Research That Matters (January 17 - 20, 2008)

There are 1.5 million people--most of whom are older adults--living in one of 16,000 U.S. nursing homes on any given day. The average age at admission is age 82; and half of people age 85+ in the U.S. die in a nursing home (National Center for Health Statistics). Care for the dying is an important aspect of nursing home care (Parker-Oliver et al; Teno et al).

The purpose of this descriptive study is to report the extent of involvement in seven end-of-life related activities, according to social service directors in a 2006 nationally representative study of nursing homes with at least 20 beds. These seven items are part of the 192 item survey instrument developed for the study. There were 1,071 social service directors who completed and returned the survey instrument (response rate of 50%); 18 percent report having earned an MSW, 33 percent a BSW, and 49 percent reported no social work education. For 58% of the sample, the director of social services was the only member of the social services staff; in 27% there were two staff members (including the director).

The percentage of the sample who reported social services were “usually” or “always” involved in the following activities (as opposed to “never” or “sometimes”) include: discussions with residents and families about possible hospice enrollment, 87%; discussions with residents and families about treatment cessation, 72%; discussions with physicians about residents' care preferences, 43%; review advanced directives with residents or families at every three months, 76%; discuss the option of DNR (do not resuscitate) with residents or families, 85%; discuss the option of DNH (do not hospitalize) with residents or families, 67% ; arrange an on-site memorial service after a resident dies, 31%. When asked how much preparation would be necessary for him/her to train another social worker to conduct a bereavement support group for residents, 68% said they could with little or no special preparation (MSW social service directors were significantly more likely to report this), while 7% of the sample reported they would not be able to do so.

Results indicate that over half of nursing home social service directors are “usually or always” involved with the end-of-life related activities with the exception of being involved with physicians about resident's care preferences, and being involved with on-sight memorial services. Analyses are underway to clarify the relationship between characteristics of the facility and those of the social services director as they relate to the independent variables which can affect social services involvement with resident's: geographic setting; profit versus not-for-profit status of the nursing home; number of beds; whether the director of social services had a degree in social work; and ratio of social services providers to residents. The results indicate that all nursing home social service departments need to be staffed to meet the emotional needs of people who are approaching the end of life as a nursing home resident, and that there is room for improvement between social workers and physicians regarding communicating about resident preferences.