the national study of nursing home

1

START HERE

(Please complete the survey)

I Don't Know

(Please call study director, Mercedes Bern-Klug at 319-335-1265)

Are you the social service director or lead social services person on-site most ofthe time for this nursing facility? If you share the lead position with someoneelse, the person who has been there the longest should complete this survey.

This survey takes about 23 minutes to complete. Your participation is important!

Yes

No (Please give this survey to the lead social services provider)

The National Study of Nursing Home Social Services

The University of Iowa School of Social Work

Contact information on back cover.

03/08/2006 –TO/mbk

2

Your answers will help build understanding of nursing home social services.

© 2006 Univerisy of Iowa School of Social Work

3

Please circle the best number for each question:

To what extent is social services involved? (If not done by any staff member, please circle "9")

9

11. Screen at-risk residents for depression... (Please specify tool, if you use one: ________________________________) 1

1

1

1

Social Services is

never involved

1.

4

4

2 3 4

4.

6.

7.

1

9

3 9

2

2

9

2 3

3

2

SECTION A: Admissions Process #1-7

5.

2.

1

9

9

9

3.

4

3

3

4

2

2

4

4

9

Social Services is sometimes

involved

Social Services is

usually involved

Social Services is

always involved

9

3

UNDERSTANDING SOCIAL SERVICE INVOLVEMENT in This Nursing Home Facility

Visit potential residents in the hospital or at home to assess for possible admission…

Orient new residents and family members to the facility…

Explain to residents/family when and how to apply for Title 19 (Medicaid)…

1 2 3 4

9

This is not done at our

facility

1

Explain to residents/families how to find information about a Medicare Part D drug plan…

Coordinate the admissions paperwork…

Engage new residents and/or family in a discussion about whether they have or want advance directives…

Screen all residents for depression upon admission… (If yes, please specifiy screening tool: ________________________________)

1

9

Provide written care plan minutes to family or resident…

SECTION B: Developing an Individualized Plan of Care #8-23

Invite resident and/or family to care plan meetings…

Attend quarterly care plan meetings…

1 2 3 4

2 3 4

2 3 4

8.

9.

10.

1

4

9

14.

17. Discuss resident's care preferences with the physician…

18.

91 4

4

3

9

3

94

2

1

2

4

9


facility

20.

Review advance directives with a resident and/or family at least quarterly… 1 2

19.

Discuss option of "Do Not Hospitalize" (DNH) with resident or family…

Discuss option of "Do Not Resuscitate" (DNR) with resident or family… 1


involved

Social Services is

usually involved

Social Services is

always involved

4

31

13. Screen residents for cognitive impairment... (Please specify tool, if you use one: ________________________________)



Social Services is

never involved

16. Be part of the team that talks with a resident/family regarding stopping treatment (such as dialysis or chemo)... 1 2

15. Be part of the team that talks with residents/families about the possibility of hospice enrollment… 1 2

Plan interventions for residents who are depressed… 1 2 3

1 2

4 9

3

9

2 3

3

4

3 4 9

22. Document residents' goals for participating in the daily life of the nursing home… 1 2

23. Document residents' goals for remaining connected to the community beyond the nursing home… 1 2

3 4 9

3 4 9

9

3 4 9

12. Screen residents for anxiety... (Please specify tool, if you use one: ________________________________) 1 2

2 3 4

21. Document residents' goals for personal growth in the care plan…

5

9

38. Arrange on-site memorial service for deceased residents…

SECTION C: Helping to Improve the Social & Psychological Well-being of Nursing Home Residents & Families #24-33

37. Identify long-stay residents who could live in the community with services… 1 2

4 9

9

SECTION D: Planning Discharges #34-38

34. Arrange services in the community for residents who are being transferred from your facility to live in the community… 1 2 3 4

36. Meet with nursing and others to discuss/decide discharge plans for non-Medicare residents...

9

3 4 9

3 4 9

9

32. Assist with recreational activities… 1 2

4 9

Help decide to transfer a resident to a psychiatric facility/unit for evaluation… 1 2 3 4 9

9

Handle disagreements between roommates… 1 2 3

2 3 4 9

2 3 4 9


involved

Social Services is

usually involved

Social Services is

always involved


facility

91 2 3 4

Social Services is

never involved

24. Facilitate family support groups… (Specify type(s): ________________________________) 1



Provide emotional support to families… 1

30.

27.

28.

29.

25.

Facilitate the Resident's Council…

Respond to resident complaints…

26.

