The National Study of Nursing Home Social Services

The National Study of Nursing Home Services The University of Iowa School of Work Contact information on back cover. START HERE Are you thesocialservicedirectororleadsocial services person on-site most of the time for this nursing facility? If you share the lead position with someone else, the person who has been there the longest should complete this survey. I Don't Know (Please complete the survey) (Please give this survey to the lead social services provider) (Please call study director, Mercedes Bern-Klug at --6) This survey takes about minutes to complete. Your participation is important! 0/08/006 TO/mbk

Your answers will help build understanding of nursing home social services. 006 Univerisy of Iowa School of Work

UNDERSTANDING SOCIAL SERVICE INVOLVEMENT in This Nursing Home Facility SECTION A: Admissions Process #-7 To what extent is social services? (If not done by any staff member, please circle "") never sometimes usually always This is not done at our facility Please circle the best number for each question:. Visit potential residents in the hospital or at home to assess for possible admission. Orient new residents and family members to the facility. Explain to residents/family when and how to apply for Title (Medicaid). Explain to residents/families how to find information about a Medicare Part D drug plan. Coordinate the admissions paperwork 6. Engage new residents and/or family in a discussion about whether they have or want advance directives 7. Screen all residents for depression upon admission (If yes, please specifiy screening tool: ) SECTION B: Developing an Individualized Plan of Care #8-8. Invite resident and/or family to care plan meetings. Attend quarterly care plan meetings 0. Provide written care plan minutes to family or resident. Screen at-risk residents for depression... (Please specify tool, if you use one: )

To what extent is social services? (If not done by any staff member, please circle "") never sometimes usually always This is not done at our facility Please circle the best number for each question:. Screen residents for anxiety... (Please specify tool, if you use one: ). Screen residents for cognitive impairment... (Please specify tool, if you use one: ). Plan interventions for residents who are depressed. Be part of the team that talks with residents/families about the possibility of hospice enrollment 6. Be part of the team that talks with a resident/family regarding stopping treatment (such as dialysis or chemo)... 7. Discuss resident's care preferences with the physician 8. Review advance directives with a resident and/or family at least quarterly. Discuss option of "Do t Resuscitate" (DNR) with resident or family 0. Discuss option of "Do t Hospitalize" (DNH) with resident or family. Document residents' goals for personal growth in the care plan. Document residents' goals for participating in the daily life of the nursing home. Document residents' goals for remaining connected to the community beyond the nursing home

SECTION C: Helping to Improve the & Psychological Well-being of Nursing Home Residents & Families #- To what extent is social services? (If not done by any staff member, please circle "") never sometimes usually always This is not done at our facility Please circle the best number for each question:. Facilitate family support groups (Specify type(s): ). Provide emotional support to families 6. Handle disagreements between roommates 7. Facilitate the Resident's Council 8. Respond to resident complaints. Respond to family complaints 0. Help decide to transfer a resident to a psychiatric facility/unit for evaluation. Provide counseling (psychotherapy) directly with resident for depression and/or mood disorder. Assist with recreational activities. Organize shopping for clothes/supplies for residents SECTION D: Planning Discharges #-8. Arrange services in the community for residents who are being transferred from your facility to live in the community. Meet with nursing and others to discuss/decide discharge plans for residents receiving Medicare rehab or sub-acute services... 6. Meet with nursing and others to discuss/decide discharge plans for non-medicare residents... 7. Identify long-stay residents who could live in the community with services 8. Arrange on-site memorial service for deceased residents

SECTION E: Involving the Entire Facility in Meeting Psychosocial Needs #-6 To what extent is social services? (If not done by any staff member, please circle "") never sometimes usually always This is not done at our facility Please circle the best number for each question:. Plan staff interventions for residents who have behavioral symptoms 0. Talk with staff about resident emotional needs. Talk with staff about family emotional needs. Deliver staff in-service training on resident rights. Deliver staff in-service training on how to identify resident physical abuse. Deliver staff in-service training on how to identify resident emotional abuse. Deliver staff in-service training on how to identify resident financial abuse/exploitation 6. Deliver staff in-service training on how to identify resident sexual abuse SECTION F: General Supportive Services #7-7. Prepare and participate in annual state survey.. 8. Recruit and coordinate volunteers. Arrange transportation for residents to receive health care 0. Inform staff about public benefits (food stamps, transportation, housing assistance, etc.) that they may be eligible for. Coordinate the search for lost possessions of residents. Help feed residents at mealtime... 6

SECTION G: Training #-6 How prepared are you to provide one-on-one training to a new social service colleague about: t able to do Could do after - days of preparation time Could do after a couple of hours of preparation Could do without special preparation Please circle the number that corresponds to the best answer:. How to report suspected resident abuse (physical, emotional, financial or sexual) to the state authorities.. How to identify residents who would benefit from psychotherapy with a clinical social worker or psychologist. How to lead a "crisis management meeting" with resident/family and staff members. 6. When to request a psychiatric consult with a psychiatrist, psychologist, or psychiatric nurse for a resident 7. How to help secure a legal guardian for a resident 8. How to lead a bereavement support group for residents. How to lead a bereavement support group for staff 60. How to identify resident's emotional needs related to health issues 6. How to evaluate the effectiveness of social services provided for residents' emotional issues 7

