Testimony on HB 6690 AAC Nursing Home Facility Minimum Staffing Levels Human Services Committee

My name is Steven Skrebutenas and I represent the board of directors of The National Association of Social Workers (NASW), Connecticut chapter. NASW, CT and I offer support to HB 6690. The proposed change for nurse staffing levels comes at a time when RNs and LPNs have to provide a higher level of care that was not seen 10 years ago in skilled nursing facilities. At present the levels are insufficient to meet the increased demands of nurses in skilled facilities. NASW Connecticut is requesting that nursing home social work staffing levels is also increase and we ask that 6690 be amended to include a decrease in the ratio of worker to beds for social work services.

Since 2003 I have worked in the capacity as a Social Worker in several skilled rehab/nursing facilities. In that time I have seen the demands on the social work staff increase to a level that is close to unmanageable. The needs of residents and facilities have changed, no longer are our grandmothers retiring to a small facilities to play afternoon bingo and socialize with peers. Today, facilities are seeking short term residents whose needs center around rehab, physical, occupational and speech therapies, when the resident meets those goals they are discharge to the community. While facilities seek short term high return residents, the needs of long term residents grow more complex. Social workers are expected to be the resident advocate, educator, counselor and friend. Social workers develop care plans that addresses the psycho-social needs for each resident, assist in adjustment to long term care, and maintain residents rights to ensure a quality to their lives.

The Public Health Code has not kept pace when it comes to social worker to resident ratios. The current ratio of 120 beds to 1 full-time social worker does not allow us to provide the care the resident so justly deserves. Under the current ratio it is a challenge to provide for the emotional, social, and financial needs of residents while meeting our other responsibilities, of family meetings, care plan meetings, discharge planning meetings, vendor meetings, attending probate court hearings, Medicare mandated reports, state mandated reports through the ASCEND system and the medical charting that is required for each intervention that social workers have with each resident.

As stated by the Executive Director of NASW Connecticut Steven Karp in his testimony, “We recommend that HB 6690 be amended to include reducing the ratio of beds to social worker to a ratio of 80 residents to 1 full-time social worker. Such a ratio is still on the high side but is a common sense compromise that recognizes the fiscal issues facing homes as well as the need for nursing home social workers to have a more reasonable caseload.”


  1. Stacy McCaughn says

    I have been working in long term care social work off and on since 2000. I hold a master’s degree in Mental Health Counseling and am sought out by peers for guidance and support. I agree whole heartedly with social workers being included in the HB6690. My opinion is that most facilities that require the Social Service Director to have additional administrative responsibilities cannot successfully manage 80 residents alone especially if any of them are Medicare patients. ONE full time social worker with no director responsibilities may be able to manage a case load of 25-30 Medicare /rehab residents. A director could reasonably handle 50 long term residents plus administrative meetings and duties. OR 10-15 MEDICARE residents and 30 long term residents. Acuity and needs of population MUST be considered, a corporate cookie cutter approach will only leave residents under served. Many Directors are salaried positions. Speaking from personal experience for the last 1.5 yrs I have worked on average 60-70 hours a week and minimally completed vital tasks and wish more could have been done for my residents. Social service directors often feel as I do that all we do is paper work and meetings and the things we love to do most like meet with and support residents and families, provide education to staff, residents and families we have no time for. Social services staff are the advocates for residents, resident rights, they monitor resident mental health, help assure social connection and adjustment, manage resident behaviors and medications and address concerns. As baby boomers age and the population of seniors in need of services grow exponentially they will have needs and expectations and the need for qualified staff will grow. Working in long term care already is generally held in an inferior position compared to other healthcare settings. Recruiting and retaining staff including social workers is already challenging. Adequate staffing is essential to providing the care residents deserve and the support their families need. Residents are sicker than in the past, families are in crisis, families are less able to care for loved ones at home due to their own jobs, families or health. Even many licensed medical model assisted living facilities care for residents have higher levels of need than in the past. Staff are only humanly capable of a certain level of performance. I work with an outstanding, dedicated team of leadership, nurses, cna’s, etc and even with best intentions resident needs could be better met and things fall through the cracks. Please support HB6690.

    Stacy McCaughn
    Social Service Director

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