Friday, September 27, 2013

Social Work in a nursing home

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Working in a nursing home, these days, means an ever increasing mountain of paper pushing for Social Workers.  State examiners come in once a year and think they can know everything you have been doing in your job by checking out the paperwork you have on file.  Even with the advent of electronic paperwork, you will find yourself trying to keep up to date with case notes and the time sensitive MDS reports that need to be submitted almost daily.  That MDS remember is Minimum Data Set which is supposed to be a quick way for the facility and state examiners to 'know' each resident's likes, dislikes, their daily habits and so forth.  But MDS reports are also how nursing homes get paid.  It is tied in to Medicare payments for each resident. 

Case notes, it is safe to say you should almost write a book on every conversation, every incident you handled and anything from how a resident looked to how they responded to your interventions.  Why a book?  Well examiners seem to want every trivial detail about each interaction you, as a Social Worker, has with each person living there.  So even if you think something might be trivial, include it anyway.  This way an examiner may still ask you questions about it, but you will have every detail already recorded for your own benefit.

Some wording of case notes can be important too.  For instance, we could not write 'resident appears to be frowning' since, sometimes some residents appear to have a permanent frown on their mouth.  We had to write: 'resident appears to have a furrowed brow' which to me, seems ridiculous at best.  

Another good piece of advice:  If you are questioned by an examiner, never, ever, volunteer any information.  It is best to only answer questions asked of you, point blank, no elaboration.  Why?  Because I saw a facility get a bad write up in the Social Services department simply because a Social Worker played Chatty Kathy and 'remembered' an important part of an incident she was questioned about concerning a resident.  She suddenly remembered something she failed to write in the case notes.  The department got written up and had to write a plan of correction (which believe me, is a nightmare in itself).  That Social Worker became so upset she resigned.  I was hired to 'fix' the situation.  So do not volunteer any information.  If you recall something important about an incident, make a note of it later in the resident's chart, but do not act like you forgot it when it happened, when questioned by an examiner, they will crucify you on the spot and tag you as a bad Social Worker.  Call it self preservation.  Are you trying to put one over on the examiners?  No, they just like to blow anything out of proportion.

I recall hearing college students, just before graduation, say: "I feel like college didn't teach me everything I need to know for a job."  They didn't.  College cannot possibly teach that stuff because every Social Work agency is different and you have to learn their policies on the job.  With nursing homes, policies vary from nursing home to nursing home within the same state, even within the same city.  Administrators will tell you to 'read their policies' but that damned book is so thick you can hardly lift it.  But my advice, if you cannot read it all in one sitting, and believe me, you can't, then when something arises you may not have encountered before, look it up then, as you need to.

A good example is: Most facilities' policy when someone has even just talked about any kind of suicide (I hate myself, I no longer feel like living this way) is to send that person out for a psychological evaluation.  Can a facility go over board and act irrational about those kinds of things?  Emphatically, YES!  We had a resident in our facility, short term, for therapy and would be going home in a few weeks.  One day, while talking to a nurse, he made a mistake and used a wrong word.  In jest, he made his finger look like a gun and pointed to his head, with a smile.  Something you and I do all the time, jokingly because we knew we said something wrong.  I got 3 reports, within five minutes that Mr So and So was acting suicidal.  Of course he was not, but staff panics about covering the facility's collective asses.

These are just a few fun projects you will face when you apply to be a Social Worker in a nursing home.