Nursing facility social work with family behavioral health challenges

ABSTRACT Nursing facility social workers play a prominent role in promoting behavioral health among family members with compromised responses to their loved one’s residing in a skilled care nursing facility. Familial behaviors in nursing home settings and social workers’ responses to them have not been systematically investigated. This study addresses the issue through quantitative and qualitative analyzes of face to face, in-depth interviews with 20 BSW/MSW licensed nursing facility social workers averaging 8.8 years of experience. The analysis conducted by a five-member research team yielded six recurring categories of compromised family behaviors: verbally aggressive, controlling/demanding, denial/unrealistic expectations, abuse/exploitation, manipulation, and disengaged/resistant. Respondents reported five categories of responses to these family behaviors: relating (tuning in, active listening, trust-building), mediating, limit-setting, educating, and advocating. Narratives of family behaviors and social worker responses revealed creative ways social workers engaged family member role ambiguity and worked to improve transactions among struggling family members, residents, and facility staff and policy. The findings provide previously unavailable evidence on the social worker’s role in promoting family behavioral health and document an empirical basis for future study. Five recommendations are offered for enriching social work practice and education with families in the context of skilled nursing facility care.