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Quality of Life - Social Services

 

Description of Federal Requirements
Comparison of State Requirements
Table Comparing States
Complete Transcript of State Requirements on Quality of Life - Social Serv ices (PDF)

Federal Regulations & Related F-tags for 483.15 Applicable Federal Regulation
(g)(1-2) Social Services | F250 - F251
 
483.15 Quality of Life
483.75 Administration
483.20 Resident Assessment
483.25 Quality of Care

Description of Federal Requirements    (TOP)    (NEXT)

Federal requirements for social work in nursing homes are sparse and non-specific. Under the Quality of Life Regulation 483.15 (g), the facility must provide medically related social services “to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.”  A facility with more than 120 beds must employ a qualified full-time social worker.  A qualified social worker is someone with at least:  (i) a bachelor’s degree in social work or a bachelor’s degree in a human serv­ices field, including but not limited to sociology, special education, rehabili­tation counseling, and psychology; and (ii) one year of supervised social work experience in a health care set­ting working directly with individuals.   The only other Federal regulation directly applicable is Administration 483.75 (b) (3) which requires that the services provided or arranged by the facility must  meet professional standards of quality; and be provided by qualified persons in accordance with each residents written plan of care.  A facility must meet all applicable State licensure standards for facilities or personnel.  Thus, if a State has a higher standard for the practice of social work and practice within a nursing home is not exempted from that standard, the facilities in that state would need to meet the higher standard.

The expectation that all residents must receive care and services to maintain their highest practicable physical, mental, and psychosocial well-being permeates the Federal nursing home regulations.    An examination of references to mental, psychological, or social functioning within the Federal regulations suggests tasks for qualified social workers, though nothing in those Federal Regulations mandates a social work role.  For example, the Quality of Care Regulation, 483.25 (f), on mental and psychosocial functioning as a care outcome, states that, based on the comprehensive assessment of a resident, the facility must ensure that: (1) a resident who displays mental or psychosocial adjustment difficulty, receives appropriate treatment and services to correct the assessed problem, and (2) a resident whose assessment did not reveal a mental or psychosocial adjustment difficulty does not display a pattern of decreased social interaction and/or increased withdrawn, angry, or depressive behaviors, unless the residents clinical condition demonstrates that such a pattern was unavoidable.  The Federal Regulation on Resident Assessment (483.20) includes Mood and Behavior Patterns, and Psychosocial well-beingas two of the areas that must be regularly assessed. Under (k) of the same regulation, the facility must develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident’smedical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment.  This comprehensive assessment is prepared by an interdisciplinary team, including the attending physician and registered nurse responsible for the resident and other appropriate staff in disciplines as determined by the resident’s needs.   Also under Assessment regulations, concerning discharge summaries, when a facility anticipates discharging a resident, the discharge summary must include under (l) (3)  a post-discharge plan of care that is developed with the participation of the resident and his or her family, which will assist the resident to adjust to his or her new living environment.  Section (m) requirespreadmission screening for mentally ill individuals and individuals with mental retardation, an issue treated in detail in a separate regulatory section.    Finally, Subpart D, 483.152 (a) (5), on criteria for nurse’s aide training programs that may be approved by the State, the training must be performed under supervision of a registered nurse who meets some other criteria, but social workers are part of a long list of supplemental instructional personnel who may be deployed in training as long as they have at least a year’s experience in their respective fields.

Comparison of State Requirements    (TOP)    (NEXT)

Most of the state statues provide requirements in addition to the federal regulations on Social Services.  However, the regulations of eight states (Arizona, Florida,  MichiganMissouriNorth CarolinaUtahVermont, and  Washington) merely reflect the standards of the federal government. 

Almost half of the states differentiate from the federal regulations with regard to social work qualifications regarding licensure and education.  AlabamaCalifornia, ColoradoDistrict of ColumbiaIdaho, IndianaKansasKentuckyMaryland, MassachusettsNebraskaNew JerseyTexasWest Virginia, and  Wyoming regulations include a provision for a license or certificate to practice granted by the state. 

