Nursing Homes Should Provide More Palliative Focused Care for their Residents

In 2012, skilled nursing facility (SNF) care accounted for $26.8 billion of health care spending. SNFs are intended to provide a setting for stabilized transitions for older adults. However, research shows that between a quarter and half of Medicare recipients are readmitted from SNF rehabilitation back to the hospital within 30 days, amounting to $4.34 billion in expenses in 2006. These patients are often in poor health and well-being, with 1 in 11 elders dying while enrolled in SNF care. Although there is a great need, palliative care is not adequately used in SNFs.

Federal regulations mandate SNFs to provide “medically related social services to attain or maintain the highest practicable resident physical, mental and psychosocial well-being.” Social workers are qualified and well-equipped to provide palliative-focused care due to their core competencies in biopsychosocial care. However, study found that social service roles are commonly filled by those who do not even possess a bachelor’s degree in social work.

Social workers are highly appropriate candidates to provide palliative-focused care for SNF residents due to their extensive training in family systems and ecological methods specialized to meet patient and family needs that can significantly influence a patient’s care plan during and after sub-acute care. However, a recent survey found that social service roles in a significant proportion of SNFs are not filled by social workers and social service workers self-report average skill levels for the provisions of palliative and psychosocial care, but time to provide such services was restricted by case load and competing obligations.

The survey’s findings on SNF social service providers elucidates crucial opportunities considering the fact that SNF residents are at high risk for failed advanced care planning, poor communication between provider and patient/family, poor quality of life, and mortality. SNFs should increase their use of social workers to give residents more high-quality psychosocial care and thus improve quality of life.