Testimony on Raised Bill 1057: An Act Concerning Nursing Homes

Human Services Committee

March 25, 2021

Submitted By: Stephen Wanczyk-Karp, LMSW

 On behalf of the National Association of Social Workers, Connecticut chapter, representing over 2,300 members, we support bill 1057, however seek the inclusion of social work to the list of staff needing improved ratios.

It is long overdue for the State to update the decades old minimum staffing levels in nursing homes to reflect the current care needs of nursing home residents. Bill 1057 addresses the staffing levels for nursing and nurse assistants and directs the Commissioner of Public Health to review and implement best practices for staffing in nursing homes. The addition of social work and recreation staff into the language of 1057, as recommended by the Long-Term Care and Assisted Living Oversight Work Group, will assure that the Department of Public Health’s review is not limited to nursing staffing.

 The National Consumer Voice for Quality Long-Term Care proposed to CMS that every facility employ at least one full-time social worker for every 50 long-stay residents and at least one full-time social worker for every 15 short-stay residents. NASW asks the Human Services Committee to include the language of S.B. 1030 on social work staffing into Bill 1057. Section 13 (b) (2) of S.B. 1030 requires the Commissioner of Public Health to determine a bed to social worker ratio that is less than the current ratio of 120 beds to 1 full-time social worker.

The social worker is the sole professional in the home responsible for the psycho-social needs of the residents. Prior to Covid-19 nursing home social workers faced 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, family meetings, 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, assisting with Money Follows the Person, 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. Add to these responsibilities an extensive amount of paperwork that includes: assessments; care plans; Mini Mental Status Exams; MDS (Minimum Data Set), Medicaid clinical evaluations, plus medical record charting of any changes with the resident.

Now we add in the impact of Covid-19 on nursing home social workers. The social worker is often the primary contact between family members and the resident. The social worker is finding ways to help families to virtually meet the staff and view the facility that their loved ones are residing in. Family concerns and resident’s isolation requires significant amounts of time for the social worker. Social workers are managing increased levels of depression by residents and anxiety of family members. Social workers are arranging for virtual meetings between the resident and family. Other staff seek personal assistance from the social worker as the work being performed is incredibly difficult. The social worker is the point person between MFP caseworkers and the resident. In one facility two social workers told me that they are working 42-50 hours per week and they are responsible for 60 beds each, not 120. Nursing home social workers are front line essential workers providing direct services to residents and families.

 We estimate that the pre-Covid-19 responsibilities of nursing home social workers left the social worker about 11 minutes per week to address individual resident’s concerns. In the spring of 2010 NASW/CT conducted a survey of nursing home social workers, with 72% of respondents citing lack of time to perform their job their biggest challenge.

 We thank the Long-Term Care and Assisted Living Oversight Work Group for their recommendation to reduce the current bed to worker ratio and urge the Human Services Committee to include social work and recreation staffing in Bill 1057.

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