The Fate and Welfare of Nursing Home Residents - Assignment Example

?The Fate & Welfare of Nursing Home Residents: Towards A Holistic Psychosocial Care Problem ment The rise in aging population has increased the demand for nursing home residential facilities. These institutions have become places of continuing care and treatment that is largely centered on biomedical model in which efficiency, consistency and standardized decision-making are of great value (Brownie & Nancarrow, 2013). However, there are studies showing that residents of nursing homes need alternative forms of care that would address other more important issues that old people are faced to. Ironically, while deteriorating health is a reason why old people have to be looked after in nursing home facilities, several studies have shown that social isolation and loneliness resulting from being placed into these institutions influence morbidity and mortality among the aged (Warburton & Lui, 2007). As cited by Roos & Malan (2012), loneliness can hasten the deterioration of a person’s health due to its effect on the immune system which consequently influences mental and physical health. This is further illustrated in the study of Fossey, Ballard, Juszczak, James, Alder, Jacoby & Howard (2006), wherein they found out that organic problems such dementia can be cured by psychosocial care as an alternative to antipsychotics. In a study by Krauss & Attman (2004), it was found that around two-thirds of the nursing home residents suffer from significant depressive symptoms. Given this, attending to the residents’ welfare and quality of life should extend beyond just medical care but towards psychosocial care which focuses on social, mental and emotional needs of residents (as cited in Galambos, Zlotnik, Bern-Klug & Zimmerman, 2009). For this reason, emerging approaches to nursing home care have leaned towards a more holistic approach to care by addressing the psychosocial aspect of nursing care. According to a report published by Institute for the Advancement of Social Work Research (IASWR) in 2005, the psychosocial approach to care deals with a constellation of social and emotional needs and the care given to meet these needs. Mental and behavioral problems common among the aged such as dementia, depression, and anxiety stem from inevitable social consequences of old age which mainly center on multiple losses both of abilities and personal relationships (Roos & Malan, 2012). Being placed in the institution itself deprives old people from personal contact with significant social networks (Roos & Malan, 2012). Addressing the psychosocial needs of nursing home residents is now being acknowledged as a fundamental component of care such that even the Minimum Data Set (MDS), which is a national mandated screening tool for implementing care in nursing homes, has been modified in its 2010 version to encourage better evaluation of residents’ psychosocial needs and health (Zimmerman, Connolly, Zlotnik, Bern-Klug & Cohen, 2012). However, despite the existence of laws that govern nursing home care, issues persist regarding the quality of care, which include psychosocial care, and the quality of life of old people in nursing home institutions (IASWR, 2005). As cited in the report of IASWR, 39% of the resident charts do not contain enough plans while 46% contain plans but were not implemented. This was also further proven by the investigation conducted by the Department of Health and Human Services in 2003 mentioned in the study of Gumbos et al. (2009), in which it was found that nursing home residents did not receive all of the psychosocial services they needed; worse, some did not receive any service at all. It appears that the psychosocial needs of nursing home residents are still not being properly accounted for due to the inadequacy of health service provisions. The study of Roos & Malan (2012) explored the psychosocial problems that nursing home residents encounter within the institution. Participants in the said study described relationships within the nursing home facility as unsafe for forming personal relationships because they feel lack of care from fellow residents which prevented them from entering such relationships. The problem is that nursing homes do not provide a stimulating environment for the residents such that activities that enhance interpersonal relationships are insufficient (Roos & Malan, 2012). The failure to establish relationships within the nursing home facilities result to loneliness, which as mentioned previously, affects the overall health of the residents. Literature Review The shortfalls in psychosocial care in nursing homes are attributed to the theoretical gaps in research. There are two areas of social interaction that have been neglected by present studies: the reason and the type of such interactions in settings like the nursing residential facilities (Hubbard, Tester & Downs, 2003). According to IASWR (2005) report, the reason why the psychosocial needs of nursing home residents are being neglected is due to the lack of comprehensive approach to monitoring and measuring psychosocial care and quality of life in these institutions. For instance, the Minimum Data Set(MDS) alone measures the psychosocial concerns such as recognition, diagnosis, and treatment of mental health disorders only from the perspective of the service provider. This contradicts the essence of psychosocial care, which ideally should center on the residents themselves. An important hindrance to the development of psychosocial approach to nursing care is the lack of qualified and accredited social workers in nursing residential institutions; thereby, contributing to the inadequate mental health and psychosocial care in these facilities. There remains to be a significant gap in the mental services provisions in these institutions such that while it is recognized that nursing homes are primary providers of mental health services, majority of residents still do not receive these services (Piacitelli & Koepsell, 1998; Russo, & Smyer, 2000). Moreover, the lack of qualified professionals may be attributed to the unavailability of adequate psychosocial evidence-based tools, guidelines and resources to support and educate nursing home staff (Zimmerman, et al., 