93 4

31. Provide counseling (psychotherapy) directly with resident for depression and/or mood disorder… 1

Respond to family complaints…

2 3 4

9

2

1 2 3 4

1

1

2 3

3 4

1 2

3 41 2

35. Meet with nursing and others to discuss/decide discharge plans for residents receiving Medicare rehab or sub-acute services... 3

4

33. Organize shopping for clothes/supplies for residents… 1 2

6

Deliver staff in-service training on resident rights…

9



52. Help feed residents at mealtime...

44. Deliver staff in-service training on how to identify resident emotional abuse…

47. Prepare and participate in annual state survey..

46.

51. Coordinate the search for lost possessions of residents… 1 2

48. Recruit and coordinate volunteers… 1 2

49. Arrange transportation for residents to receive health care…

Inform staff about public benefits (food stamps, transportation, housing assistance, etc.) that they may be eligible for… 1

50.

3 4 9

9

1 2

Social Services is

never involved

42.

41.

40.

Plan staff interventions for residents who have behavioral symptoms…

39.

Talk with staff about family emotional needs… 1

93 41 2

1 2

9

1

SECTION E: Involving the Entire Facility in Meeting Psychosocial Needs #39-46


involved

Social Services is

usually involved

Social Services is

always involved


facility

2

4

3 4

4 9

9

3 4

1 2 4

3 4

3

3

45. Deliver staff in-service training on how to identify resident financial abuse/exploitation…

SECTION F: General Supportive Services #47-52

1 2

1 2 9

Deliver staff in-service training on how to identify resident sexual abuse…

4

93 4

3

9

9

3 4 9

9

9Talk with staff about resident emotional needs… 1

1 2 3 4

2 3

2 3 4

43. Deliver staff in-service training on how to identify resident physical abuse… 1 2

2 3 4

7

1 2 3 4

3 4

1 2 3 4

2 3 4

1 2 3 4

2 3 4

1 2 3 4

1 2

How prepared are you to provide one-on-one training to a new social service colleague about:

1 2 3 4

1 2 3 4

1

61. How to evaluate the effectiveness of social services provided for residents' emotional issues…

56. When to request a psychiatric consult with a psychiatrist, psychologist, or psychiatric nurse for a resident…

55. How to lead a "crisis management meeting" with resident/family and staff members….

58. How to lead a bereavement support group for residents …

57. How to help secure a legal guardian for a resident…

53. How to report suspected resident abuse (physical, emotional, financial or sexual) to the state authorities….

54. How to identify residents who would benefit from psychotherapy with a clinical social worker or psychologist…

1

SECTION G: Training #53-61

Not able to doCould do

without special preparation

Could do after 2-3 days of

preparation time

Please circle the number that corresponds to the best answer:

Could do after a couple of hours of preparation

60. How to identify resident's emotional needs related to health issues…

59. How to lead a bereavement support group for staff …

8

5

5Strongly Agree

Somewhat Disagree Somewhat Agree

5

Somewhat Agree

1 2 4

1 32 4

3 4

Somewhat Disagree

5

Strongly Agree

Working with families is part of my job.

1 2 3 4

Strongly Disagree Neutral

1 2 4Strongly Disagree Neutral

3 5

5Strongly AgreeNeutral

We are Interested in Your Opinion.

62.

4

3

63. On average, I have enough time in my work day to address resident emotional needs.

31 2

I have autonomy in my job. I can decide which activities I am going to work on each day.

68. During my first week as a social services director, I knew what my role was.

66.

1 2 4 53

67.

Strongly Agree

Strongly AgreeNeutral

I am satisfied with my salary and benefits.

Neutral

In general, the nursing staff and the social services staff work well together in this facility.

1 2

I feel I am thriving (not just surviving) in my job.

Neutral Strongly Agree

Strongly Disagree

For the statements below, please indicate how much you agree or disagree:

Neutral Strongly AgreeStrongly Disagree Somewhat Disagree

65.

64.

Somewhat Agree

Strongly Disagree


Strongly Disagree Somewhat Disagree Somewhat Agree



Strongly Disagree

69. In general , I enjoy working with older adults.

1 2 3 4 5Strongly AgreeStrongly Disagree Somewhat Disagree Neutral Somewhat Agree

9

72. I would like more training to help address resident emotional needs.

1 2 53 4

Strongly Agree

Strongly Agree

5Strongly Disagree Somewhat Disagree Neutral Somewhat Agree Strongly Agree

1 2 3 4

Strongly Agree

73.

