High quality professional practice standards are an important hallmark of a profession. One of NASW’s primary functions has been to develop standards of practice for social workers in different fields.
This document sets practice standards for nursing home social workers in Massachusetts. They were developed by the Nursing Home Shared Interest Group of the National Association of Social Workers, Massachusetts Chapter through a democratic process involving input from nursing home social workers throughout the Commonwealth. NASW strongly supports the implementation of these standards in Massachusetts.
In 1991, The NASW Nursing Home Shared Interest Group made a decision by which they hoped to impact the practice of social work in nursing homes throughout the Commonwealth. The Shared Interest Group decided to develop its own Practice Standards rather than rely on the State or the nursing home industry. This Development was preceded by over twelve years of work by the Shared Interest Group with the Department of Public Health in an attempt to formulate new State regulations regarding social work practice in nursing homes.
The work was abandoned by the State following the election of a new governor. This disappointment led the Shared Interest Group to empower the social work community to take charge of their own professional destiny and to develop their own standards.
The Shared Interest Group began its work by forming a Practice Standards Sub-Committee, composed of social workers from different geographical areas. One of the primary goals was to involve as many social workers as possible, so they could claim ownership in the project. This was accomplished through the participation of hundreds of social workers over a four year period. Regional social workers from the Berkshires to Cape Cod drafted different sections of the document which were reviewed by the Sub-Committee.
There was an ongoing exchange of material between the groups. This work was supplemented by the involvement of participants at the Annual Nursing Home Social Work Conference which is attended by over 300 people. Attendees provided the Sub-Committee with comments, which were reviewed and evaluated. The project culminated with a series of seven state-wide hearings, which were attended by over 140 social workers. The material from the hearings was evaluated and incorporated into a final draft. This was adopted by the Executive Committee and the Board of Directors of the Massachusetts Chapter of NASW.
These Standards provide the reader with a foundation for social work practice in the nursing home. They are not intended to be a manual about how to practice social work in the nursing home. How social workers practice is dependent upon individual experiences, education, and levels of competency. These standards begin with a preamble, basic social work functions. They are: administration, advocacy, clinical, consultation, and education. It concludes with personnel practices. Each section has an introduction that provides the rationale for the standard and is followed by an Interpretation.
In conclusion, these Practice Standards are a constant in the midst of an ever changing health care system. The industry has seen the birth of Medicare, Medicaid, and Managed Health Care. The challenges faced by social workers, health care professional, and consumers is to maintain these standards which strive to assure humane and compassionate treatment of nursing home residents and their families.
The nursing home social worker is mandated to adhere to the professional Code of Ethics of the National Association of Social Workers. We have a legal obligation to adhere to governmental laws. We have a professional responsibility to provide good service, and to bring about change when laws unjustly affect our client population. We are responsible for fostering a climate; policies and routines which enable residents to retain individuality, independence and dignity.Administration
The Social Worker shall carry out administrative functions in order to meet the needs of residents.Standard A
The Social Worker shall participate in the development and implementation of policies regarding resident care, social work practice, and personnel policies.Interpretation:
1. The Social Worker shall be a part of the interdisciplinary team that meets regularly to review facility policies and procedures regarding compliance with State and Federal regulations.
2. The Social Worker shall influence policies that affect resident care and the quality of residents’ lives.
3. The Social Worker shall be involved with the development of policies that affect social service job descriptions, employment criteria, work standards, job benefits.Standard B
The Social Worker shall be knowledgeable of and maintain regular contact with all community resources.Interpretation:
1. The Social Worker shall develop a knowledge base of community resources which are available to the long-term-care resident as well as those residents with discharge potential.
2. The Social Worker shall assume a pro-active role in supporting and utilizing community resources.
3. The Social Worker shall maintain a current resource file.
4. The Social Worker shall educate the community regarding the nursing home as a resource.Standard C
The Social Worker shall participate in quality assurance in order to assure effective practice of social work in meeting residents’ needs.Interpretation:
1. The Social Worker shall participate in regular quality assurance interdisciplinary team meetings.
2. The Social Worker shall identify problems and develop and implement studies relative to issues affecting residents.
3. The Social Worker shall develop recommendations resulting from quality assurance data.Standard D
The Social Worker shall understand and meet all government requirement for social service documentation.Advocacy
The Social Worker shall be an advocate who promotes self-advocacy for residents and an increased awareness of issues that impact on the quality of life of nursing home residents.Standard A
The Social Worker shall be knowledgeable of nursing home, community and governmental practices that directly or indirectly affect nursing home residents.Interpretation:
1. The Social Worker shall work with the interdisciplinary team and administration to promote and protect residents’ rights and the psychosocial well-being of each resident.