2012). The standards of practice among the professionals and service providers that constitute the nursing home staff are generally inclusive of roles and processes alone without the needed protocols and guidelines that would allow for consistency of service. According to the recommendations presented in the study of Zimmerman et al. (2012), psychosocial care should be person-centered. In a literature review conductive by Brownie & Nancarrow (2013), person-centered care was described as empowering the staff and placing the decision-making authority as close to the nursing home resident as possible. Such approach was said to be associated with positive influences both on the facility staff and the nursing home residents. As far as the residents are concerned, it was reported that this approach results to improvement of psychological status such that it results to lower rates of boredom and feelings of helplessness (Brownie & Nancarrow, 2013). Meanwhile, it is difficult to establish an evidence-based education of nursing home staff because even the mere national statistical demographics of the participation of the profession in nursing care is lacking. According to the report of IASWR (2005), the structural existence of social service provider is not routinely evaluated by the current federal and state regulatory bodies. These statistics would have served as a solid evidence of the need to reform psychosocial care in nursing homes. In addition, while several researches have stressed the importance of psychosocial care in the welfare of nursing home residents, there is no single professional research from which the effectiveness of such approach to care is clearly and directly demonstrated (IASWR, 2005). As such, the conceptual and even the operational connections between proper psychosocial care and its corresponding outcome are absent. Just like the national statistical demographics, a concrete study regarding this matter could have provided all the needed proofs for establishing a better psychosocial approach to care. Given the theoretical gaps in research, there are several recommendations presented in various studies as to how to further improve psychosocial care in nursing homes now that the problems have been recognized. For instance, in addressing the problem of evidence-based training of nursing home staff, Galambos et al. (2009) cited that the present studies regarding the limitations of psychosocial care in nursing homes should promote education of facility staff that is geared towards enhancing capacity for sustainable long-term care. This means formulating specific qualifications that have to be fulfilled in order to practice psychosocial care in nursing home facilities. As such, the role, function and intervention among nursing home personnel must be clarified and specified. Meanwhile, there is no other way to address the problem of inadequate statistics that is supposed to serve as basis of future research on psychosocial care than to track the records of social workers employed in nursing residential facilities and build a statistical trail from the gathered data (IASWR, 2005). The information gathered should provide documentation on the extent of qualifications of the presently employed nursing home personnel. In addition, it is also important to identify the activities and functions being performed by the staff and to assess how each of this complies with the person-centered approach of psychosocial care. This entails combined efforts of national and state administrators and regulators of nursing home facilities in order to form and interdisciplinary approach to psychosocial care in nursing homes (IASWR, 2005). This involves formulating standardized means to monitor and measure quality of care in nursing homes. Lastly, the problem of inadequate means of monitoring and psychosocial care in nursing homes calls for the need of comprehensive monitoring and measurement not only of psychosocial care being provided by nursing home personnel but also of the quality of life of residents. Alongside with this, it is important to provide opportunities to mental health professionals, physicians and other members that constitute the nursing home staff to conduct studies not only on the currently available data but also on the existing situation of psychosocial care in nursing homes in order to fill the theoretical gaps in research that hinder the growth of psychosocial approach to care (IASWR, 2005). References Brownie, S. & Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. Clinical Interventions In Aging, 8:1-10. Fossey, J., Ballard, C., Juszczak, E., James, I., Alder, N., Jacoby, R. & Howard, R. (2006). Enhanced psychosocial care as an alternative to use of antipsychotics in nursing homes for residents with severe dementia: a cluster randomised trial. The Journal of Quality Research in Dementia, 4. Galambos, C., Zlotnik, J.L., Bern-Klug, M. & Zimmerman, S. (2009). Improving psychosocial care in nursing homes: challenges for social work education. Journal of Social Work Education, 45(2). Hubbard, G., Tester, S. & Downs, M. (2003). Meaningful social interactions between older people in institutional care settings. Ageing & Society, 23: 99-114. Institute for the Advancement of Social Work Research (IASWR). (2005). . Washington, DC: Vourlekis, B., Zlotnik, J.L. & Simons, K. Piacitelli, J. & Koepsell, T. (1998). Compliance with PASARR recommendations for Medicaid recipients in nursing homes. Journal of the American Geriatrics Society, 46: 1132-1136. Roos, V. & Malan, L. (2012). The role of context and the interpersonal experience of loneliness among older people in a residential care facility. Global Health Action, 5: 18861. Russo, P. A., & Smyer, M. A. (2000). Use of mental health services by persons with a mental illness in nursing facilities: Initial impacts of OBRA 87. Journal of Aging & Health, 12: 560-578. Warburton, J. & Lui, C.W. (2007). Social isolation and loneliness in older people: A literature review. University of Queensland Australasian Centre on Ageing. Zimmerman, S., Connolly, R., Zlotnik, J.L., Bern-Klug, M. & Cohen, W. (2012). Psychosocial care in nursing homes in the era of the MDS 3.0: perspectives of the experts. Journal of Gerontological Social Work, 55(5):444–61  Read More