78. I enjoy being a nursing home social services staff person.

Strongly Disagree Somewhat Disagree Neutral Somewhat Agree

Strongly Agree

77. In my job there is too much paper work, and not enough time to meet with residents face-to-face.

1 2 3 4 5


Strongly Agree

76. My boss treats me like an important part of the team.

1 2 3 4 5


Strongly Agree

75. In general, the administrator at this facility cares deeply about the residents.

1 2 3 4 5


Strongly Agree

74. I would like more training in how to work effectively as part of a health care team.

1 2 3 4 5


Strongly Agree

I would like more training to help address family needs related to the nursing home.

1 2 3 4 5



71. In general, this facility provides high overall Quality of Life to residents.

1 2 3 4 5


70. In general, this facility provides high quality medical care to residents.

1 2 3 4 5

10

The following list are things that might be barriers to identifying and meeting thesocial and emotional needs of residents. Please rate to what degree they are abarrier in your facility…

During the past 5 years, have you received at least one hour of training on any of these areas?

1 = Not a barrier at all - 4 = Major Barrier

Not enough support from my boss...

Having to do things that others could do…

Minor Barrier Major Barrier

79. Not enough time… 3 4

Not a Barrier Moderate Barrier

1 2

84.

2

1

2

2

80. Burdensome paperwork…

Insufficient number of trained social service staff…

1

81.

3

2 3 4

3

2

1

4

88. Sexism Yes

186. Not enough family involvement…

87. Racism

Yes

Yes

Yes No

92. Disability discrimination

Yes

89. Ageism

Yes

90. Homophobia

91. Religious prejudice

No

No

No

No

No

Insufficient number of trained nurse aide staff…

82.

3 4

1

4

3 4

3

83.

85.

Not clear what social service role is…

4

3 4

1 2

1 2

I don’t know. (skip to #95)

No, we have not and are not planning to do culture change. (skip to #95)

93. You may have heard of the "culture change movement" affecting some nursing homes in the U.S. This is aprocess of transforming a traditional and institutional nursing home into one that is designed around the needsand desires of residents, in other words, into a nursing home culture that is "person-centered". The goal is todevelop a nursing home culture that supports residents and helps them to grow and develop. Is your nursinghome facility part of the culture change movement?

Yes, we are in the process of implementing culture change.

1

1

1

1

1

1

1

2

2

2

2

2

2

2

3

11

94. To what extent was (or is) social services involved in helping the facility to implement "culture change".

Social services was/is the LEAD department for culture change

Social services was/is somewhat involved in culture change

Other: ___________________________________________________________________________

Not Important at All Very Important

In your opinion, how important is each factor in terms of preparing new social service staff to be effective in addressing resident emotional issues ?

5

5

3

4 5

4

95.

96.

97.

4

4

1Previous experience working in a nursing home in ANY capacity…

Being trained by an experienced social service person…

3

1 2 3

2

1

1 2 3

2

99.

98.

1Having a Masters degree in social services… 2 3 4

4

4

5

5

100. Previous experience working with older adults in the community (ex. senior center or Area Agency on Aging)… 1

Having a bachelor's degree in some human service field…

2 53 4

5

101. Previous experience working in a hospital or health clinic setting... 1 2

102. Access to continuing education workshops that focus on the role of the nursing home social service staff…

5

52 3 4103. Having an educational background in

aging issues…

2

3

1

31

105.

3 4 5104. Previous experience being supervised in

a counseling setting… 1 2

106. Other:(please list)

________________________________________ 1 2 3 4 5

Having a bachelor's degree in social work…

5

Other:(please list)

________________________________________ 1 2 3 4

1

2

3

12

No Don't Know

112-A

112-B

112-C

112-D

112-E

No Don't Know

Yes No Don't Know

Yes

Yes

Yes

Yes No

108. Is Social Services its own department?

I don't know

If yes, has your job description been up-dated in the last 5 years?110.

Yes

No

109. Do you have a written job description?

more than 3 people (please indicate the number: ______ )

Yes

No, Social Services is combined with Activities

No, (please explain: _______________________________________________________________ )

one person

two people

three people

Questions About the Social Service Staffing

107. How many people are employed, either full-time or part-time in Social Services in this nursing home facility, as of last Monday? Do NOT include consultants. (mark the best answer with an "X")

No (skip to question #111)

Yes

Associate's degree in: _______________________No Don't Know

Other (please list his/her title: ______________________________________________________ )

Don't Know

Master's degree in: __________________________

111. Who is your boss? (Who do you report to, in the facility?)

The Administrator

The Director of Nursing

Other: _____________________________________

112. What is your boss's formal educational attainment? (Answer each level, please)

High school degree or GED

Bachelor's degree in: ________________________

1

2

3

4

2

3

1

1

1

2

3

2

1

2

3

321

321

321

321

321

13

Skip this section if there are only 2 social service people on staff. Please skip to #122

