Thursday, June 26, 2014

Social Work in a nursing home the here and now

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Writing many blogs about doing Social Work in nursing homes and mainly talking about culture change, I realize many Social Workers are interested in the day to day workings of the job.  What does the job actually entail?  How do you handle certain situations?  Subjects like that.  To answer those questions and to be specific, is a difficult thing to do.  Why?  I personally think Social Work is part training and part talent.  Either you like it a lot, it can be a thankless job, or you look at it as just a paycheck.  Either you enjoy helping others solve personal problems, or you look at it as a paycheck and nothing more.  I emphasize the latter because if it's just a paycheck and nothing more, you won't be as good at it as you should be.  Simple as that.

 A big part of the job is the mechanics of the MDS, or now, the MDS 3.1.  MDS stands for: Minimum Data Set, meaning the federal and state agencies hope you and they can get to know all about a new nursing home person, in a few basic questions.  This always makes me laugh, because it's the equivalent of an employer hoping to know you by a resume and a few basic questions.  Can't be done, but since traditional nursing homes value the bottom line above all else, they need some pointless instrument to make it appear as if each individual resident is important to them.  Trust me, since most nursing homes are corporate owned, that too is not their goal.  The most interest those corporate nursing homes have in residents living there is how each resident contributes their bank account and the elevation of their bottom line.  I know it sounds harsh, but to me, traditional nursing homes is harsh business.  

 As far as the MDS is concerned, any nursing home you work for will call in a consultant to assist you in wording the MDS and in chart writing.  Why?  Well, it's much like using the Taleo hiring, resume process.  The consultant will give you key words to use in order to win the 'what do they want to read' game.  That's exactly what it is too, a game.  A dance done primarily for the state and federal agencies, designed to appease them.

 For example: when writing goals for each person, the goal should say:  "Resident's goal is to................blah, blah, blah."  Too many Social Workers will say:" Resident will................blah, blah, blah."  Using the word will makes it look like you are imposing your will, on them and not helping them achieve their goals. This is a no, no for examiners when combing through your charts.

Another duty of Social Workers is defining when a resident needs a 'psychiatric evaluation."  The evaluation is a part of state and federal agencies rule that no resident will be a threat to another resident.  We know this is pretty much BS because other residents have been know to hurt each other quite often.  This rule is broken a lot because nursing homes are out for money.  Empty homes equal not enough profit.  But the general rule for the psych eval is this:  If a resident is diagnosed with depression without the diagnosis of dementia, you have to order a psych eval.  I guess it is assumed by state and federal agencies that depressed people are dangerous.

Crazy as all this seems, such is the daily role of a Social Worker in a nursing home.