Several studies have highlighted the efficiency of profit-oriented organizations compared to non-profit organizations. In the nursing homes or long term care facility too, this is no exception, where the profit driven homes are seen to be technically and economically efficient than the non- profit facilities. The operation of the non-profit homes is directed to ensuring that revenues and costs are relatively equal. The non-profit nursing homes, run by government, religious bodies and even by private philanthropic affiliations are not seriously classified for their performance and quality, and are largely categorized together (Knox, Blankmeyer and Stutzman).
Research done into staffing levels of profit and non-profit nursing homes however, show that nursing homes in the non-profit sector have higher staffing levels, compared to profit oriented nursing organizations. Literature on nursing homes in the US show that non-profit care facilities have higher number of direct care staff and lower staff turnover rates. It should be noted here that the majority of nursing homes in the US are profit oriented while in Canada, the majority are non-profit care homes (Margaret J et al., 2005).
Social workers in health care have addressed the problems and situations associated with illnesses, seeing things in the bigger perspective, while also addressing the immediate concerns. The largest area of focus in social work is perhaps in the health field. Social workers have performed their expected or required roles, and have also raised awareness among other health care professionals to look beyond disease or ailment of the patient; into the psychological and social aspects of the ailment and its treatment (Dhooper, 1997).
The responsibilities associated with social work in long-term nursing homes include tasks with patients and their families, both within and outside the hospital. Most social workers in hospitals are responsible for functions like high risk screening, social and psychological assessments, coordinated patient care, discharge planning and follow up.
In long term care facilities, the social worker is required to be aware of the traditional and non traditional social work involvement and their roles, and appropriately examine the most suitable application. The social workers review the evidence base systematically and accordingly develop protocols and recommendations for practice. They encourage academic and practice partnerships and try to identify similar areas of concern, with their medical colleagues.
The social workers perform several roles, even beyond that expected of a social service worker. However there is no formal profile of the tasks associated with social worker in nursing home care. The law and regulatory governing are restricted to finding out the presence and absence of the social worker. There is no certification or recognition process to evaluate the contributions of the social worker particularly in the non-profit nursing homes.
An important aspect of social work in health setting is assessment, including psychosocial assessment. Client problems need to be assessed to begin treatment intervention, irrespective of the ailment or the people. Assessment helps in gathering, analyzing and evaluating relevant information based on which appropriate treatment strategies are implemented. Sometimes the social worker may be required to service at homes of clients. Interviewing clients at home, particularly the elderly ones, offers an informal atmosphere and reinforces to the client that he or she is supported and is not left alone (Mellor and Solomon, 1996).
Use of client’s first name, hugging, accepting a cup of tea are all part of a professional conduct of a social worker. The social worker is also sought to address psychosocial needs in nursing homes, to treat mental health problems. The social work provider’s perspective in diagnosing and treating anxiety, dementia and depression is considered necessary. Through appropriate in-home interventions, social work providers even ascertain ineffective diagnosis and delivery of inappropriate care. They address several issues with social relevance like relationship loss, adjustment to environment, terminal care etc.
In the non-emergency nursing home admissions, social work personnel carry out the psychosocial assessment of the client during the initial contact. Based on this assessment, the level of required social work involvement, preparation of social work activity and discharge plans are finalized. This assessment also marks the beginning of the patient-social worker relationship. The social worker may at times be required to alert other physicians on existing psychosocial problems, which they should consider before medical interventions.
Here the social worker must ensure that patient details or medical history are not breached or misused by anyone having access to it. Preadmission screenings by social workers can reduce unwanted readmissions while also reducing the stay in nursing homes. Discharge planning may be involved with many ethical issues or even legal issues for the social worker. The social worker has a crucial role in sorting conflict between patient expectations and nursing home obligations. When patients with very little hope of recovery or irreversible conditions are discharged, they and their families consider the nursing home to have abandoned them and experience a loss of hope. Here the social worker, attempts to change this perception by planning for the future through problem solving.
The role of social worker in non-profit long term care is highly diverse from being a psychotherapist, social work consultant and a consultant on psychosocial issues. They assist client immensely in their transition to and from long-term care. They associate elders and families to community facilities and services through appropriate brokering, cause and needs advocacy.
They help in planning long-term care with the client and their family and resolve issues in finance, legal and social requirements. In care planning, the social service provider needs to develop plans taking into consideration the arrangements and psychosocial support for older persons. The plans, particularly long term care plans must be accommodative of any physical or cognitive changes, as and when it arises.
Social workers need to be wise to accept and respect the fact that clients, particularly older clients in long-term care have the right to choose or decide on matters pertaining to their treatment (Vourlekis, et. al, 2005). Social workers also need to be conscious of the ethical issues arising in their work with older clients.
Long term care is not just restricted to the caring of elderly people. Long term care can be associated with any age, like even with children having long term health implications.
The services provided by social workers are very diverse and is associated with both, a health perspective and a social perspective. The quality of delivery for the health factor is judged based on technical aspects of care like treatment outcomes and evaluation of care process. The quality of social services provided is judged based on the opinion and perception of the users. In contrast to acute care which is associated to restoration of normal health, long term care is more associated in suppressing or preventing further decline in health condition or progress of disability (Gooloo, Wunderlich, Kohler, 2001). Sometime people would adapt to heir disabilities and adverse health conditions and may even begin to depend less on social or medical assistance for a considerably long period of time.
The role of social worker in the non-profit long term care is immense and cannot be overlooked. They are involved in all aspects of patient care from assessment to discharge, apart from ensuring their social well being. Given the trend in modern medicine, where newer and sophisticated treatments increase life span, the population of elderly people has been increasing significantly, and more elderly people are likely to seek nursing care for various reasons. Also with newer diseases, associated with developing life styles, food habits, and environment; people are likely to seek more medical intervention for unconventional diseases. Therefore people across all ages and backgrounds seeking medical intervention would have more social implications and social relevance, relying more on the social worker to deliver.
Knox K.J., Blankmeyer E.C and Stutzman J.R., (2006) Comparative Performance and Quality among Nonprofit Nursing Facilities in Texas, Nonprofit and Voluntary Sector Quarterly. Sage Publications [Electronic Version] downloaded on 10th May 2008 from http://nvs.sagepub.com/cgi/reprint/35/4/631
Margaret J et al., (2005) Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter? Canadian Medical Association Journal, March 1, 2005 [Electronic Version] downloaded on 10th May 2008 from http://www.cmaj.ca/cgi/content/full/172/5/645
Vourlekis B, Zlotnik J.L, Simons K., (2005) Institute for the advancement of Social Work Research, Evaluating Social Work Services in Nursing Homes: Toward Quality Psychosocial Care [Electronic Version] downloaded on 11th May 2008 from http://www.charityadvantage.com/iaswr/IASWRNursingHome.pdf
Dhooper S.S., (1997) Social Work in Health Care in the 21st Century. Sage Publications, London
Mellor J and Solomon R., (1996) Geriatric Social Work Education Haworth Press.
Gooloo S, Wunderlich, Kohler P.O., (Eds) (2001) Improving the Quality of Long-term Care, National Academies Press