For such patients as the one in this case, home-based treatment would probably be the most beneficial because it would cause less family disruption, which is already a problem for Elsie. It would also give the social worker an opportunity to see the problems facing Elsie first-hand and show her how to cope with them.
The Minimum Data Set (MDS) quality indicator used to assess patients who are "depressed without treatment " may not be accurate enough to assess patients in need of mental health intervention (Zisselamn, Warren, Cutillo-Schmitter and Denman 2002, p.1-5). Social work staff completing such forms on nursing-home patients have been found to miss many patients who were receiving psychotropic medications. However, after further specialized training sessions led by psychiatric clinical nurse specialists to educate nurses and social workers about psychotropic medications, clinical characteristics of psychiatric diagnosis, chart review methods, and coordination of medical care mental health intervention, significant increases in diagnostic ability were seen. This points to the need for accurately diagnosing patients who may need mental health intervention, and how to know when they are on medication.
Unfortunately, there are not enough well-trained social workers available for serving the older population. Scharlach, Simon and Dal Santo (2002, pp.5-17) found in California that only 42 percent of adult protective service workers, 36 percent of case managers, and less than 10 percent of other personnel had masters' degrees in social work. Qualified personnel are not being hired for several reasons - inadequate salaries, insufficient ethnically diverse applicants, and lack of properly educated and trained personnel. Another problem is that social workers overwhelmingly focus on personal rather than environmental or interpersonal conceptions of the problems facing their clients (Rosen and Livne 1992, pp.85-96). This w...
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