THE IMPACT OF SOCIAL WORKERS ON POST-ACUTE CARE DISCHARGE OUTCOMES

Abstract

Background: Social service staff may play a key role in helping post-acute care patients in skilled nursing facilities return home, yet few studies quantify how social service staff contribute to better patient outcomes. Method: A quasi-experimental statistical approach, regression discontinuity, was used among newly-admitted, Medicare post-acute care patients (65+) to examine the relationship between higher qualifications of social service workers and various discharge outcomes. National data (2011-2015) were drawn from the Online Survey Certification and Reporting system, the Certification and Survey Provider Enhanced Reports, and the Minimum Data Set. Findings: Patients in facilities with a greater proportion of more qualified social service staff (qualified social workers vs. paraprofessionals) had better discharge outcomes. Post-acute care patients were more likely to be discharged home within 30 days, compared to being re-hospitalized or remaining in the facility. Conclusion: Policymakers and providers should support efforts to increase the qualifications of social service staff.

Full text

GSA 2019 Annual Scientific Meeting
backgrounds. Results indicate complex trajectories of in-
crease, decrease, and continuity as individuals move into their
later years. We also detect a “return to religion” among baby
boomers. We discuss these ndings in terms of both life-course
personality theories and social integration/support
A TEST OF THE OKLAHOMA INMATE FORGIVENESS
AND WELL-BEING MODEL
GeorgeK. Randall1 and Alex Bishop2, 1. Sam Houston State
University, Huntsville, Texas, United States, 2. Oklahoma
State University, Stillwater, Oklahoma, United States
Data was collected from older male offenders (N = 86
non-violent; N = 163 violent) incarcerated in Oklahoma.
Testing a forgiveness model, positive evaluation of life PVOL
was regressed on religiosity (REL) and forgiveness of self
(FSelf), others (FOthers), and situation (FSit) using hierarch-
ical OLS regression. Blocks of predictors included: a) age
and education; b) religiosity; and c) FSelf, FOthers, and FSit.
For the non-violent model of PVOL signicant predictors in-
cluded REL (β=.26, p ≤ .01) and FSelf (β=.40, p ≤ .01). For
the violent offender model of PVOL signicant predictors in-
cluded REL (β=.31, p ≤ .001), FS (β=.21, p ≤ .01) and FSit
(β=.33, p ≤ .001). Result indicate effects of REL and FSelf
for both non-violent and violent offenders but a unique asso-
ciation of FSit for violent offenders. Implications for geron-
tological inquiry, practice, and policy are discussed.
SHARING ONE ANOTHER'S BURDENS:
CONGREGATIONAL SUPPORT OF CAREGIVERS FOR
PERSONS LIVING WITH DEMENTIA
Brianna Garrison1, 1. Baylor University, Houston, Texas,
United States
This presentation will discuss the ndings and implications
from a mixed-methods study examining the impact of sup-
port services for caregivers of persons living with Dementia
in their faith community. Caregivers and persons living with
dementia participating in religious activities report numerous
psychosocial benets. Faith communities are the primary so-
cial network for older adults, with 48% of older adults at-
tending religious services at least once weekly. Results will
highlight specic opportunities for local congregations to
foster spiritual connection and meaningful engagement with
caregivers of persons living with Dementia. Findings will also
describe key considerations and pathways for social work
practitioners, researchers, and religious leaders to better serve
older adults in their communities by providing education
and strengths-based interventions in the context of local con-
gregations. These ndings have the potential to increase the
reach of such programs to diverse, underserved populations.
