Factors Related to Psychosocial Outcomes in Skilled Nursing Facilities

Background and Purpose: Persons living in skilled nursing facilities (SNFs) have extensive psychosocial needs, yet the services provided to address those needs appear insufficient (Department of Health and Human Services (DHHS), 2003). Facility social workers are the primary providers of psychosocial services and both workload and knowledge barriers are known to interfere with their ability to meet residents' psychosocial needs (Tirrito, 1996; O'Neill & Rosen, 1998; DHHS, 2003, Parker-Oliver & Kurzejeski, 2003). However, specific factors that either enable psychosocial care or reduce the barriers to service delivery have received limited attention. Furthermore, little is known about the connection between service provision and indicators of facility quality associated with resident outcomes, such as state survey inspection results. As a component of a larger research project, this study assessed predictive relationships between social worker characteristics, work environment factors, and negative state survey findings related to psychosocial service delivery.

Methods: A cross-sectional research design was utilized and merged two sources of data, one primary and one secondary. Primary data associated with facility work environment and social worker characteristics were collected via a self-administered questionnaire mailed to Social Service Directors (SSDs) in Washington State SNFs (N = 202). Secondary data associated with negative psychosocial-related survey findings were obtained from the Online Survey and Certification Reporting database (OSCAR), a computerized national record of state survey inspection results (Harrington et al., 2000). Logistic regression was utilized to assess work environment and social work level factors predictive of survey deficiencies related to the provision of inadequate psychosocial services.

Results: Factors that increase the odds of receiving a deficiency in psychosocial services were identified as well as those that decrease the odds of receiving such a deficiency. Example factors that lower the odds include 1) a higher priority attributed to residents' access to mental health services, 2) a higher priority attributed to residents' ability to maintain contact with friends, family, and the community, 3) more social work personnel on staff, 4) more SSD time devoted to providing crisis intervention, 5) arranging hospice care, and 6) training or consulting with facility staff related to psychosocial issues. Conversely, factors are associated with higher odds that a facility will receive a deficiency in psychosocial services include 1) higher priority attributed to providing individualized activities and opportunities for social and group interaction, 2) more SSD time devoted to assisting residents and families with finances, 3) arranging mental health services, and 4) updating facility policies to reflect residents' needs.

Conclusions and Implications: Rather than direct predictors of psychosocial deficiencies, the factors identified by this study are likely indictors of broader issues influencing state survey outcomes. For example, assisting residents and families in making financial arrangements and accessing mental health are not services SSDs should avoid providing. Rather, the relationship between frequent provision of such services and deficiencies in psychosocial care likely stems from underlying facility challenges that are a primary link to negative outcomes, for example high levels of low income clients and residents with more severe psychiatric problems.