We, the social workers of the nursing homes of Minnesota, in
order to form a more viable framework for professional practices of ourselves
and for psycho-social health of our residents do hereby ordain and
establish these Standards of Practice of Social Work in the Nursing Home
Social work holds first and foremost the dignity and
self-determinism of its residents. It seeks to resolve the problems
presented by residents by viewing them from a holistic perspective within the
environmental context. Therefore, as social workers within the nursing
home settings, we seek to advocate in an institutional system. This
requires complex knowledge and skills, a strong professional commitment, and
The set of skills and knowledge outlined here
represents a mastery level which could only be achieved with two to five years
of direct experience in long-term care, given a background of education in
social work. To maintain these standards requires personal dedication,
education, and an environment of support from the employer and from regulatory
bodies. We believe these standards of practice out-line a professional
competence each nursing home must foster and each social worker in that setting
must strive to embody.
The framework can also serve as a guide
for administrators and policy-makers to create environments in which these
standards can be achieved for the ultimate benefit of nursing home residents.
A. Initial Preparation
The optimal preparation is a bachelor's degree or a master's
degree from an accredited School of Social Work. The social worker
should have a demonstrated interest in long term care, the elderly and
The Minimum preparation necessary is a bachelor's or
master's degree in a related field limited to human services, social
services, psychology or sociology.
It is recommended that the social worker be licensed in the
State of Minnesota, or eligible for licensure.
It is suggested that for the first two years of practice, a
nursing home social worker be supervised by someone meeting the requirements
of number 1, 2 or 3 above who has two or more years experience in a nursing
home, or as comparable to the licensure supervision standards for Minnesota.
B. Ongoing Training
The purpose and value of ongoing training is to keep up to
date with regulations, skills, issues, theories, and ethics.
A nursing home social worker should participate in not less
than 30 hours of training every two years (as consistent with every
Minnesota licensure standards) provided by a variety of sources or settings,
including the following:
MNHWSA workshops, retreats, seminars and meetings.
Care Providers, MAHA or other State offered programs.
Programs offered by other associations or service groups.
In-house inservice training (but this should account for not
more than half of training hours).
College coursework, either at the bachelor or graduate
Newsletters and journals on long term care, social work,
aging and related fields.
Seminars enhancing professional stress management,
By Networking with other social work professionals reviewing
and sharing theories and techniques, the social worker gains updated
perspectives which benefit the nursing home social work setting.
Because nursing home social work departments tend to be small and located
within the larger institutional settings surrounded by other disciplines, it
is vital that social workers regularly attend meetings and training sessions
outside the nursing home.
The nursing home social worker must display appearance,
language, and style of interaction, a level of professionalism which fosters
trust in the social worker's ability to emphasize with and advocate for the
In validating an advocacy role, display a dedication which
instills confidence in the people one serves and works with.
Convey both self-confidence and empathy to build
Each social worker must recognize and enact the role as
resident advocate above all else.
Uphold residents rights, dignity and respect.
Ensure least restrictive environment including chemical and
physical restraint reduction.
Advocate and assist with planning for a discharge/transfer
and the utilization of community resources.
A social worker should act as a role model for all staff and
families in advocating resident autonomy. Show willingness to promote
social work values, ethics and resident rights even when challenged by
The nursing home social worker must maintain a clear
identification with the philosophies and goals of social work.
Educate others regarding the professional role and identity
of social work.
Share knowledge base with colleagues.
Be aware of and follow National Association of Social
Workers Code of ethics.
The social worker has an important role in documentation and
shall establish and follow systems which enable sharing of information with
the professional team. Documentation (i.e., assessments, histories,
plans, goals, and progress reports) is one of the visible and permanent
reflections of the social worker's professional capabilities and of
accomplishments toward resident goals.
The social worker must be aware of limits, both professional
Recognize legal limits and boundaries of the practice.
Identify when a case requires professional knowledge or
skills beyond one's current capacity. Seek additional information or
refer the issue to another practitioner.
Be aware of personal biases in specific cases. Seek
consultation from a colleague or supervisor, or refer the case elsewhere.
A social worker must respect other disciplines, giving value
to their positions and contributions.
The social worker would enhance professionalism through an
active role in MNHSWA and other national, state and local associations.
B. Caseload and Additional Duties
Based on a 1992 survey conducted by the MNHSWA, a caseload of
not more than 50 residents per full time social worker would be necessary to
allow adequate time in which to perform advocacy, counseling and documentation
functions. Additional duties such as management, supervision and admission
coordination would require an increase in social work staff for the
facility. The inclusion of social workers in these functions is valid and
important to maintaining a resident-centered perspective in the operation of the
facility. This may vary depending on the type with which the social worker
The MNHSWA recommends a salary range as recognized be the
National Association of social Workers. Salary ranges may vary according
to size, location and ownership of individual facilities along with the
experience and education of the individual social worker.