SESSION 1480 (SYMPOSIUM)
INTEREST GROUP SESSION—RESEARCH IN QUALITY
OF CARE: LIVING IN AND LEAVING NURSING
HOMES: THE FACTORS THAT CONTRIBUTE
TO QUALITY OF LIFE, HEALTH, AND SAFETY
OUTCOMES
Chair: Nancy Kusmaul, University of Maryland, Baltimore
County, Baltimore, Maryland, United States
Discussant: Mercedes Bern-Klug, University of Iowa, Iowa
City, Iowa, Andorra
Nursing homes house some of the most vulnerable older
adults. They often have complex medical conditions and/or
cognitive impairments that put them at risk for negative out-
comes and poor quality of life. These outcomes can be altered
through incorporating evidence-based practices aimed to im-
prove care and residents’ life experiences. In this symposium
we will explore factors that are shown to inuence outcomes
and quality of life for people that live in and are discharged
from, long term care settings. Amy Roberts and colleagues
will explore the inuences of nursing home social service
staff qualications on residents’ discharge outcomes. Colleen
Galambos and colleagues will present ndings on advance
directives and their impact on reducing potentially avoidable
hospitalizations. Kelsey Simons and colleagues will discuss the
potential for unmet needs for mental health services as part
of nursing home care transitions, and will discuss a model of
quality improvement that addresses this gap in care. Vivian
Miller will present ndings on the impact transportation ac-
cess has on the ability of community-dwelling family members
to visit and provide social support to their family member resi-
dents in long-term care. Finally, Nancy Kusmaul and Gretchen
Tucker report the ndings of their study comparing percep-
tions of nursing home residents, direct care staff, management,
and families on the care practices that inuence resident health
and quality of life while they live in a long term care setting.
PERSON-CENTERED CARE: DEFINITIONS AND
PERCEPTIONS OF VARIOUS STAKEHOLDERS
Nancy Kusmaul,1 and Gretchen Tucker1, 1. University of
Maryland Baltimore County, Baltimore, Maryland, United
States
Implementation of culture change in nursing homes shifts
the care model from a traditional, more medically focused
approach to person-directed care. Person-directed care pro-
motes resident autonomy and decision making and the em-
powerment of direct care staff. In this paper, we examine
how different stakeholders in nursing homes (residents,
family members, direct care staff, administrative staff) con-
ceptualize and experience a selection of person-centered care
concepts (consistent assignment, meal choice, waking/bed-
time practices, and bathing). We describe the commonalities
and differences in the ways different groups of stakeholders
operationalize these core person centered care practices and
describe areas of potential conict of views. Lastly, we con-
sider how the well-being and quality of life for residents is
affected by the use of these practices.
THE IMPACT OF SOCIAL WORKERS ON POST-ACUTE
CARE DISCHARGE OUTCOMES
AmyRestorick Roberts,1 AmyRestorick Roberts,1
JohnR. Bowblis,1 and AustinC. Smith1, 1. Miami
University, Oxford, Ohio, United States
Background: Social service staff may play a key role in
helping post-acute care patients in skilled nursing facilities
return home, yet few studies quantify how social service staff
contribute to better patient outcomes. Method: A quasi-
experimental statistical approach, regression discontinuity,
was used among newly-admitted, Medicare post-acute care
Innovation in Aging, 2019, Vol. 3, No. S1 359
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GSA 2019 Annual Scientific Meeting
patients (65+) to examine the relationship between higher
qualications of social service workers and various discharge
outcomes. National data (2011-2015) were drawn from
the Online Survey Certication and Reporting system, the
Certication and Survey Provider Enhanced Reports, and
the Minimum Data Set. Findings: Patients in facilities with
a greater proportion of more qualied social service staff
(qualied social workers vs. paraprofessionals) had better
discharge outcomes. Post-acute care patients were more
likely to be discharged home within 30days, compared to
being re-hospitalized or remaining in the facility. Conclusion:
Policymakers and providers should support efforts to in-
crease the qualications of social service staff.
THE RELATIONSHIP BETWEEN ADVANCE
DIRECTIVE COMPLETION AND POTENTIALLY
AVOIDABLE HOSPITALIZATIONS
ColleenM. Galambos,1 Marilyn Rantz,2 Lori Popejoy,2
Pritchett Angelita,2 and Greg Petroski3, 1. University of
Wisconsin Milwaukee, Milwaukee, Wisconsin, United
States, 2. University of Missouri Sinclair School of Nursing,
Columbia, Missouri, United States, 3. Ofce of Medical re-
search, Columbia, Missouri, United States
Advance directive (AD) completion can improve transi-
tions between hospitals and skilled nursing facilities (SNF’s).