10-15 years more than 15 years

118. How many years of nursing home social services experience? (In any nursing home)

less than 1 year 1-3 years 4-9 years

117. Does this person have an undergraduate college degree?

No I don't know Yes, in ____________________________

116. Average number of PAID hours per week, at this nursing home in social services?

Less than 20 20-34 35 or more


Staff #2 Section

Skip the "Staff #2" and "Staff #3" sections if you are the only social service person on staff. Please skip to #122

115. How many years of nursing home social services experience do you have? (In any nursing home)


114. Do you have an undergraduate college degree?

No I don't know Yes, in ___________________________

113.

Less than 20 20-34

For each person who works in nursing home social services in this facility, pleasecomplete the following information. Include employees only. Please do notinclude consultants. If you have more than 3 people, please provide informationabout yourself and the 2 people who have been there the longest.

Average number of PAID hours per week, at this nursing home in social services?

Staff #1 - You

35 or more


Staff #3 Section

121. How many years of nursing home social services experience? (In any nursing home)


120. Does this person have an undergraduate college degree?

No I don't know Yes, in ____________________________

119. Average number of PAID hours per week, at this nursing home in social services?

Less than 20 20-34 35 or more1

1

1 2

2

2 3

3

3

4 5

2

2

2

2

2

2

3

3

3

3

3

3

4

4 5

5

1

1

1

1

1

1

14

N/A

N/A

N/A

N/A

N/A

136. Do you wear a beeper at work? Yes No

135. Yes NoDo you use the Internet at home at least once per week?

No

134. Do you have access to the Internet at work? Yes No

123. How helpful is the consultant in supporting and supervising social service staff?

Do you have your own computer at work? Yes No131.

Not Helpful Extremely Helpful

5

I don't know

Yes

No

122. Does your facility have a contract with an outside social service consultant who provides support and supervision to social service staff? (If "no" skip to #124)

1 2 3 4

124. Does your facility contract with an outside clinical social worker, psychologist, or psychiatric nurse to provide counseling services directly to any of the residents?

Yes

No

I don't know

Does your facility use e-mail for staff communication?

Please use an "X" to mark "yes" or "no" for each item…

The following questions ask about your working conditions and resources.

132. Do you have access to any computer at work? Yes No

133. Yes

Please indicate the areas of responsibility for the nursing home social service staff.Responsible for providing social services to: (N/A = Not Applicable, check N/A if not part of facility)

125. Yes NoResidents in nursing facility, "long-term care" beds? N/A

126. Residents in nursing facility Dementia unit? Yes No

127. Residents in nursing facility Hospice unit? Yes No

128.Yes No

Residents in Skilled Care / Rehab (Medicare beds in your facility) ?

129. Residents in Assisted Living? Yes No

130. Residents in hospital connected to nursing facility? Yes No

2

2

2

2

2

2

1

1

1

1

1

1

1

1

2

2

3

3

21

21

21

21

21

21

3

3

3

3

3

3

15

$20,000 - $24,999

$35,000 - $39,999

$60,000 or more

Less than $15,000

$25,000 - $29,999

$15,000 - $19,999

$30,000 - $34,999

143. Does your facility have computerized resident care plans? Yes No

NoDoes your facility have computerized resident medical records and progress notes?

No

Do you have your own (private) office? Yes No

Do you have a private place to make phone calls? Yes

140.

142.

141.

Yes

139. Do you have clerical support at work? Yes No

Do you have voicemail or answering machine at work?

137.Yes No

138. Yes No

Are you sometimes "on-call" during evenings and weekends?

Work-related Job Benefits at This Nursing Home Facility

144. Does your nursing home employer offer health benefits to you?

Yes

No (skip to #146)

I don't know

If, yes, do you have health insurance coverage through your employer?145.

Yes

No, I obtain coverage through my spouse

No, I don't have health benefits

Other (Please explain: ________________________________________________________________ )

I don't know

147. What is your estimated annual gross (before taxes) wages/salary from this job?

146. Is your employer paying into a work-related private pension plan on your behalf?

Yes

No

$40,000 - $49,999 $50,000 - $59,999

1

1

1

2

2

2

3

3

3

4

2

2

2

2

2

2

2

1

1

1

1

1

1

1

1

4

2

5

3

6

7 8 9

16

158. Recognition of the value of social services, from other staff...

More flexibility in my hours…

153.