2. The Social Worker has a legal and professional responsibility to prevent and address resident abuse.
3. The Social Worker shall identify community changes and opportunities such as legislation, regulations, and programs that affect nursing home residents.Standard B
The Social Worker shall assist residents, family, significant others, and staff on how to effectively advocate for the residents.Interpretation:
1. The Social Worker shall work with residents, family, significant others, and staff individually or in groups to provide support, information and organization for taking a more pro-active role in making changes which improve the quality of life for individual residents as well as within the nursing home and in the community.Clinical
The Social Worker shall be responsible for doing the psychosocial assessment, social history, care planning and clinical interventions with residents, family and significant others in order to alleviate social and emotional problems within the nursing home.Standard A
The Social Worker shall develop individualized, comprehensive psychosocial assessments for each resident.Interpretation:
1. The Social Worker shall record and develop psychosocial history and assessments in a timely fashion to be part of the resident’s permanent record.
2. The Social Worker shall include the resident, family members, significant others, and referral sources as sources of data.
3. The Social Worker shall consider the following: identifying data, cultural and background information, personal characteristics, interpersonal relationships, functioning levels, orientation, attitudes, decision making abilities, mental status, coping, behavior patterns, and legal issues.
4. The Social Worker shall develop discharge planning to reflect the resident’s potential to return to the community.
5. The Social Worker shall assess the need and nature of counseling for residents including the use of community mental health services.Standard B
The Social Worker shall participate in the development of an interdisciplinary treatment plan for each resident.Interpretation:
1. The plan shall include: identified psychosocial problems of resident, family and significant others insofar as they impact on the resident; short and long term goals which attempt to resolve identified problems; approaches for social work intervention.
2. Discharge planning and referrals to community resources (as appropriate) shall be included.
3. Residents and their family and significant others shall be encouraged to participate in the formulation process, ongoing evaluation, and reassessment with the interdisciplinary team.Standard C
The Social Worker shall ensure the appropriate provision of counseling services for residents with identified psychosocial needs.Interpretation:
1. Individual, group, and family treatment modalities shall be utilized.
2. During the initial period following admission the Social Worker shall provide intensive and frequent contacts with the resident, family and significant others.
3. The Social Worker shall provide time-limited counseling services to residents as deemed appropriate.
4. The Social Worker shall refer to appropriate community mental health services.Consultation
Social service consultation shall be provided on a planned basis with sufficient frequency to enable the Social Worker, administration and facility staff to meet the psychosocial needs of residents.Standard A
The consultant shall provide clinical consultation to the staff Social Worker.Interpretation:
1. The Social Worker shall review clinical services focusing on psychodynamics, delivery and documentation of services.
2. The consultant shall assist the staff Social Worker to further develop and maximize skills in interviewing, assessment, recording, and treatment modalities.Standard B
The consultant shall provide general consultation to the staff Social Worker.Interpretation:
1. The consultant shall discuss administrative and organizational issues, program planning, professional development, and long-term-care issues.
2. The consultant shall provide support to the Social Worker and enable the Social Worker to self advocateStandard C
The consultant shall provide consultation to the administration.Interpretation:
1. The consultant shall discuss program planning, policy development, and priority setting regarding social services.
2 The consultant (including personnel issues), shall review the function and role of the staff Social Worker.
3. The consultant shall advocate for social services with administration and other staff members.Standard D
The consultant shall provide consultation to the facility staff.Interpretation:
1. The consultant shall be available to provide case consultation regarding psychosocial needs of residents, family and significant others.
2. The consultant shall provide inservice education to the staff on selected topics or clinical concerns.Education
The Social Worker shall educate residents, family, significant others, and staff in order to create an atmosphere where residents are cared for, respected and appreciated as individuals.Standard A
The Social Worker shall educate nursing home staff on an ongoing basis regarding the Social Worker’s role in the facility and the psychosocial needs of residents and their family and significant others.Interpretation:
The Social Worker shall have regular contact with nursing home staff and participate in periodic planned inservices. This allows the Social Worker to help sensitize the staff to:
• They psychosocial problems of aging, illness and disability, both in general and how they specifically impact a particular resident or family member.
• The importance of each staff member’s involvement in caring for residents.
• An awareness of cultural diversity.
• The role of the Social Worker.Standard B
The Social Worker shall educate residents, family and significant others about living in a nursing home setting and options available to them.Interpretation:
The Social Worker shall have regular contact with residents and their family and significant others to help them understand:
• Their rights and responsibilities.
• How to problem solve when conflicts arise.