Some state regulations deviate from the credential requirement ascribed by the federal statute of a bachelor’s degree in social work or a human service field plus one year of healthcare related social work experience. Two states (Oklahoma and Oregon) include provisions that fall below the federal requirements.  Eight states (AlabamaAlaskaHawaiiKentuckyMassachusetts, New JerseyNew Mexico, and  Wisconsin) maintain requirements that are higher.  Seven states (CaliforniaColorado, ConnecticutKansasNebraskaRhode Island, and  Wyoming) have requirements both higher and lower than the federal qualifications for a social worker.

The state of Alaska requires a master’s degree in social work. 

Alabama regulations require both a license and a degree in social work, either a bachelor’s or master’s. 

California regulations delineate three levels of nursing home social workers.  A clinical social worker requires a license from theCalifornia Board of Behavioral Science Examiners.  An assistant social worker must have a bachelor’s degree in social work and supervision by a clinical social worker.  The third level, the social work associate, receives orientation, on-the-job training, and supervision from a clinical or assistant social worker. 

The qualifications in Colorado mandate a state license, a social work degree (bachelor’s or master’s), or a human service degree in conjunction with monthly supervision from a licensed social worker.  Colorado also permits a person without these credentials but a high school diploma or GED employed as a nursing home social worker prior to the implementation of this legislation to continue in this role with consultation.  Additionally, rural areas in this state may to apply for a waiver if a qualified social worker is unavailable.

Connecticut requires a social worker to have at least a BSW plus one year of healthcare experience.  A designee must have at least an associate’s degree in social work.  Designees employed before January 1, 1989 may continue in their role with no restrictions.

Hawaii regulations require a social work degree (BSW or MSW) plus two years of healthcare experience.

Kansas statutes include the qualifications of a license, a bachelor’s degree in human services or a state approved training course with supervision from a licensed social worker. 

Kentucky statutes require either a license or a related degree.

Massachusetts mandates a license and a social work degree (BSW or MSW).

a href="NH Regs Topic Pdfs/QL - Social Work/NE sw.pdf" title="NE sw" class="center">Nebraska regulations regarding social work credentials include certification, a degree (associates, bachelor’s in human service, BSW, or MSW) plus geriatric experience, or two years of geriatric experience with consultation. 

The state of New Jersey is unique in that its regulations designate a role entitled “advisory social work staff”.  This role requires a master’s degree in social work from an accredited university.  A facility must either have an advisory social worker on staff or consult with a person with such credentials a minimum of eight hours per month.  The statutes delineate the expectation of this position to be available for scheduled evening and weekend times for interaction with residents and families and for emergency purposes seven days a week.  The functions of the advisory social worker include but are not limited to pre-admission planning, admission consultation, group counseling with residents and families, and support groups for families. 

Oklahoma includes the successful completion of a state approved social services training course as a minimal credential for a social worker. 

Where as Oregon permits a social service provider with  an associates degree and two years of healthcare experience to practice social work in a nursing home.

Rhode Island requires qualified social workers to have a bachelor’s degree in social work.  However, those not meeting the required social work credentials may be eligible for a variance.

New Mexico and Wisconsin statutes include a master’s degree in social work in the qualifications for a social worker in addition to a human services bachelor’s degree.

A clinical social worker in Wyoming has a license from the state.  A social service associate requires a degree in human services with one year of healthcare experience or two years of experience in healthcare plus consultation from a social worker.

Therefore, facilities not employing qualified social workers per individual state statute in ArkansasColoradoHawaiiIdaho,IllinoisKentuckyMarylandMassachusettsNevada, Pennsylvania, New MexicoNorth DakotaRhode IslandSouth Dakota, TexasWisconsin, and  Wyoming require consultation or supervision from a social worker meeting the qualifications defined for each state.

ArkansasDistrict of ColumbiaGeorgiaIdahoMassachusettsMississippiOklahomaSouth Carolina, and  Wyoming statutes indicate that nursing facilities not providing social services may contract with an outside social service agency. 

The regulations for seventeen states (CaliforniaColoradoConnecticutDistrict of ColumbiaIndianaKentuckyMaine, MassachusettsNebraskaNew JerseyNew MexicoNew York,  OhioOregonTennesseeWisconsin, and  Wyoming) provide direction regarding the functions of the social worker.

