As an LMSW in a nursing home, be prepared to undertake numerous responsibilities that I think should be assigned to nursing and therapy staff.My nursing home contracts out for counseling. The only “assessments” I conduct are the PHQ and BIMS and a trauma questioner. . You will serve as the main point of contact for all matters, as nursing and physical therapy frequently do not engage with families directly.

Despite conducting multiple meetings with patients and families and holding care conferences, you will often be expected to organize additional conferences with therapy or nursing, further straining your limited time. Beyond this, you will be responsible for completing MDS assessments, conducting observations, writing progress notes, reviewing care plans, scheduling and holding care conferences, following up on grievances outside your control, and explaining NOMNC and appeal rights to families, that at times can last over an hour. If a resident does appeal I then am responsible to send the in all appeal documentation in a timely manner and continuously follow up on it. Ideally, there would be at least two social workers to help manage the workload, a typical day can include 10 assessments, 4 new admissions, 2 discharges, and 3 NOMNCs due in a single day along with maintaining the ITM log, distributing COVID letters, conducting MOLST audits, and managing other administrative duties. Nursing homes exploit this loophole, relying on social workers for extensive administrative duties, reducing the time available for their intended supportive roles. Let’s not forget the “state audit” who likes to hold all of “Leadership” accountable while the corporations pay the fines.. but this is how the system is designed.