• What community, social and health services are available to them, including discharge planning.Standard C
The Social Worker shall supervise students assigned to social services.Interpretation:
1. The Social Worker shall assign tasks in accordance with guidelines from the student’s school.
2. The Social Worker shall be accountable for the student’s work and documentation.Personnel Practices
The Social Worker shall be in compliance with government regulations and shall adhere to the professional code of ethics of NASW and the Social Work Licensing Board. The Social Worker shall be provided with the necessary administrative support in order to carry out the Social Work mission.Standard A
Any Social Worker who staffs a long-term-care facility shall have a license in the Commonwealth of Massachusetts at the Licensed Social Worker (LSW) or higher level of licensure.Interpretation:
1. The Social Worker shall be licensed in accordance with state and federal regulations.
2. The minimum number of Social Worker hours per week shall be determined on a ration of 1 social work hour per 1.5 residents.
3. Frequent transfers, admissions, and discharges shall warrant an increase in social work hours per resident.Standard B
The Social Workers shall receive supervision by a licensed MSW Social Worker (LICSW or LICSW eligible).Interpretation:
The number of hours per month of supervision shall be based on a minimum ration of one hour of supervision to every five hours of social work per week.Standard C
The Social Worker shall meet the requirement for continuing education as designated by the Commonwealth.Interpretation:
1. The Social Worker shall be provided the opportunity to complete continuing education requirements in order to maintain his/her social work license.
2. The Social Worker shall be reimbursed by the employer and be provided the time to attend educational programs that shall benefit the facility and enhance his/her practice.Standard D
The Social Worker shall engage in activities which shall increase professional knowledge and enhance professional development.Interpretation:
1. The Social Worker shall expand knowledge and skill levels to increase the level of proficiency in carrying out the identified social work roles.
2. The Social Worker shall have access to adequate and updated written material pertinent to the performance and enhancement of the social work function.
3. The Social Worker shall be provided with the time and opportunity to participate in professional organizations and to network with colleagues.Standard E
The Social Worker shall require adequate supplies, clerical services, and office space to effectively and adequately carry out the social work function.Interpretation:
1. The Social Worker shall have a quiet, comfortable, secure, furnished, private, and handicapped-accessible office. This shall ensure confidentiality for residents, family and staff.
2. The Social Worker shall have a secure file cabinet in the office to maintain confidentiality of records.
3. The Social Worker shall have a telephone and have access to other modes of communication (fax machine, computers, etc.) in order to effectively carry out his/her responsibilities.
4. The Social Worker shall be provided with adequate clerical services.Standard F
The nursing home shall have written policies in place which describe the contract between the Social Worker and the nursing home in order to identify mutual expectations during the Social Worker’s employment.Interpretation:
1. A written contract shall identify the teams of employment between the Social Worker and the nursing home.
2. The Social Worker’s immediate supervisor shall provide an annual written and oral evaluation of the Social Worker.
NASW Code of Ethics (Summary)
The primary mission of the social work profession is to enhance human well-being and help meet basic human needs, with particular attention to the needs of people who are vulnerable, oppressed, and living in poverty. A historic and defining feature of social work is the profession’s focus on individual well-being in a social context and the well-being of society. Fundamental to social work is attention to the environmental forces that create, contribute to , and address problems in living.
The mission of the social work profession is rooted in a set of core values. These core values, embraced by social workers throughout the profession’s history, and the foundation of social work’s unique purpose and perspective. Core values, and the ethical principles that flow from them, must be balanced with the context and complexity of the human experience.
Core Values and Ethical Principles
Core value: Service
Ethical principle: Social worker’s primary goal is to help people in need and to address social problems.
Core value: Social Justice
Ethical Principle: Social workers challenge social justice.
Core value: Dignity and Worth of the Person
Ethical Principle: Social workers respect the inherent dignity and worth of the person.
Core value: Importance of Human Relationships
Ethical Principle: Social workers recognize the central importance of human relationships.
Core value: Integrity
Ethical Principle: Social workers behave in a trustworthy manner.
Core value: Competence
Ethical Principle: Social workers practice within their areas of competence and develop and enhance their professional experience.
The NASW Code of Ethics delineates standards regarding:
• Social workers’ ethical responsibilities to clients,
• Social workers’ ethical responsibilities to colleagues,
• Social workers’ ethical responsibilities in practice settings,
• Social workers’ ethical responsibilities as professionals,
• Social workers’ ethical responsibilities to the social work profession,
• Social workers’ ethical responsibilities to the broader society.
The above is an extract of the NASW Code of Ethics approved by the 1996 Delegate Assembly.
See also: NURSING HOME MODEL JOB DESCRIPTION