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Nursing Home Model Job Description

Statement of Purpose

The social worker will work with residents in the nursing home by identifying their psychosocial, mental and emotional needs along with providing, developing, and/or aiding in the access of services to meet those needs. Services will be provided in accordance with the National Association of Social Workers (NASW) Code of Ethics along with strict adherence to government regulations. The nursing home social worker is responsible for fostering a climate, policies and routines that enable residents to maximize their individuality, independence and dignity. This climate shall provide residents with the highest practical level of physical, mental and psychosocial well-being and quality of life.

Qualifications

  • Academic: Academic credentials as mandated by current state licensure requirements
  • Licensure: LSW, LCSW, or LICSW in Massachusetts
  • Experience: Prior work with elders in a community or long-term care setting is preferred
  • Skills: The nursing home social worker must have skills in communication, assessment and social work methods and techniques. He/she should be able to work effectively with a variety of disciplines in an individual and team setting. He/she should have a working understanding of social systems along with the ability to implement pertinent state and federal regulations.

Primary Duties and Responsibilities

In fulfilling his or her primary duties and responsibilities, the nursing home social worker shall exercise professional judgment in carrying out a variety of activities that maximize the well-being and quality of life of residents. The following is a listing of those duties according to the NASW Nursing Home Social Work Practice Standards:

Administrative

  1. Review facility policies and procedures as part of the facility’s interdisciplinary team to assure compliance with state and federal regulations.
  2. Participate in reviewing and setting policies concerning resident care and quality of life.
  3. Participate in developing facility social work policies.
  4. Develop, maintain and utilize a listing of current community resources that are useful to residents and their families/significant others.
  5. Participate in quality assurance interdisciplinary team meetings.
  6. Understand and meet all government requirements for social service documentation.
  7. Document progress in meeting the psychosocial needs of residents.

Advocacy

  1. Work with the interdisciplinary team and administration to promote and protect resident rights and the psychological well being of each resident. Prevent and address resident abuse as mandated by law and professional licensure.
  2. Identify community changes and opportunities such as legislation, regulations and programs that affect nursing home residents.
  3. Work with residents, families, significant others and staff to provide support, information and organization for taking a more proactive role in self advocacy to improve the quality of life/care for individual residents and those who live and work within the nursing home and the community at large.

Clinical

  1. Complete a social history and psychosocial assessment for each resident that identifies social, emotional, and psychological needs.
  2. Participate in the development of a written, interdisciplinary plan of care for each resident that identifies the psychosocial needs/issues of the resident, the goals to be accomplished for those needs/issues, and the appropriate social worker interventions.
  3. Ensure or provide therapeutic interventions to assist residents in coping with their transition and adjustment to a long-term care facility, including their social, emotional, and psychological needs.
  4. Ensure or provide support and education to residents/family members/significant others to assist in their understanding of placement and facility issues in addition to referring them to the appropriate social service agencies when the facility does not provide the needed services.
  5. Provide groups for residents/family members/significant others as appropriate to their needs.
  6. Provide clinical interventions to address catastrophic events that occur during the resident’s stay in the facility.
  7. Coordinate the resident discharge planning process and make referrals for appropriate home care services prior to the resident’s return to the community.

Education

  1. Educate staff regarding the role of the social worker in the facility and the psychosocial needs of the residents and their families/significant others including the problems of aging and disability.
  2. Educate staff regarding cultural diversity and each staff member’s importance when caring for residents. Educate staff regarding residents’ rights and how to recognize and prevent abuse, neglect and mistreatment.
  3. Educate residents and families/significant others regarding their rights and responsibilities, effective problem solving and the extent of community, health and social services that are available to them, including those necessary for effective discharge planning.
  4. Supervise students assigned to social services in accordance with the respective school guidelines and monitor and document the progress of their work.

Consultation

Social service consultation shall be provided by a MSW, LICSW on a planned basis with sufficient frequency to enable the social worker(s), administration and facility staff to improve the quality of life of residents by meeting their psychosocial needs. The social work consultant shall have had prior experience with elders especially regarding placement and adjustment issues in nursing facilities. In addition, the social work consultant should be familiar both with regulations about social work in nursing homes and issues that might impact resident care when working on an interdisciplinary team. The consultative services should focus on each of the following three distinct groups:

a) Social Worker

  • Review documentation and service delivery.
  • Develop and maximize the social worker’s skills in psychosocial assessment, interviewing, documentation and treatment methods.
  • Review administration, organizational concerns, program planning and long-term strategic issues.
  • Encourage professional development and self-advocacy.

b) Management Staff

  • Review program planning, policy development, priority setting regarding social services and the function/role of the social worker(s).
  • Advocate for social services as central to improving the quality of life of residents.

c) Other Facility Staff

  • Provide case consultation.
  • Provide in-services.
  • Assist in the interpretation of social work issues to clinical staff.

See also: NURSING HOME SOCIAL WORK PRACTICE STANDARDS

National Association of Social Workers - Massachusetts Chapter
14 Beacon Street, Suite 409, Boston MA 02108
tel: (617)227-9635 fax: (617)227-9877 email: chapter@naswma.org
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