Scripps Gerontology Center research fellows study effects of social services on patient outcomes

John Bowblis (left) and Amy Roberts (right) are working with Medicare data to determine whether social services staffing affects patient outcomes.

Wellness is about much more than physical health. Even people in top physical condition can experience the ill-effects of depression, isolation. Those things can have an even greater impact on people with a recent illness or injury. Sometimes, these so-called psychosocial factors can even be the difference between temporary and permanent nursing home care.

“Most people who go into a nursing home are short-stay residents,” says John Bowblis, associate professor of economics and Endres Associate Research Fellow in Miami University’s Farmer School of Business and a research fellow with the Scripps Gerontology Center. “Residents go to a nursing home for rehab after some type of hospitalization, and the goal for most of those people is to go back home.”

With physical and psychosocial functioning so intertwined, whether a patient is, in fact, able to return home depends not just on the nursing services these facilities provide, but also on the social services. Yet, while there are many regulations for professional nursing staff in nursing homes, there are few for social services staff. In practice, according to a study by the Centers for Medicare and Medicaid Services (CMS), the typical nursing home resident has about 3 hours of contact with CNAs, LPNs, and RNs each day, but only about 6 minutes of contact with social workers.

Whether changes in public policy related to social services staff might lead to better outcomes for patients is a question Bowblis and his collaborator, Amy Roberts, also a research fellow with the Scripps Gerontology Center and assistant professor of family science and social work, would like to answer. The pair are currently leading one of the first national studies to assess the impact of social services staffing in nursing homes.

The data Bowblis and Roberts are working with comes from CMS’s Minimum Data Set (MDS), merged with the Certification and Survey Provider Enhanced Reporting (CASPER) system. Together, these data sets document every Medicare fee-for-service admission to a nursing home, along with the staffing characteristics of those facilities. Bowblis applies statistical methods to this data to identify statistical relationships between social services staffing data and patient outcomes. Roberts then helps interpret the practical implications of those insights for organizational and public policy.

One concern for Roberts is credentialing. “Nursing homes do not always hire licensed social workers but instead hire unlicensed paraprofessionals for social services positions,” she says. “In this study, we want to see if having qualified social workers in such positions leads to better psychosocial functioning for residents.”

Bowblis and Roberts expect to have the first results of their study sometime this summer, with publications and presentations to follow. When their findings are released, policy wonks will not be the only ones paying attention. Advocacy groups, including the Retirement Research Foundation – which provided the $50,000 grant to fund Bowblis and Roberts’ study – and professional organizations, such as the National Association of Social Workers, will take note as well.

The same is true for nursing home providers. “Nursing homes don’t necessarily want to spend money on this type of staff,” Bowblis says of social workers. “But they’re willing to do things that produce good returns on investment. If managers know that hiring qualified social workers is going to get patients back into the community, they know that will enhance the quality of their services and attract more people to their facility. That’s a good thing.”

For Roberts, that kind of win-win-win for patients, providers, and society would be a natural extension of a win-win research partnership. When she and Bowblis met at a networking event at the Scripps Gerontology Center, they quickly realized their individual areas of research – his on the quality of care provided by facilities and hers on residents’ quality of life – could complement each other.

“The interdisciplinary work we’re doing together is innovative and mutually beneficial,” Roberts says. “Teaming up has worked out even better than we’d hoped.”

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Written by Heather Beattey Johnston, Associate Director of Research Communications, Office for the Advancement of Research and Scholarship, Miami University.

Hands photo by Government of Alberta, via Flickr, used under Creative Commons license. Photo of Bowblis and Roberts by Scott Kissell, Miami University Photo Services.