Medically Related Social Services

Medically-related social services are the things you do for residents every day to maintain, and even improve, their psychosocial wellbeing. Below are the federal regulations that apply to all skilled nursing facilities in the U.S. that accept Medicare & Medicaid funding.

FTag 745

F745 (Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17) §483.40(d) The facility must provide medically-related social services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident.

INTENT §483.40(d) To assure that sufficient and appropriate social services are provided to meet the resident’s needs.

DEFINITIONS §483.40(d) Definitions are provided to clarify terminology related to behavioral health services and the attainment or maintenance of a resident’s highest practicable well-being. “Medically-related social services” means services provided by the facility’s staff to assist residents in attaining or maintaining their mental and psychosocial health.

Examples of medically-related social services include, but are not limited to the following:

• Advocating for residents and assisting them in the assertion of their rights within the facility in accordance with §483.10, Resident Rights, §483.12, Freedom from Abuse, Neglect, and Exploitation, §483.15, Transitions of Care, §483.20, Resident Assessments (PASARR), and §483.21, Comprehensive Person-Centered Care Planning;
• Assisting residents in voicing and obtaining resolution to grievances about treatment, living conditions, visitation rights, and accommodation of needs;
• Assisting or arranging for a resident’s communication of needs through the resident’s primary method of communication or in a language that the resident understands;
• Making arrangements for obtaining items, such as clothing and personal items;
• Assisting with informing and educating residents, their family, and/or representative(s) about health care options and ramifications;
• Making referrals and obtaining needed services from outside entities (e.g., talking books, absentee ballots, community wheelchair transportation);
• Assisting residents with financial and legal matters (e.g., applying for pensions, referrals to lawyers, referrals to funeral homes for preplanning arrangements);
• Transitions of care services (e.g., assisting the resident with identifying community placement options and completion of the application process, arranging intake for home care services for residents returning home, assisting with transfer arrangements to other facilities);
• Providing or arranging for needed mental and psychosocial counseling services;
• Identifying and seeking ways to support residents’ individual needs through the assessment and care planning process;
• Encouraging staff to maintain or enhance each resident’s dignity in recognition of each resident’s individuality;
• Assisting residents with advance care planning, including but not limited to completion of advance directives (For additional information pertaining to advance directives, refer to §483.10(g)(12) (F578)), Advance Directives);
• Identifying and promoting individualized, non-pharmacological approaches to care that meet the mental and psychosocial needs of each resident; and
• Meeting the needs of residents who are grieving from losses and coping with stressful events. Situations in which the facility should provide social services or obtain needed services from outside entities include, but are not limited to the following:
• Lack of an effective family or community support system or legal representative;
• Expressions or indications of distress that affect the resident’s mental and psychosocial well-being, resulting from depression, chronic diseases (e.g., Alzheimer’s disease and other dementia related diseases, schizophrenia, multiple sclerosis), difficulty with personal interaction and socialization skills, and resident to resident altercations;
• Abuse of any kind (e.g., alcohol or other drugs, physical, psychological, sexual, neglect, exploitation);
• Difficulty coping with change or loss (e.g., change in living arrangement, change in condition or functional ability, loss of meaningful employment or activities, loss of a loved one); and • Need for emotional support.
• NOTE: When needed services are not covered by Medicaid, nursing facilities are still required to attempt to obtain these services on behalf of the resident (e.g., arranging transportation services)

For additional consultation For immediate support, call or text (310) 386-5576.

F850 Social Worker

Any facility with more than 120 beds must employ a qualified social worker on a full- time basis. A qualified social worker is:

• §483.70(p)(1) An individual with a minimum of a bachelor’s degree in social work or a bachelor’s degree in a human services field including, but not limited to, sociology, gerontology, special education, rehabilitation counseling, and psychology; and
• §483.70(p)(2) One year of supervised social work experience in a health care setting working directly with individuals.

GUIDANCE §483.70(p) The regulations do not require a Social Worker when a facility has equal to or less than 120 beds. If the facility has more than 120 beds and its full-time social worker does not provide on- site coverage on a full-time basis determine how these services are provided to meet the individual needs of the resident whenever needed. If social services deficiencies are identified refer to §483.40(d), F745, regardless of the number of beds.

KEY ELEMENTS OF NONCOMPLIANCE : A facility with more than 120 beds did not employ a qualified social worker on a full-time basis; or The individual functioning as the social worker did not meet the qualifications specified in this regulation.

For additional consultation For immediate support, call or text (310) 386-5576.