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

The National Association of Social Workers, Connecticut chapter, supports HB 6690. The minimum requirement for nurse staffing levels at nursing homes are insufficient. Likewise, nursing home social work staffing levels is also in dire need of updating and we ask that 6690 be amended to include a decrease in the ratio of worker to beds for social work services.

The Public Health Code is woefully inadequate when it comes to the beds-to-worker ratio for social work services. The current ratio of 120 beds to 1 full-time social worker dates back well over 25 years and bears no resemblance to a reasonable ratio for the current nursing home population. In essence, we are using a 20th century ratio to address 21st century needs of nursing home residents.

In just the past 10 years the presenting issues by seniors entering nursing homes has become much more acute in terms of complex diagnosis and mental health status. The degree of care needed demands greater attention by the nursing home social worker, yet the staffing ratio for nursing home social work has not been adjusted in accordance with these changing needs.

Nursing home social workers face multiple tasks and responsibilities including but nowhere near limited to: prompt referral for patients and families in financial need, helping each patient to adjust to the social and emotional needs related to nursing home placement, care plan meetings, staff meetings, developing plans of care for the social and emotional needs of the resident, counseling residents and family members, discharge planning, coordinating care with outside services, dealing with issues of conservatorship, protecting resident rights, assessing cognitive and mental functioning, dealing with resident to resident altercations, providing emotional support for residents coping with loss of independence and function, and staff training on resident rights. Then add an increasingly extensive amount of paperwork that includes: assessments; care plans; Mini Mental Status Exams; the new MDS 3.0 (Minimum Data Set) done upon admission, quarterly, annually and when a change in condition occur, Medicaid clinical evaluations, plus medical record charting of any changes with the resident. All of this and more is required of the social worker at a ratio of 1 full-time social worker to 120 residents. The current ratio is absurd, outdated, undoable, and downright insane, and is a major factor in why qualified social workers burn out and leave the field of nursing home social work.

We estimate that under the current ratio and given the current responsibilities of nursing home social workers that the worker has about 11 minutes per week to address individual residents concerns and needs. In the spring of 2010 NASW/CT conducted a survey of nursing home social workers. When asked what their biggest challenges were 72% answered it was lack of time to effectively perform their job.

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.

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