ArkansasCaliforniaConnecticutDelawareIdahoIllinoisIndiana, MaineNew JerseyNorth DakotaOklahomaRhode IslandSouth Carolina, and  Wyoming statues require facilities to have policies and procedures specific to social services.

ArkansasCaliforniaGeorgiaHawaiiIdahoIllinois, IndianaIowaKentuckyMaineMarylandMassachusettsMinnesota, MississippiNevadaNew JerseyNew MexicoOklahomaOregonRhode IslandSouth CarolinaTexas, Virginia, and Wyoming include provisions regarding documentation in their regulations.

The federal guidelines mandate a full time social worker for facilities with more than 120 beds.  Ten state regulations delineate their own provisions related to the ratio of social works to number of residents.  These states include  ArkansasConnecticut, IndianaKansasMaineMassachusetts, NevadaNew JerseyOklahoma, and  West Virginia.

Thirteen states (CaliforniaConnecticutDistrict of ColumbiaHawaiiIdahoMaineMarylandMississippiNew JerseyOregon, South DakotaTennessee, and  Wyoming) require that social workers have space that is appropriate for private conversations.  Hawaii and Mississippi regulations also mandate that the space utilized by social services staff be accessible to residents.

AlaskaCalifornia, ConnecticutGeorgiaIowaKentuckyMississippiMontanaOregon, and  Wyoming require social workers to participate in orientation and/or in-service training on the psychosocial and emotional needs of residents for direct care staff.

The provision of information on social services is a requirement of nurse’s aid training in the state of South Dakota.

Two states regulations include information regarding Alzheimer’s special care units.  Colorado statutes require the provision of additional social services staff for Alzheimer’s care units to assist with the psychosocial needs of the residents and their families. Illinois requires dementia specific training to all staff working in a special care unit including for the social worker. 

Only three states (KansasLouisiana, and Montana) address the issue of elder abuse in their nursing home regulations.  Kansas statues define protective services and the role of nursing home staff in the prevention of elder maltreatment.  Mandated reporting and the reporting process are the focus of Louisiana regulations.  Montana laws delineate the process of investigating suspected elder maltreatment.  

Table Comparing States    (TOP)

Note: If the States in this table are not hyper-linked, their provisions do not appear to address the topic, and therefore, do not alter the Federal Regulatory scope.  The Table summarizes content on Quality of Life - Social Services by State (with a link to each State's specific language).  Link to a downloadable PDF document containing all State requirements on Quality of LIfe - Social Services.