A. Assessing, Planning, & Documentation
To be an effective case manager, a nursing home social
worker must possess skills to acquire the information necessary to provide
appropriate service to each resident.
Interviewing skills are essential, using questions and
environment in a purposeful manner to gather information. Attention
must be given to both verbal and nonverbal communication, utilizing
observation and listening skills. Techniques must include interviewing
individuals as well as groups.
Possess research skills including the ability to gather data
from any written document, particularly medical records.
Once adequate information is gathered, a nursing home social
worker must possess the information, drawing conclusions, completing initial
and drawing ongoing assessments.
Assessments must be comprehensive, often expanding on the
State and Federal minimum standards (i.e., "Minimum Data Set").
A good assessment process includes an initial
assessment, the purposeful subsequent assessments, identifying residents
needs, problems, goals, strengths and weaknesses, recognizing the positive
and negative aspects of every situation.
Utilize assessment techniques to identify and evaluate
cognitive, emotional, interpersonal, legal, financial, social and behavioral
As a member of the interdisciplinary team which includes the
resident, a nursing home social worker must apply the assessment to develop
a useful plan of care.
Advocate for a resident-directed plan of care, with resident
Formulate individualized goals which are behavioral and
Re-evaluate interventions and goals as indicated by any
changes in circumstances involving the status of the resident.
Continually gather new information, reassess, and update the
plan of care.
The social worker must be intricately involved in the
implementation of the plan of care, outlining specific approaches that will
enable the resident to attain individual goals.
Nursing home social workers must document thoroughly in
progress notes, assessment records and the plan of care.
Documentation must be clear, useful, accurate and legible.
The social worker must differentiate between objective and
Documentation must be individualized.
In coordination with other disciplines, documentation must
reflect consistency in assessments, the plan of care, and progress notes.
A nursing home social worker advocates for resident rights
to ensure quality of life and access to known entitlements within the
family, nursing home, and government agencies.
A nursing home social worker should demonstrate leadership
In working with nursing home residents, the social worker
should possess problem solving skills. These skills include the
ability to investigate, evaluate, negotiate, make recommendations and
resolve the issues.
A social worker should have skills to disseminate
information clearly through meetings and educational programs with
residents, staff, families and the public. The ability to successfully
perform public speaking at the listener's level is important.
A social worker should possess good writing skills to inform
others at a reader-friendly level.
It is important in completing job tasks for the social
worker to prioritize and use good organizational skills.
Through a good social service "quality assurance"
program, a nursing home social worker would critique, evaluate, and seek to
improve the quality of services provided.
In order to professionally serve residents, nursing home social
workers need knowledge of social work methods which offers structure to the
practice of this discipline. Appropriate use of assessment tools (i.e.,
Minimum Data Set (MDS), Mental Status Questionnaire (MSQ), etc.) and clinical
methods (i.e., crisis intervention, mediation, negotiation, facilitation,
referrals, consults, etc.) assists is addressing and implementing planned change
B. Knowledge Bases and Theories for practice
In order to more effectively serve the unique population in the
nursing home, the social worker should have knowledge of the established
theories of human development and human behavior as well as knowledge in the
Historical perspectives/era of development
Nursing home social workers need working knowledge of
federal and state regulations and interpretations as they pertain to the
social work function and responsibility, especially resident rights.
Nursing home social workers must also possess a working
knowledge of county interventions such as Pre-Admission Screening (PAS),
Vulnerable Adults, etc. are also needed.
Nursing home social workers must have input and subsequently
follow facility policies and procedures relating to their disciplines.
A general knowledge of pending legislation as it applies to nursing home
D. Legal Issues
A social worker must gain familiarity with various legal issues
and how they pertain to the people served. The social worker should know
the provisions of the law, any definition, how to implement it, and what role
the social worker can play.
Financial Power of Attorney -- General of Durable; and how
Power of Attorney for Health Care Decisions.
Disclosure of presence
Financial (i.e., RSDI, SSI, VA, Medical Assistance, General
Assistance, Alternative Care Grants (ACG) Elderly Waivers and CADI.)
Advocacy (i.e., ombudsman, County Adult Protection, legal
aid, political systems, Area Agency on Aging, Office of Health Facility
Functional Assistance (transportation, homecare, meals on
wheels, social opportunities, adult day care, durable medical equipment,
emergency response equipment.)
Alternate Placement (own home, apartments, board and lodging
or board and care facilities, family homes, other nursing homes, assisted
living settings, adult foster homes, subsidized housing, etc.)
Support/Information/Education (AARP, local volunteer groups,
church efforts, family, neighbors, friends, senior centers, county human
services, hospice services, veteran's administration, hospitals, Alzheimer's