Social workers play a vital role in improving the quality of nursing home residents' lives.
But qualifications of nursing home social workers vary wildly in part because of low federal standards and inconsistent state laws, the first national study on nursing home social workers reveals.
Only half of nursing home social workers have a degree in social work, and 20 percent do not have a four-year degree, a University of Iowa survey of 1,071 nursing home social service directors shows.
Despite their desire to learn, two-thirds of nursing home social workers report they do not belong to a professional organization that helps to keep them up to date on nursing home social work issues, and only 38 percent are licensed in social work.
For-profit nursing homes are 31 percent less likely to hire a degreed social worker.
The numbers are concerning, given the important responsibilities nursing home social workers have, said Mercedes Bern-Klug, the assistant professor of social work in the UI College of Liberal Arts and Sciences who led the study.
Nursing home social workers advocate for residents and watch for signs of stress and depression. They connect residents and families with resources in and outside the nursing home and facilitate transitions such as hospice, a hospital stay or a return to independence. They guide families, residents and care providers through difficult conversations or conflicts.
"Nursing home social workers handle very serious emotional issues affecting residents, family members and other staff members, and they deserve to be educated on how to handle these issues," Bern-Klug said. "Everyone benefits when nursing homes hire qualified social workers."
Older adults struggle with dementia, and the highest rates of suicide are among older adults. Some are victims of physical, emotional or financial abuse.
"Still, many people in charge of social work in nursing homes aren't social workers, and the federal government doesn't require that they be social workers," Bern-Klug said.
Homes with more than 120 beds are required by federal law to employ a full-time social worker, but anyone with a bachelor's degree in any human service field -- not necessarily social work -- and one year of supervised experience in the field is considered qualified.
Seventy percent of nursing homes have less than 120 beds, and therefore are not required by federal law to employ a social worker. Most homes do employ one -- but typically only one -- which means devoting adequate time to each client is difficult, Bern-Klug said. Many times social workers' jobs involve other duties like marketing or activity planning.
"I asked 1,000 social workers, 'How many residents can you handle? Federal guidelines say you can do 120,'" Bern-Klug said. "An overwhelming majority said fewer than 60.
"We need legislation to demand well-prepared social workers and to set reasonable social worker-to-resident ratios, but unless families demand changes, it will be difficult to get them," Bern-Klug said. "Decades of research has documented the negative consequences of having too few nurses in a nursing home, and still we don't have strong laws demanding a realistic nursing ratio."
Bern-Klug examined state laws and found that 10 states don't address qualifications for nursing home social workers, and seven state codes do not appear to comply with federal standards. Twenty-one states require a social work degree, and most others require a four-year degree, but not in social work.
Iowa's guidelines for social services in nursing homes with more than 120 beds are identical to the federal guidelines. Iowa code does not address the social service credentials of the majority of its nursing homes, which have fewer than 120 beds.