One CMS Innovations Demonstration Project, The Missouri
Quality Initiative (MOQI), focused on improving advance
directive documentation and use in sixteen SNF’s. An ana-
lysis was conducted of data collected from annual chart in-
ventories occurring over four years. Using a logistic mixed
model, results indicated statistical signicance (p<0.001) for
increased AD documentation. Greatest gains occurred at
project mid-point. The relationship between having an ad-
vance directive and occurrence of transfer to a hospital was
tested on a sample of 1563 residents with length of stays
more than 30days. Residents who did not have an advance
directive were more likely to be transferred. Alogistic re-
gression was conducted and the results were statistically sig-
nicant (p<0.02). The MOQI model and initiatives will be
explained followed by a discussion of research methodology,
data collection, and analyses. Practice implications will be
discussed.
ADDRESSING AN UNMET NEED FOR MENTAL
HEALTH SUPPORT DURING CARE TRANSITIONS
FROM NURSING FACILITIES
Kelsey Simons,1 Katherine Luci,2 Lauren Hagemann,2
M.Lindsey Jacobs,4 Emily Bower,5 Morgan Eichorst,6 and
Michelle Hilgeman7, 1. VISN Center of Excellence for
Suicide Prevention, Canandaigua, New York, United States,
2. Salem VA Medical Center, Salem, Virginia, United States,
4. VA Boston Healthcare System, Brockton, Massachusetts,
United States, 5. VISN Center of Excellence for Suicide
Prevention, Canandaigua, New York, United States, 6.
VA Northern Indiana Health Care System, Mishawaka,
Indiana, United States, 7. Research & Development Service,
Tuscaloosa, Alabama, United States
Mental health (MH) disorders are common among
skilled nursing facility (SNF) residents and may inhibit re-
habilitation goals. Moreover, discharges to the community
from SNFs are periods of heightened suicide risk within the
Veterans Health Administration (VHA), suggesting an ur-
gent need for improved continuity of MH care. This paper
presents results of medical records reviews indicating a po-
tential gap in MH services at discharge from VHA SNFs.
A quality improvement project (”Suicide Awareness for
Veterans Exiting Community Living Centers” – SAVE-CLC),
designed to address this gap, will also be discussed. Piloted
in 3 sites (N=66) in 2018, SAVE-CLC clinicians adminis-
tered depression screens by phone to 47 Veterans (71%) after
SNF discharge and helped connect Veterans to MH services.
24 Veterans (26%) received a second such call. Patients
and caregivers expressed high satisfaction with SAVE-CLC
(n=35, 97%). Implications for quality improvements in SNF
care transitions will be discussed.
TRANSPORTATION IS THE DRIVER TO VISIT:
DOES COMMUNITY CONNECTEDNESS AFFECT
DEPRESSION SYMPTOMS OF RESIDENTS?
VivianJ. Miller1, 1. University of Texas at Arlington,
Arlington, Texas, United States
A recent study found that lack of transportation access (or,
transportation disadvantage), together with travel time, is a
major barrier for community members to visit their loved ones
residing in long-term care nursing homes (Miller, 2018). This
transportation disadvantage not only may contribute to de-
creased visitation but also prohibits family from providing social
support to residents, which is imperative for residents to main-
tain decreased symptoms of depression, a sense of belonging,
and highest well-being. A sequential mixed-methodological
study was conducted across 11 CMS-certiable nursing homes
in North Central Texas to examine this effect of transportation
disadvantage of community members on depressive symptoms
of their family in long term care (N=89 dyads). Findings from
this study will be presented. Additionally, implications for so-
cial work, transportation planning, policymakers, and other
key professions will be discussed.
SESSION 1485 (SYMPOSIUM)
MIGC 2019 SYMPOSIUM: STRENGTH IN CREATING
DIVERSIFIED SPACES IN EDUCATION AND
RESEARCH ON AGING
Chair: AdrienneT.Aiken Morgan, North Carolina A&T
State University, Greensboro, North Carolina, United States
Co-Chair: Candace Brown, Duke University, Durham,
North Carolina, United States
Discussant: GregoryR. Samanez-Larkin, Duke University,
Durham, North Carolina, United States
Populations of minority older adults will continue to in-
crease at an accelerated pace in the coming decades. As such,
it is increasingly important to disseminate minority aging
education and research topics in spaces that will prepare
gerontology scholars to address the needs of diverse elders.
This symposium will highlight efforts to diversify academic
spaces by scholars engaged in minority aging education and
research. The rst presentation describes a service-learning
pedagogical approach to teaching minority aging topics to
graduate students. It will discuss how a gerontological social
work course seeks to offer real-world learning experiences
through community partnership. The second presentation
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