The social isolation caused by COVID-19 requires an expansive workforce considering not all nursing homes have trained social workers. – Lynn Friss Feinberg, MSW
Nursing homes and COVID-19 are today’s hot topics. With mounting cases of COVID-19, nursing homes have faced many challenges, especially with providing social services. On top of helping older adults adjust to their new life in a supportive care setting and advocating for their rights and needs, social workers are faced with ethical dilemmas, stress, and fears for resident safety. What can we do about it?
Today, we are joined by Nancy Kusmaul, PhD, MSW, and Lynn Friss Feinberg, MSW, to discuss social workers’ role in nursing homes.
Part One of ‘The Role Of Social Workers In Nursing Homes’
Nancy Kusmaul, PhD, MSW, is an Associate Professor in the Baccalaureate Social Work program at UMBC. She received her PhD from the University at Buffalo School of Social Work and her MSW from the University of Michigan. Dr. Kusmaul worked in nursing homes and hospitals for more than a decade. Her research focuses on organizational culture, trauma-informed care, and the impact of trauma experienced on the workforce. She is interested in direct care workers’ experience in organizations, particularly Certified Nursing Assistants in nursing homes. She is a 2019-2020 Health and Aging Policy Fellow with Senator Ron Wyden and the Centers for Medicare and Medicaid Services. She is a member of the Baltimore County Elder Abuse Coalition and the National Association of Social Workers (NASW). She co-chairs the Aging Committee for the Maryland Chapter of NASW, and she is a fellow of the Gerontological Society of America.
Lynn Friss Feinberg is a Senior Strategic Policy Advisor at the AARP Public Policy Institute, responsible for family caregiving and long-term care issues. She came to AARP from the National Partnership for Women & Families, serving as the first Director of the Campaign for Better Care. Previously, she served as the Deputy Director of the National Center on Caregiving at the San Francisco-based Family Caregiver Alliance (FCA). At FCA, she directed the National Consensus Project for Caregiver Assessment and led the first 50-state study on publicly-funded caregiving programs in the U.S. She has published and lectured widely on family care policy and practice. She has held leadership positions on numerous advisory boards and committees, including the American Bar Association’s Commission on Law and Aging, and the National Academies of Sciences, Engineering, and Medicine’s Committee on Family Caregiving for Older Adults. Ms. Feinberg is a past Chair of the American Society on Aging (ASA) Board of Directors and a past Chair of the Public Policy Committee at the Gerontological Society of America (GSA).
In 2007-2008, Ms. Feinberg served as the John Heinz Senate Fellow in Aging in the office of former U.S. Senator Barbara Boxer. She received the ASA Leadership Award in 2006, and the Paul Nathanson Distinguished Advocate Award in 2015 from Justice in Aging for her career work on family care issues. Ms. Feinberg holds a master’s degree in social welfare and gerontology from the University of California at Berkeley.
Any facility with more than one hundred and twenty beds must employ a qualified social worker on a full-time basis.
– Nancy Kusmaul, PhD, MSW
COVID-19 spreads easily in nursing homes and older adults living in these facilities (residents) are at the greatest risk of death if there is an outbreak. This is why a lot of attention has been focused on keeping residents safe. Not only the nursing homes experiencing a shortage of PPE, but the implementation of visitation restrictions made it challenging for them to communicate with the resident’s family members. We didn’t have a national strategy to deal with a pandemic, and because of all of these things, nursing homes were hit hard by COVID-19.
While it’s critically important to have adequate nursing certified nursing assistants, we would all agree with that if we want to improve the quality of care or people residing in nursing homes and other long-term care facilities, COVID-19 has pointed out that we need to have more social support, more emotional support, and connection to the outside world. Family and friends are critically important, particularly at the end of life. That is a key component of both health care and long-term care, particularly since long term care is someone’s home!
Social workers are uniquely trained to recognize the importance of family support and the social aspects of care. We need trained social workers who are willing to get involved in national conversations to ensure that we have high-quality social work that includes emotional support at the community level.
Part Two of ‘The Role Of Social Workers In Nursing Homes’
Any facility with more than one hundred and twenty beds must employ a qualified social worker on a full-time basis. However, a qualified social worker is an individual with a minimum of a bachelor’s degree in social work or a bachelor’s degree in a human services field, including but not limited to sociology, gerontology, special education, rehab, counseling, and psychology, and one year of supervised social work experience in a health care setting, which means that the person in the social work role may not have social work training.
The broad qualifications for social workers could be because of the same struggles we have nurse staffing requirements. Nursing homes are only required to have one Registered Nurse (RN) in the building for 8 hours a day, and that could be a RN with an associate’s degree, a baccalaureate degree or higher. The majority of care delivered in nursing homes, however, is delivered by Licensed Practical Nurses (LPNs) and Certified Nursing Assistants (CNAs).
Assisted livings are uniquely challenged in the
pandemic because they are not federally regulated.
– Nancy Kusmaul, PhD, MSW
Unlike skilled nursing homes, assisted living facilities are uniquely challenged in the pandemic because they are not federally regulated. There are no federal statutes that cover assisted living, and they’re not required to have a social worker. So, they have faced some of the same challenges as nursing homes with less guidance and no social work support for residents or their families. COVID-19 resulted in millions of older adults living in both of these environments to be denied visitation by family and/or friends. This has been devastating to both the older adults and their family members – who are considered to be “visitors”.
Many family members of people in nursing homes took care of them at home for years before they got to the point where they needed a nursing home. These caregivers know their family member’s needs, moods, and changes in condition better than anyone else. They are the eyes and ears. They are the ones who can communicate with staff and advocate for their residents. They are care partners. And yet, when they are placed in the category of visitors, it sounds more like a luxury than an integral and essential member of the care team. They should be allowed to be in the nursing home as a care partner – not as a visitor.
These are some examples of policies that impact social work practice and nursing home residents, and social workers are well positioned to advocate for changes to both. Real change happens one step at a time. We must remember that shaping good public policies is a cornerstone of social work.
How to Connect More with Lynn Friss Feinberg and Nancy Kusmaul
I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer.
I obtained my PhD in Nursing and a post-Master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (2011) ) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities.
Find out more about her work HERE.