Janet Rehnquist
Inspector General
March, 2003

OEI-02-01-00610

The objective of this study was to determine whether Medicare skilled nursing facility residents are receiving psychosocial services in compliance with federal requirements.

The Omnibus Budget Reconciliation Act (OBRA) of 1987 requires skilled nursing facilities (SNFs) to provide "medically-related social services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident" and specifies that "the services provided or arranged by the facility must meet professional standards of quality." The OBRA of 1987 further states that a skilled nursing facility with over 120 beds is required to employ a minimum of one full-time social worker with at least a bachelors degree in social work, or another human service field, and 1 year of supervised social work experience in a health care setting working directly with individuals. For facilities with 120 beds or less, medically-related social services must still be provided. However, there is no specific requirement that they be performed by a qualified social worker, on either a full-time or part-time basis.

The OBRA of 1987 also mandates that each resident have a comprehensive initial assessment and periodic assessments, which include mental health evaluations. In addition to mental health evaluations, examples of medically-related social services include conducting psychosocial interventions, such as counseling residents and their families, and evaluating residents progress and functioning. Ideally, all identified psychosocial needs are addressed in a care plan, and all needed services are provided.

Our review of skilled nursing facilities compliance with federal psychosocial service requirements is based on data from multiple sources. We used a random sample of 299 recently admitted Medicare skilled nursing home beneficiaries to review the credentials of social workers associated with the skilled nursing facilities serving these beneficiaries. In addition, we reviewed the medical records of these same 299 SNF residents to determine the extent to which they were assessed for and received psychosocial services. We selected a separate sample of Medicare certified skilled nursing facilities and interviewed 84 social workers and nursing home administrators. Using data from a third sample, we interviewed 32 state surveyors. Finally, we analyzed Online Survey and Certification Reporting System (OSCAR) data and National Ombudsman Reporting System (NORS) data for deficiencies and complaints related to psychosocial services.