Decision-Making Influence: An Empirical Study of Social Workers in Nursing Homes

Abstract

Health care research on social workers' organizational influence has focused almost exclusively on the hospital setting. Little is known about social workers' influence in nursing homes, in particular organizational factors that support or constrain their impact on resident care. This article presents findings from a survey of 90 social workers employed in 53 nursing homes who identified their level of influence in five spheres of organizational decision making. With the exception of personnel decisions, there were few differences between the influence levels of the directors of social services and social workers without administrative responsibilities. Number of full-time-equivalent social workers, type of ownership, and length of employment of the director of social services were significantly related to the level of perceived influence held by the director of social services. The implications of these findings for social work practice in nursing homes are discussed.

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“…The findings of Kruzich and Powell (1995) indicate that the autonomy of nursing home residents can be increased by the important role social workers play in empowering residents. Berger and Majerovitz (1998) advise that even elderly people experiencing mild dementia should not be excluded from health care decisions, finding that they were still able to make treatment choices in keeping with their previous decisions.…”

Multilevel Factors Related to Psychosocial Care Outcomes in Washington State Skilled Nursing Facilities

“…Six structural factors influencing quality of care were examined: facility ownership type (Castle & Shea, 1997;Harrington, Woolhander, Mullan, Carrillo, & Himmelstein, 2002), ownership turnover (Castle, 2000;, multifacility chain affiliation (Castle, 2000;Kruzich, 2005), facility size (Anderson, Issel, & McDaniel, 2003;Bravo, DeWals, Dubois, & Charpentier, 1999;Castle, 2001), facility location (Bravo et al, 1999;Mor, Zinn, Angelelli, Teno, & Miller, 2004), and the size of the social services professional's caseload (Anderson, Hsieh, & Su, 1998;Kruzich & Powell, 1995;Harrington et al, 2000). Although other structural factors also play a role in care outcomes, for example nursing home bed supply and unemployment rates in the facility's vicinity (Mor et al, 2004), these six factors were most frequently mentioned in the literature, were measured by readily available data, and promoted study feasibility.…”

“…Relevant process factors include the extent of the social services professional's job autonomy (Gleason-Wynn & Mindel, 1999;Vourlekis, Zlotnik, & Simonsm 2005), decision-making influence (Kruzich, Clifton, & Kelber, 1992;Kruzich & Powell, 1995), and supervisor and coworker support levels (Gleason-Wynn & Mindel, 1999;Greene, Graham, Haulotte, Nixon-Garcia, & Gleason-Wynn, 2005), as well as the frequency of psychosocial service delivery (Vourlekis et al, 1992b;DHHS, 2003) and the facility's overall prioritization of residents' psychosocial needs (Fairchild-Remsen, 1992;Vourlekis et al, 1992b;Harrington et al, 2000).…”

Nursing Home Social Worker Skills and End-of-Life Planning

“…As such, social workers are stakeholders in care outcomes for residents. Social work directors in many facilities already are involved in developing and implementing facility policies; many also are responsible for training staff in resident's rights and related care issues (Kruzich & Powell, 1995). Thus, it seems within their purview to help effect systems-wide changes that promote palliative care policies and practices for residents in advanced stages of chronic diseases.…”