We are Interested in Your Opinion. For the statements below, please indicate how much you agree or disagree: 6. I have autonomy in my job. I can decide which activities I am going to work on each day. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 6. On average, I have enough time in my work day to address resident emotional needs. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 6. In general, the nursing staff and the social services staff work well together in this facility. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 6. I feel I am thriving (not just surviving) in my job. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 66. I am satisfied with my salary and benefits. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 67. Working with families is part of my job. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 68. During my first week as a social services director, I knew what my role was. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 6. In general, I enjoy working with older adults. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 8

70. In general, this facility provides high quality medical care to residents. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 7. In general, this facility provides high overall Quality of Life to residents. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 7. I would like more training to help address resident emotional needs. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 7. I would like more training to help address family needs related to the nursing home. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 7. I would like more training in how to work effectively as part of a health care team. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 7. In general, the administrator at this facility cares deeply about the residents. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 76. My boss treats me like an important part of the team. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 77. In my job there is too much paper work, and not enough time to meet with residents face-to-face. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree 78. I enjoy being a nursing home social services staff person. Strongly Disagree Somewhat Disagree Neutral Somewhat Agree

The following list are things that might be barriers to identifying and meeting the social and emotional needs of residents. Please rate to what degree they are a barrier in your facility t a Barrier Minor Barrier Moderate Barrier Major Barrier = t a barrier at all - = Major Barrier 7. t enough time 80. Burdensome paperwork 8. Insufficient number of trained social service staff 8. Insufficient number of trained nurse aide staff 8. Having to do things that others could do 8. t clear what social service role is 8. t enough support from my boss... 86. t enough family involvement During the past years, have you received at least one hour of training on any of these areas? 87. Racism 88. Sexism 8. Ageism 0. Homophobia. Religious prejudice. Disability discrimination. You may have heard of the "culture change movement" affecting some nursing homes in the U.S. This is a process of transforming a traditional and institutional nursing home into one that is designed around the needs and desires of residents, in other words, into a nursing home culture that is "person-centered". The goal is to develop a nursing home culture that supports residents and helps them to grow and develop. Is your nursing home facility part of the culture change movement?, we are in the process of implementing culture change., we have not and are not planning to do culture change. (skip to #) I don t know. (skip to #) 0

. To what extent was (or is) social services in helping the facility to implement "culture change". services was/is the LEAD department for culture change services was/is somewhat in culture change Other: In your opinion, how important is each factor in terms of preparing new social service staff to be effective in addressing resident emotional issues? t Important at All Very Important. Previous experience working in a nursing home in ANY capacity 6. Being trained by an experienced social service person 7. Having a bachelor's degree in social work 8. Having a bachelor's degree in some human service field. Having a Masters degree in social services 00. Previous experience working with older adults in the community (ex. senior center or Area Agency on Aging) 0. Previous experience working in a hospital or health clinic setting... 0. Access to continuing education workshops that focus on the role of the nursing home social service staff 0. Having an educational background in aging issues 0. Previous experience being supervised in a counseling setting 0. Other:(please list) 06. Other:(please list)

Questions About the Service Staffing 07. How many people are employed, either full-time or part-time in Services in this nursing home facility, as of last Monday? Do NOT include consultants. (mark the best answer with an "X") one person two people three people more than people (please indicate the number: ) 08. Is Services its own department?, combined with Activities, (please explain: ) 0. Do you have a written job description? (skip to question #) 0. If yes, has your job description been up-dated in the last years? I don't know. Who is your boss? (Who do you report to, in the facility?) The Administrator The Director of Nursing Other (please list his/her title: ). What is your boss's formal educational attainment? (Answer each level, please) -A Don't Know High school degree or GED -B Don't Know Associate's degree in: -C Don't Know Bachelor's degree in: -D Don't Know Master's degree in: -E Don't Know Other:

For each person who works in nursing home social services in this facility, please complete the following information. Include employees only. Please do not include consultants. If you have more than people, please provide information about yourself and the people who have been there the longest. Staff # - You. Average number of PAID hours per week, at this nursing home in social services? Less than 0 0- or more. Do you have an undergraduate college degree? I don't know, in. How many years of nursing home social services experience do you have? (In any nursing home) less than year - years - years 0- years more than years Skip the "Staff #" and "Staff #" sections if you are the only social service person on staff. Please skip to # Staff # Section 6. Average number of PAID hours per week, at this nursing home in social services? Less than 0 0- or more 7. Does this person have an undergraduate college degree? I don't know, in 8. How many years of nursing home social services experience? (In any nursing home) less than year - years - years 0- years more than years Skip this section if there are only social service people on staff. Please skip to # Staff # Section. Average number of PAID hours per week, at this nursing home in social services? Less than 0 0- or more 0. Does this person have an undergraduate college degree? I don't know, in. How many years of nursing home social services experience? (In any nursing home) less than year - years - years 0- years more than years

