (Simons, 2006).
In additon To academic qualifcatons, social workers in a geriaTric se³ng musT have an
undersTanding oF The physical and psychosocial changes ThaT accompany The aging process.
±hey musT undersTand The unique needs oF The elderly and demonsTraTe a desire To work wiTh
The problems and issues conFrontng clienTs in nursing Facilites.
±he clienT populaton in nursing homes will contnue To become increasingly diverse in race and
eThniciTy. ±his is partcularly True in geographic areas where There are sizable numbers oF eThnic
groups. Working wiTh These clienTs requires an undersTanding oF and sensitviTy To culTural
di´erences.
Social workers should also possess cerTain personaliTy TraiTs such as TrusTworThiness,
compassion, patence, Thoughµulness, and abiliTy To lisTen. ±hey musT be knowledgeable oF
communiTy resources, and They need To esTablish linkages wiTh various exTernal agencies in
order To obTain needed services For patenTs and Their Families.
Knowledge oF Aging and The Elderly
An undersTanding oF aging and The special needs oF The aged is essental For anyone working in a
long-Term care se³ng. Caregivers’ a³Tudes regarding older people can in¶uence how The
elderly are TreaTed. ±he social worker is o·en called upon To assisT oTher sTa´ members in The
FaciliTy wiTh aging-relaTed issues. Social workers also generally provide sTa´ Training on issues
perTaining To geronTology—an area oF knowledge ThaT deals wiTh The undersTanding oF The aging
process, The changes accompanying aging, and The special problems associaTed wiTh aging.
UndersTanding Aging
In our socieTy, people are generally considered elderly or a “senior” when They are in Their mid-
60s. AT This age, people FrequenTly Take Formal retremenT From work, become eligible For Social
SecuriTy and Medicare, and sTarT paying more a²enton To some oF The sympToms ThaT naTurally
accompany advancing age. However, age iTselF merely provides a chronological conTexT. In FacT,
di´erenT people age di´erenTly. A³Tudes Toward one’s own aging, and behaviors associaTed
wiTh The issues oF aging, di´er From person To person. ¸rom This perspectve, The elderly are a
very heTerogeneous group.
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