154.

157.

9

159.

Opportunity to meet with social services staff in other facilities… 1 2 3

155.

156.

More feedback from my boss about how I'm doing my job…

Better working relations with nursing staff…

9

3

9

How much would the following factors improve your job satisfaction?

A little A lot Fine as is, no need to improve

152. Tuition reimbursement for taking college credit classes…

Better health insurance…

Higher salary/wage… 1

1

1

1

1

93

3 9

3

9

3

151. 2

Moderately

150. Better pension plan…

2148.

2

2

149.

9

1 2 3 9

1 2 3

9

1 2 3 9

1 2 3

3 9

3 9

162.

1 2 3

161.

Other:

________________________________________ 31 2

160.

9

Being able to focus on the social and emotional concerns of residents…

Supervision and support from an outside, qualified social work consultant... 1 2 3 9

9

1 2

Reimbursement for attending conferences…

21

More feedback on what my job responsibilities are…

2

More influence in how the nursing facility treats residents, family, and staff…

17

(Feel free to attach an additional page.)

In this facility:

In the same job

Yes, (please list the full name of each organization that helps keep you up-to-date)

_____________________________________________________________________________________________________________________________________________Would you be interested in joining a national network of nursing home social service directors?

Yes

No

163.

165. Where do you think you will be working in 2 years? (Choose the ONE BEST answer)

Do you belong to a professional organization that helps you keep up-to-date on issues affecting social services in nursing home facilities?

No

164.

166. We are interested in any other comments you may have about Nursing Home Social Services:

In a different job (explain: __________________________________________ )

In a different nursing home:

As Social Service Director

In a different job (explain: __________________________________________ )

Other: ___________________________________________________________________________

In assisted living

Not in long-term care at all

I hope to be retired in two years, and not working for pay

1

1

2

2

5

6

7

8

3

4

1

2

18

Yes (In what field: ___________________ )

No

Undergraduate Degree Graduate DegreePlease Check One:

65+45-54 55-64

Yes No

Native American

Other:____________

What is your age: 18-25 26-34

White Multi-racial

African American Asian/Pacific IslanderWhat is your race:

Are you working on a college degree at this time?

35-44

No

No

Yes (please list: _______________________________________ )

No

Yes (please list: _______________________________________ )

Are you certified or registered in any field?

Are you currently licensed in a field other than social work?

Are you of Hispanic origin?

182.

172.

173.

168.

169.

170.

179.

Associates degree in non-social work

180.

181.

174.

175.

176.

177.

178.

Bachelor's degree in social work

Are you currently licensed in social work?

Yes No

In what year did you graduate with your highest degree?

Master's degree in social work

Bachelor's degree in non-social work (please list the field: ___________________________)

Yes

____________ year

No

Yes (please specify your license, for example "LCSW": _______________ )

Yes No

Yes No

Master's degree in non-social work (please list the field: ___________________________)

No

Please answer YES or NO for each level of formal education by putting an "X" in the correct box to indicate education you have completed:

High school degree or GED Yes No171.

Associates degree in social work Yes No

Yes

DEMOGRAPHICS

167. What is your gender: Male Female1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

2

2

2

22

2

2

2

2

2

2

2

2

2

2

3

3

4 5 6

4 5

1

2

A B

6

19

187. ____________ bedsHow many total beds are there in this nursing home facility ? (Do not include assisted living or CCRC)

2-5 homes

6-20 homes

21-50 homes

51 or more homes

185. Is this facility part of a chain of 3 or more nursing homes? (make an "X" by the best answer)

No

Yes (please specify quantity below)

Thank you for your experience and insight!

Please estimate your current occupancy rate for this month:189.

188.

____________ %

How many private rooms? ____________ private rooms

190. Please let us know what your impression of this survey is: ____________________

Not for profit

Is this facility religious based?

I don't know

Yes, it is religious-based

No, it is not religious based

I don't know

Group results will be posted on www.uiowa.edu/~socialwk Fall 2006

FACILITY DEMOGRAPHICS

183. What is the facility's ZIP CODE:

184.

186.

For profit

Is this a for-profit, not-for-profit, or government facility?

Government owned

I don't know

1

1

2

2

3

4

3

5

6

1

2

3

4

20

(319) 335-1711 fax

Rm 308 North HallSchool of Social Work

University of Iowa

Mercedes Bern-Klug

Iowa City, IA 52242

(319) 335-1265 phone

Thank you!

P l e a s e c o m p l e t e a n d r e t u r n t o :

the national study of nursing home

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