BSW and MSW Nursing Home Social Services Directors More Likely to be Able to Train a Colleague on How to Have Advance Care Conversations

Nursing homes (NH) serve residents with a broad range of needs. Resident acuity has increased as some people turn to assisted living, leaving those without financial resources and with greater care needs seeking NH admission. Consequently, many NH residents are at high risk for a sudden and serious health decline. Knowing resident care preferences, in the event the ability to communicate is lost, is important. We report whether the social services director having a social work degree is associated with the amount of preparation time needed to train a colleague how to engage in advance care planning.

Federal law requires that all health care facilities accepting federal payment inform patients/residents of their right to have an advance directive. Federal law also requires that NHs with more than 120 beds employ at least one full-time “social worker” although that person is not required to have earned a social work degree. Note that two-thirds of US NHs have fewer than 120 beds.

Methods: A 2019 quantitative survey of a nationally representative sample of 924 social services directors was administered. We call the department “social services”, and the employees are either social workers (with a BSW or MSW) or a social services staff person (without a social work degree). Bi-variate analyses tested for a relationship between social work degree status of the director and the amount of preparation time needed to train a social services colleague how to engage residents and families in advance care planning conversations, including discussing palliative and hospice care. Possible responses include: could do with no prep time, would need up to two hours of prep time, would need up to ten hours of prep time, and not able to do.

Results: Although not required to by law, most NHs do employ at least one social services staff person, and in about half of NH’s the social services director holds a BSW or MSW. About half (52%) of social services directors reported they would need no prep time to train a social services colleague about engaging in advance care planning, and another 37% indicated they would need up to two hours of prep time. Seven percent would need up to ten hours of prep time and one percent reported they would not be able to engage in such training. Having earned a BSW or MSW was positively associated with being able to provide training to a colleague with no prep time needed, or up to two hours needed (versus needing up to ten hours or not being able to do) (p. < .05).

Conclusions: Having the opportunity to engage in advance care conversations can assist residents and families in understanding their options and rights and in knowing what questions to direct toward their primary care providers so that informed choices can be made and communicated. Social services staff able to do so are an asset to residents, families, and fellow staff. BSW and MSW employees are more likely to be able to train others to engage in these conversations.