Nursing Home Residents' Legal Access to Onsite Professional Psychosocial Care: Federal and State Regulations Do Not Meet Minimum Professional Social Work Standards

Background and Objective: The federal government holds nursing homes (NHs) responsible for assessing and addressing resident psychosocial needs. The staff person most responsible for psychosocial care planning is the social worker. However, the federal government requires only NHs with 120+ beds to employ one full-time social worker, and that person need not hold a social work degree. We compare/contrast state laws against federal laws and professional standards in terms of the minimum qualifications of NH social workers to determine in which states NH residents are legally entitled to receive services from a professional social work staff member. Research Design and Methods: Qualitative content analysis of language regarding NH social worker qualifications in state (and DC) administrative codes. Results: Twelve states do not address NH social worker qualifications. Up to 25 states appear to be out of federal compliance. Only Maine appears to meet the NASW professional standards. Other states approaching the standards include: Alaska, Arkansas, Connecticut, Illinois, Massachusetts, Minnesota, and West Virginia. Discussion: The vast majority of the 3 million residents a year served by U.S. NHs are not entitled to social work staff who meet minimum professional standards, despite new federal regulations calling for trauma-informed and culturally competent care planning and the recognition that the needs of residents (including psychosocial needs) have continued to increase over past decades. Changes in federal regulations are recommended so that all NH residents have access to professional psychosocial services provided by a staff person who has earned at least a bachelor's degree in social work and who carries a reasonable caseload.