483.15 Quality of Life

Social Services
State Goes beyond Federal Regulations? Subjects Addressed: How State Differs From or Expands On Federal Regulations
Alabama Yes Clarifies social service designee qualifications; space and privacy requirements.
Alaska Yes Social work role.
Arizona Yes Social worker definition; administrator appointees.
Arkansas Yes Policy manual; role description for social worker; further defining of qualified social worker; role of designee; privacy; records & assessment.
California Yes 3 levels of social services staff: clinical social worker, social work assistant, & social work aide; social work unit described; equipment; space; requirements for "special treatment program."
Colorado Yes Social services assessment one week from admission; social service plan detailed (emphasizes transitions and referrals); record-keeping; facilities & equipment; section on secured unit and requirement for social services to combat isolation.
Connecticut Yes Credentials for qualified social worker, qualified social work consultant, and social service designee are all higher than federal; social service staff to resident ratios;
Delaware Yes Very brief additional discussion of social service role.
District of Columbia Yes Social services role; space and privacy; record keeping.
Florida No Florida regulations do not have requirements related to social services.
Georgia Yes Social services program have responsibility for orienting other staff to social work issues; short additions on role; record keeping.
Hawaii Yes Qualifications greater than federal requirements; staffing levels greater than federal requirements; social services plan; recording requirements; office & privacy.
Idaho Yes Job description; policies; plans of service; job descriptions; distinction between program delivered by facility directly or provided by outside agency; roles and responsibilities of designee in 2nd model or in 1st if the social worker is not qualified; space; records
Illinois Yes Specifications for dementia special care units.
Indiana Yes Social work role; staffing levels; qualifications.
Iowa Yes Written social services program; individual plans and goals.
Kansas Yes Definition of social service designee; staffing ratio for social services personnel.
Kentucky Yes Provide medically-related social services; if more than 120 beds, full-time, qualified staff member required; social worker qualifications.
Louisiana Yes Definitions of ancillary service and social service designee; provide medically-related social services; definition of social services designee.
Maine Yes Qualifications going beyond federal; social services staff ratio; role description; assessment; records; administrative support and space; emphasis on team.
Maryland Yes Social history 7 days after admission and content of social history; records; space.
Massachusetts Yes Social services levels of staff; requirements for facilities with 40 or more residents; evaluation and identification of needs after admission; roles; Facilitating return to community as part of role; social service roles in in-service to rest of staff; social service records—content and confidentiality.
Michigan Yes Social Services designee shall assist patient and family; shall be aware of public and private resources.
Minnesota Yes Organized social services department; qualifications exceeding federal; admission history and assessment within 14 days of admission, updated at least annually & integrated into the clinical record;
Mississippi Yes Social services orientation for al personnel; social services records; space for social services; office space;
Missouri Yes Qualifications of Social Services designee.
Montana Yes Montana regulations do not go beyond the federal regulations.
Nebraska Yes Clarification of qualifications; brief stipulations on role.
Nevada Yes Role, qualifications,
New Hampshire Yes Phrase about social services being offered to resident on roommate's death, as needed.
New Jersey Yes Mandatory social work policies & procedures; mandatory social work staff qualifications (above federal); assessment within 14 days before or after admission; mandatory social work "amounts" and availability; detailed role specification; advisory social work; weekend and evening availability; office space; advisory social services for dementia programs.
New Mexico Yes Role; assessment; care planning; qualifications
New York Yes Qualifications higher than federal requirements; detailed role description.
North Carolina Yes Provide medically-related social services; if more than 120 beds, full-time, qualified staff member required; social worker qualifications; required office space.
North Dakota Yes Requirements for staff member to assess residents' psychosocial needs and associated provision of services; contract for outside agency or individual to provide social services; policies and procedures required.
Ohio Yes Brief addition that facility will ensure that social services for admission or discharge planning meets needs for "safe and appropriate transfers."
Oklahoma Yes Clinical social service records with progress notes at least monthly; roles; staff ratios with at least 20 hours a week regardless of number of residents; qualifications (not higher than federal).
Oregon Yes Social services director; roles; social services plan & progress notes.
Pennsylvania Yes Qualifications of social worker; goals of social services; if more than 120 beds, full-time, qualified social worker required; if less than 120 beds, consultation by a qualified social worker and documentation.
Rhode Island Yes Brief role description; confidentiality.
South Carolina Yes Social services history obtained within 7 business days of admission & "kept current;" role statement, including discharge planning.
South Dakota Yes Office space; consultant requirements if no qualified social worker.
Tennessee Yes Social history within 2 weeks of admission and "appropriately maintained;" space for privacy; brief description of role.
Texas Yes Definition of qualified social worker; assessment; role of social worker in Alzheimer's units.
Utah Yes Role; clarification that role may be performed by a consultant.
Vermont Yes Provide medically-related social services; if more than 120 beds, full-time, qualified social worker required; qualifications of social worker.
Virginia Yes Brief addition on qualifications and on role.
Washington Yes In new construction, convenient office space "to work area" needed.
West Virginia Yes Added staffing standards—a NH with 60 or more beds must have full-time qualified social worker; social work role in Alzheimer's dementia special care unit
Wisconsin Yes Admission history; care planning role; specified services provided by social work.
Wisconsin Yes Responsibilities and services to be provided; qualifications of full-time or part-time social worker; social history and social services componenet of plan of care shall be developed.
Wyoming Yes Current records &p-to-date progress notes maintained in clinical record; confidentiality of records; privacy for interviews; roles.

Complete Transcript of State Requirements on Quality of Life - Social Services    (TOP)