. Does your facility have a contract with an outside social service consultant who provides support and supervision to social service staff? (If "no" skip to #) I don't know. How helpful is the consultant in supporting and supervising social service staff? t Helpful Extremely Helpful. Does your facility contract with an outside clinical social worker, psychologist, or psychiatric nurse to provide counseling services directly to any of the residents? I don't know Please indicate the areas of responsibility for the nursing home social service staff. Responsible for providing social services to: (N/A = t Applicable, check N/A if not part of facility). Residents in nursing facility, "long-term care" beds? N/A 6. Residents in nursing facility Dementia unit? N/A 7. Residents in nursing facility Hospice unit? N/A 8. Residents in Skilled Care / Rehab (Medicare beds in your facility)? N/A. Residents in Assisted Living? N/A 0. Residents in hospital connected to nursing facility? The following questions ask about your working conditions and resources. Please use an "X" to mark "yes" or "no" for each item N/A. Do you have your own computer at work?. Do you have access to any computer at work?. Does your facility use e-mail for staff communication?. Do you have access to the Internet at work?. Do you use the Internet at home at least once per week? 6. Do you wear a beeper at work?

7. Are you sometimes "on-call" during evenings and weekends? 8. Do you have voicemail or answering machine at work?. Do you have clerical support at work? 0. Do you have your own (private) office?. Do you have a private place to make phone calls?. Does your facility have computerized resident medical records and progress notes?. Does your facility have computerized resident care plans? Work-related Job Benefits at This Nursing Home Facility. Does your nursing home employer offer health benefits to you? (skip to #6) I don't know. If, yes, do you have health insurance coverage through your employer?, I obtain coverage through my spouse, I don't have health benefits Other (Please explain: ) 6. Is your employer paying into a work-related private pension plan on your behalf? I don't know 7. What is your estimated annual gross (before taxes) wages/salary from this job? Less than $,000 $,000 - $, $,000 - $, $0,000 - $, 6 7 $0,000 - $, 8 $0,000 - $, $0,000 - $, $,000 - $, $60,000 or more

How much would the following factors improve your job satisfaction? A little Moderately A lot Fine as is, no need to improve 8. Higher salary/wage. Better health insurance 0. Better pension plan. Reimbursement for attending conferences. Tuition reimbursement for taking college credit classes. Opportunity to meet with social services staff in other facilities. More feedback from my boss about how I'm doing my job. Better working relations with nursing staff 6. More flexibility in my hours 7. More feedback on what my job responsibilities are 8. Recognition of the value of social services, from other staff.... More influence in how the nursing facility treats residents, family, and staff 60. Being able to focus on the social and emotional concerns of residents 6. Supervision and support from an outside, qualified social work consultant... 6. Other: 6

6. Do you belong to a professional organization that helps you keep up-to-date on issues affecting social services in nursing home facilities?, (please list the full name of each organization that helps keep you up-to-date) 6. Would you be interested in joining a national network of nursing home social service directors? 6. Where do you think you will be working in years? (Choose the ONE BEST answer) In this facility: In the same job In a different job (explain: ) In a different nursing home: As Service Director In a different job (explain: ) 6 7 8 In assisted living t in long-term care at all I hope to be retired in two years, and not working for pay Other: 66. We are interested in any other comments you may have about Nursing Home Services: (Feel free to attach an additional page.) 7

DEMOGRAPHICS 67. What is your gender: Male Female 68. What is your age: 8-6- - - -6 6 6+ 6. What is your race: African American Asian/Pacific Islander Native American White Multi-racial 6 Other: 70. Are you of Hispanic origin? Please answer YES or NO for each level of formal education by putting an "X" in the correct box to indicate education you have completed: 7. 7. 7. 7. 7. 76. 77. High school degree or GED Associates degree in social work Associates degree in non-social work Bachelor's degree in social work Bachelor's degree in non-social work (please list the field: ) Master's degree in social work Master's degree in non-social work (please list the field: ) 78. In what year did you graduate with your highest degree? year 7. 80. 8. Are you currently licensed in social work? (please specify your license, for example "LCSW": ) Are you currently licensed in a field other than social work? (please list: ) Are you certified or registered in any field? (please list: ) 8. Are you working on a college degree at this time? (In what field: ) Please Check One: A Undergraduate Degree B Graduate Degree 8

FACILITY DEMOGRAPHICS 8. What is the facility's ZIP CODE: 8. Is this a for-profit, not-for-profit, or government facility? For profit t for profit Government owned I don't know 8. Is this facility part of a chain of or more nursing homes? (make an "X" by the best answer) (please specify quantity below) - homes 6-0 homes -0 homes or more homes 6 I don't know 86. Is this facility religious based?, it is religious-based, it is not religious based I don't know 87. How many total beds are there in this nursing home facility? beds (Do not include assisted living or CCRC) 88. How many private rooms? private rooms 8. Please estimate your current occupancy rate for this month: % 0. Please let us know what your impression of this survey is: Thank you for your experience and insight! Group results will be posted on www.uiowa.edu/~socialwk Fall 006

Thank you! P l e a s e c o m p l e t e a n d r e t u r n t o : Mercedes Bern-Klug Rm 08 rth Hall School of Work University of Iowa Iowa City, IA () -6 phone () -7 fax 0