Code of Massachusetts Regulations
105 CMR - DEPARTMENT OF PUBLIC HEALTH
Title 105 CMR 150.000 - Standards for Long-Term Care Facilities
Section 150.011 - Social Services

Universal Citation: 105 MA Code of Regs 105.150

Current through Register 1531, September 27, 2024

(A) Facilities providing Level I, II or III care shall provide for appropriate and sufficient social services to meet the social and emotional needs of residents in accordance with written policies and procedures.

(B) Social services shall be provided either directly by personnel employed by the facility or through written contracts with public or private social agencies, hospitals, clinics or other institutions, or with individual social workers, provided services meet the requirements set out herein, and services are administered in accordance with the facilities' policies and procedures.

(C) Social service supervision shall be provided on a planned basis with sufficient frequency to assure adequate review of social service plans and residents' care.

(D) Social services whether provided directly by the facility or through written contracts shall be integrated with the medical, nursing, activity and other associated resident care services.

(E) The social work staffing of facilities shall be based on the number of residents in the facility rather than on the level of care of the facility.

Social services shall be provided by a MSW social worker or BA social worker. If social services are provided by a BA social worker, the facility must have a written agreement for social work consultation and supervision from a MSW social worker.

(1) All facilities providing care for more than 80 residents shall provide a minimum of one half-time social worker. If the social worker is a BA social worker, the facility shall provide consultation from a MSW social worker for at least eight hours per month.

(2) All facilities providing care for between 40 and 80 residents shall provide the services of a social worker for a minimum of eight hours per week. If the social worker is a BA social worker, appropriate consultation and supervision shall be provided as needed.

(3) All facilities that provide care for fewer than 40 residents shall provide the services of a social worker (MSW or BA) at least four hours per week. If the social worker is a BA social worker, appropriate consultation and supervision shall be provided as needed.

(4) In addition, all facilities shall provide additional social workers and ancillary social service personnel under appropriate supervision to meet the emotional and social needs of the residents.

(5) Facilities providing Level IV care only shall be required to provide social service staff and social services only as indicated by residents' needs.
(a) A CSF, Resident Care Facilities and multi-level facilities with Level IV units with Community Support Residents shall be required to provide or arrange to provide a minimum of one hour of social services per Community Support Resident per month, or more if indicated by the residents' needs.

(b) All social workers providing social services in Level IV facilities shall be licensed according to Board of Registration of Social Workers requirements.
1. Only Master's level licensed social workers will be allowed to provide clinical services, including the development of the Mental Health Treatment Plan for Community Support Residents.

2. LSWs providing clinical services must be supervised by either an LCSW degree or by an LICSW.

(c) Each Community Support Resident shall have a written individualized mental health treatment plan jointly developed by the Community Support Resident and the attending social worker in consultation with the resident's physician, psychiatrist, support services coordinator, and other involved mental health consultants if needed.

The mental health treatment plan shall be developed as soon as possible but no later than two weeks after admission. Each plan shall be first reviewed by a social worker 30 days after it is first developed and every 90 days thereafter.

(d) Content of Mental Health Treatment Plan. The individual mental health plan should be the focus of the Community Support Resident's plan of care and all other plans should be consistent with this mental health plan. The support plan should include the parts of the mental health plan which require the development of specific activities, arrangement of services, or other specific actions which should be implemented by the Coordinator in conjunction with other facility based staff. The Mental Health Plan should include the following:
1. an annual psychosocial assessment;

2. a psychosocial history that includes the mental health history and clinical diagnoses of the resident;

3. an assessment of a resident's psychosocial strengths, weaknesses and service needs;

4. recommended short and long term treatment goals and objectives, described in clear, specific, and measurable narrative statements;

5. recommended services, agencies and programs to meet the mental health needs of a resident;

6. a recommended starting date for services and the anticipated duration of these services;

7. evaluation procedures, recordings and criteria for determining a resident's progress and how a resident's mental health needs are being addressed;

8. modification(s) of a resident's treatment plan and psychotropic medications and an explanation of the rationale(s) used for modifying the plan, and medications;

9. written record(s) of the results of mental health or psychiatric consultations and written records of the psychotropic medications a resident has received or is receiving.

10. written consent by the resident or his or her guardian.

(e) If a mental health treatment plan is declined by a resident, the attending social worker, in consultation with the resident's psychiatrist and/or physician, shall make all efforts to meet with the resident, to determine how a plan might be developed and/or modified in order to accommodate the resident's objections, concerns, and suggestions. Reasons for partial or total rejection of the plan must be noted in the resident's record.

(6) A SNCFC with a minimum of 40 beds shall provide the services of one full time LCSW who has training and/or experience in developmental disabilities and one full time LSW. For every additional 20 beds there shall be provided an additional half-time LSW.

(F) Social service programs shall be coordinated with the resources and services of public and private agencies or institutions in order to stimulate alternative care plans in the community, to provide continuity of care for residents and to promote long-range social and health planning.

(G) Emotional and social factors shall be considered in relation to medical, nursing, and other factors in determining the appropriateness of placement of residents.

(H) Social Service Plan. Prior to admission, or as soon as possible after admission, there shall be an evaluation of the resident's social needs and a plan shall be formulated and recorded for providing such care. This plan shall include information regarding pertinent personal, interpersonal and situational problems influencing management and probable duration of stay. To the extent possible, the plan shall be developed with the resident.

In a SNCFC a social service plan shall be part of the resident's care plan and to the extent possible, the plan shall be developed with the resident, the resident's family or guardian and shall reflect permanency planning efforts.

(I) Social service needs of residents shall be identified on admission and services provided to meet these during treatment and care in the facility and in planning for discharge.

(J) Assistance shall be provided every resident directly or through referral to, or consultation with, an appropriate agency when there are indications financial help is needed.

(K) Appropriate action shall be taken and case work services provided to resolve social and emotional problems related to the resident's illness or state of health, his response to treatment, his or her home and family situation and his or her adjustment to care in the facility.

(L) Social services shall include provision of educational programs for the facility staff in order to promote the development of a therapeutic community, a congenial atmosphere and healthy interpersonal relationships in all facilities.

(1) In a SNCFC social services staff shall provide educational programs for the facility staff including but not limited to: resident rights, child abuse, mistreatment and neglect and reporting requirements.

(2) In a SNCFC, social services staff shall provide for regularly scheduled parent/guardian educational and support programs and parent (guardian)/child-centered activities.

(M) Discharge or transfer plans and decisions shall consider the resident's home situation, financial resources, social needs, and community resources as well as his or her medical and nursing requirements.

In a SNCFC, discharge or transfer plans shall be discussed at least annually and in conjunction with care plan annual review. Formal discharge or transfer planning efforts shall be documented in the care plan. Referrals to alternative adult facilities must be indicated when a SNCFC resident turns 20 years old as well as referral to the Bureau of Transitional Planning in accordance with M.G.L. c. 688.

(N) In a SNCFC, the social worker shall assist in the coordination of family visits to the resident and in arranging residents' visits outside the facility when appropriate and ordered by the resident's primary care provider. The social worker shall also assist in coordinating arrangements for the resident's return to home or other placement.

(O) Facilities shall maintain records of pertinent social information, action taken to meet social needs and written evidence of periodic case review on all residents. Pertinent social data and information about personal and family problems shall be made available only to the resident's primary care provider, appropriate members of the nursing staff, and other key personnel who are directly involved in the resident's care, or to recognized health or welfare agencies. There shall be appropriate policies and procedures for ensuring the confidentiality of such information.

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