H. Wayne Nelson

Injustice and conflict in nursing homes: toward advocacy and exchange

Abstract This article examines the relational dynamics and patterns of conflict exhibited in the two interdependent parties in Americas nursing homes. In the framework of the social exchange theory of structural power, it explains how the asymmetrical structure of dependence and control in nursing homes eliminates the possibility of fair bargaining—normal conflict—between staff and patients. In the absence of any opportunity for reciprocal rewards and punishment, patients tend to adopt submissive influence strategies, whereas staff members tend to neglect, exploit, or abuse difficult or resistant patients. The author examines the exchange dynamics of adversarial tactics and the prevalence of third-party conflict in the nursing home, and shows that a partisan, patient-directed ally could rebalance power and eliminate inequities in the nursing home environment.

Volunteer and Paid Staff Relationships

Summary In this article, we examine theoretical perspectives and studies on volunteer and paid staff relationships to determine what administrators in social work can glean from theory and research. We also draw from the conceptual literature in the area of volunteerism, as well as our experience with one nationally mandated program that utilizes 90% volunteers and 10% paid employees. Implications for social work administration include recognizing the culture of ones program or organization and the norms associated with volunteerism, as well as understanding the nature of psychological contracting for both paid employees and volunteers. Guidelines for assessing volunteer/paid staff culture are provided.

The causes and consequences of conflict and violence in nursing homes: working toward a collaborative work culture.

Interpersonal conflict, often spiraling to violence and abuse, is one of the most daunting challenges facing nursing home administrators and their departmental heads. Mounting evidence documents how they spend an inordinate amount of time dealing with angry families, adversarial ombudsmen, regulators, and other hostile parties as well as handling the aftermath of the ubiquitous conflict between the residents and their direct caregivers. All this is in addition to coping with the normal interdepartmental and line staff forms of conflict that typify any organization. This paper details the special dynamics that accelerate dysfunctional conflict in nursing homes and presents strategies, tactics, and style recommendations that will help nursing home leaders build more collaborative work cultures to minimize the effects of dysfunctional conflict.

Volunteer and Paid Ombudsmen Investigating Complaints in Six States: A Natural Triaging

The Long Term Care Ombudsman Program provides an opportunity to explore how a public mandate is implemented through the use of paid and volunteer ombudsmen who investigate complaints in long-term care facilities. In this article, the authors report partial findings from a growing database across six states, focusing on what is known about the use of volunteers and paid staff complaint investigation. Findings reveal differences in the types of complaints received, the sources of complaints, and the percentage of complex (difficult) complaints investigated by volunteers and paid staff. These differences result in a natural triaging that occurs among volunteers and paid staff, so that complaints viewed as difficult to verify and resolve are automatically given to paid staff.

Disaster Services with Frail Older Persons: From Preparation to Recovery

Hurricanes claim the lives of the frail elderly more than any other age group due to this population’s reduced health status and heightened dependence, especially for those institutionalized. Social workers are obligated and ethically compelled (NASW, 1996, Code of ethics of the National Association of Social Workers. Washington, DC: NASW) to meet this high-risk group’s disaster readiness and recovery needs as posed to them by unexpected meteorological crises like Hurricanes Katrina, Rita, Gustav, and Ike. This chapter critically assesses social works’ tested but largely unheralded traditional disaster roles, as well as new ones that are emerging in the wake of Katrina and in light of recent developments in the field of emergency preparedness. These mandate that the social work profession boost its capacity and capability to provide competent emergency services to ease the suffering of older individuals before, during, and after a crisis. Recommendations by the AMA, The American Red Cross, AARP, and various disaster and gerontological scholars are synthesized.

The Social Worker-Ombudsman Partnership

Abstract This article presents a tactical protocol to guide social workers and ombudsmen in explaining their conflict behavior in fundamentally imbalanced power structures like nursing homes. It is argued that efficient case advocacy requires the selection of tactics based on the confluence of two conditional factors on a low to high continuum in the following priority: (a) the urgency and severity of the residents needs, and (b) the facilitys level of resistance. Seven possible influence tactics are presented within the broad strategies of relation-building, campaign/collaboration, and contest.

Factors Effecting Volunteer Ombudsman Effort and Service Duration: Comparing Active and Resigned Volunteers

Volunteers are key to successful ombudsmen programs. Motivating them and keeping them is difficult. The principal goal of this article is to compare active and resigned volunteer ombudsman perceptions (along with select demographic influences) of factors that either encouraged or discouraged their work. The authors find that former ombudsmen felt more role ambiguity, greater nursing facility resistance, higher boredom, and desired better supervision than active volunteer ombudsmen. They also served less time in significantly smaller facilities. Both active and resigned volunteers perceived relatively high role conflict. Implications regarding strategies to improve volunteer ombudsman work effort and retention are discussed.

Rights-based advocacy in long-term care : Geriatric nursing and long term-care ombudsmen

Abstract Both long-term care (LTC) ombudsmen and nurses are committed to advocacy, but often find themselves at odds due to fundamentally divergent orientation to patient care and advocacy issues within the nursing home setting. This paper compares these advocacy alignments, identifies areas of potential conflict, and provides grounds for cooperation and mutual support. Specifically, we argue that nursing advocacy, despite a theoretical bow to autonomy, is typically beneficent and can be limited by employment status, professional orientation, and subordination to dominant physician and administrative authorities. Conversely, LTC ombudsmen are guided by the autonomy principle, and are, by law, free of any conflict of interest with the resident. The paper concludes with a discussion of common goals that should be adopted by elder care nurses and ombudsmen in order to improve mutual understanding and communication that is essential to building partnerships that effectively and creatively solve issues that emerge from resident physical and socio-emotional problems.

Training Residents' Rights Case Advocates in Effective Situational Conflict Skills

Abstract Despite work that is inherently conflictual, very little dispute resolution training is provided to the paid and volunteer ombudsmen who investigate complaints in Americas elder care facilities. This article explains how the special conflict dynamics of long-term care support the implementation of a two-phased knowledge- and skills-based training program designed to develop skills in situational conflict. The benefits of situational conflict training are explored in the context of the long-term care systems highly regulated, yet fundamentally unbalanced power structure which promotes inequity and issue rigidity, undermining the advocates use of collaborative Strategies in favor of adversarial tactics.

State Long-Term Care Ombudsmen's Perceptions of Their Program's Disaster Preparedness Roles and Readiness

A telephone survey of 43 state long-term care ombudsmen (LTCO) assessed their familiarity with relevant long-term care disaster resources, their provision of disaster aids and training to staff, and their perceived preparedness to lead their programs during public crises. Thirty-four directors (78%) reported being fairly well to fully prepared to support their local programs during public emergencies. However, ANOVAs showed that the 27 disaster experienced ombudsmen felt no better prepared to help their local paid and volunteer staff deal with public emergencies than disaster inexperienced ombudsmen. Those directly involved with emergency planners felt better prepared to help their substate staff to know where to start helping residents during a public crisis than ombudsmen who had no involvement with disaster planners. Familiarity with the Centers for Medicare and Medicaid Services Emergency Planning Checklist for LTC Ombudsmen (2007) was strongly associated with the ombudsmen’s familiarity with emergency resources and regulations.