Amy Restorick Roberts

Who Hires Social Workers? Structural and Contextual Determinants of Social Service Staffing in Nursing Homes

Although nurse staffing has been extensively studied within nursing homes (NHs), social services has received less attention. The study describes how social service departments are organized in NHs and examines the structural characteristics of NHs and other macro-focused contextual factors that explain differences in social service staffing patterns using longitudinal national data (Certification and Survey Provider Enhanced Reports, 2009-2012). NHs have three patterns of staffing for social services, using qualified social workers (QSWs); paraprofessional social service staff; and interprofessional teams, consisting of both QSWs and paraprofessionals. Although most NHs employ a QSW (89 percent), nearly half provide social services through interprofessional teams, and 11 percent rely exclusively on paraprofessionals. Along with state and federal regulations that depend on facility size, other contextual and structural factors within NHs also influence staffing. NHs most likely to hire QSWs are large facilities in urban areas within a health care complex, owned by nonprofit organizations, with more payer mixes associated with more profitable reimbursement. QSWs are least likely to be hired in small facilities in rural areas. The influence of policy in supporting the professionalization of social service staff and the need for QSWs with expertise in gerontology, especially in rural NHs, are discussed.

Secondhand Smoke and Women’s Cognitive Function in China

Abstract Exposure to secondhand smoke (SHS) is known to be harmful to health. However, the association between household SHS and cognitive function among middle‐aged and older women in China is understudied. Lagged dependent variable regression was used to examine the association between household SHS exposure and the cognitive function of married women who had been exposed to SHS, using data from 2 waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011‐2013). Controlling for age, educational attainment, geographic residence, household expenditures, and chronic conditions (i.e., hypertension, diabetes, and depressive symptoms), the results indicated that longer SHS exposure was associated with a greater decline in memory over 2 years. After comparing differences across age groups, this pattern was significant for women aged 55‐64 years. Furthermore, those who were illiterate, lived in rural areas, and reported depressive symptoms had a greater decline in memory. With evidence linking household SHS exposure with a higher risk of cognitive decline, effective education and public health intervention programs are urgently needed. Stronger tobacco control regulations and education about the dangers of household SHS are viable strategies to reduce the impending dementia epidemic in China.

Quality of Life Trajectories of Older Adults Living in Senior Housing

Quality of life (QoL) in the face of declining health, mobility, and social losses is a central issue for older adults. Our study examined changes in QoL over time for older adults residing in independent senior housing within continuing care retirement communities (CCRCs) and estimated how residents’ social engagement during their first year influenced QoL over the next 4 years. Data were drawn from a 5-year panel study of 267 older adults who moved into senior housing within four CCRCs. Although initial QoL varied between individuals, QoL declined for the group over time. One component of early social engagement—participating in a greater number of formal social activities organized by the CCRC—significantly slowed the rate of decline in QoL. Findings suggest that senior housing residents may benefit from early participation in organized social and leisure activities soon after move-in to forestall declines in QoL over the long term.

Cost-Effective Adjustments to Nursing Home Staffing to Improve Quality:

Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing. After adjusting for wages, the most cost-effective investment for improving overall deficiency outcomes was increasing social services. Deficiencies related to quality of care were improved most by increasing administrative nursing and social service staff. Quality of life deficiencies were improved most by increasing social service and activities staff. Approaches to improve quality through staffing adjustments should target specific types of staff to maximize return on investment.

Teaching Note—Social Work Week: Harnessing the Potential of Group Practice to Achieve Transformational Learning

ABSTRACT Transformative learning approaches in social work education emphasize the importance of bringing together experience, critical reflection, and dialogue to promote individual and social change. An experiential learning assignment, Social Work Week, was designed to sharpen undergraduate students’ group practice skills and introduce them to the range of macro practice available to social workers using a transformational teaching approach. Social Work Week required students to work together in task groups to plan, implement, and evaluate this university-wide collaborative project that featured 11 student-led events over 5 days. Transformational teaching approaches place unique demands on students and the instructors. We share lessons learned and propose recommendations for adapting this project to further student learning in social work practice courses.

Family Satisfaction With Nursing Home Care: Findings and Implications From Two State Comparison

Family satisfaction, while recognized as important, is frequently missing from validated measures of long-term care quality. This is the first study to compare family satisfaction across two states using validated measures and to compare the organizational and structural factors associated with higher family satisfaction with nursing home care. Data sources are family satisfaction surveys from Minnesota (MN) and Ohio (OH), linked to facility characteristics from Certification and Survey Provider Enhanced Reports (CASPER) for both states (N = 378 facilities for MN; N = 926 facilities for OH). Activities and food were among lowest rated items in both states. Relationships with staff were the highest rated domain. Higher occupancy rates, smaller facility size, and non-profit ownership consistently predicted better satisfaction in both states. Our findings show consistent organizational factors associated with family satisfaction and provide further evidence to the validity of family satisfaction as a person-centered measure of quality. This lays the foundation for tool development on the national level.

Older Adults’ Experiences with Audiovisual Virtual Reality: Perceived Usefulness and Other Factors Influencing Technology Acceptance

ABSTRACT Objective: This study explores how older adults respond to audiovisual virtual reality (VR) and perceive its usefulness to their lives. Method: Focus groups were conducted with residents of a retirement community after they viewed two audiovisual VR simulations (n = 41). Thematic analysis was used to identify patterns in responses. Results: Older adults described positive and negative emotional reactions to aspects of the VR experience, articulated content preferences, shared ideas to improve the usability of the equipment, and identified facilitators and barriers that influenced perceived usefulness. Recommendations for improving this technology include maximizing the positive aspects of VR through increasing interactivity, facilitating socializing with friends or family, and enhancing older adults’ ease of use. Desired content of simulations involved travel, continuing education, reminiscence, and self-care/therapy. Conclusion: Virtual reality was reviewed positively, yet modifications are necessary to facilitate optimal user experience and potential benefit for this population. Clinical Implications: As older adults are interested in using VR, especially if poor health prevents the continuation of desirable activities or new experiences, it is important to respond to older adults’ preferences and remove barriers that limit use and enjoyment.

Miami Six-O: Lessons Learned From an Intergenerational Game Design Workshop

This chapter reports on the Miami Six-O project, a creative intergenerational workshop aimed at developing a meaningful play experience for and with older adults. During the project, 5 older adults and 4 undergraduate game design students participated in a 4-step creative process, which resulted in 6 playable paper prototypes. Their collaboration was observed by a team of 2 professors and 3 graduate assistants. The resulting notes and audio recordings were analyzed through open, selective and theoretical coding. The project found that it is possible to successfully co-create game designs that are meaningful for both the older adults and the students, though how these teams worked together influenced the outcomes. Furthermore, we discovered that shared popular culture references and design themes such as competition, creativity, diversion, and social connectedness were helpful in moving the creative process forward and overcoming generational differences.

Effects of chronic illness on daily life and barriers to self-care for older women: A mixed-methods exploration

ABSTRACT This mixed-methods study examined the subjective experience of living with chronic illness and identified barriers to self-care. Community-dwelling older women with chronic illness completed an initial (N = 138) and follow-up mailed survey 6 months later (N = 130). On average, participants reported four comorbid health conditions and the corresponding physical pain, activities curtailed or relinquished, and time and energy focused on managing health. Only 34% of participants practiced all 10 key self-care behaviors. Reported barriers to self-management included pain, lack of financial resources, and worry. In the regression analysis, having more depressive symptoms was a significant predictor of challenges with self-care behaviors.