Abstract:

There has been a trend towards initiating & increasing social work services in long-term care facilities. At the same time there has been little conceptualization of the role of the professionsal social worker in such settings, especially in rural areas. The purpose here is to describe a model for developing social work services for staff in nursing homes. This model was developed from consultation services provided over the last three years to a large, private nursing home corporation consisting of 5 nursing homes, & a public regional hospital center with a nursing care component. All of these facilities are located in rural areas necessitating a focus on problems specific to rural areas. The model is based on role theory & operationalized through the use of the concepts of conventional & interpersonal roles, & roles taking & role making. These concepts are discussed in relation to interaction among the professional social worker, facility staff, administrators, boards of directors, regulatory agencies, external fee for service providers (eg, MDs, nurses, psychologists), residents, families, & rural community resources. Methods of avoiding total reliance on & rehabilitation process by full-time staff are explored through emphasis on a milieu orientation & an integrative role model of the social worker rather than one of exclusively providing clinical social work services. Practical means of implementing this model are explained by focusing on three sets of problematic role relations of: (1) resident interpersonal relationships, (2) staff relationships, & (3) staff/resident relationships. These sets are explored in relation to the natural interpersonal conflicts that result from living together in a close, structured setting where limited physical functioning is characteristic. These areas are discussed through demonstrating specific means of intervention to produce maximum therapeutic benefit.