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Rebekah Bray, MHA, is a certified dementia practitioner as well as a certified sex offender treatment provider. She has seven years of long-term care experience including administration, social work and recreation. She is the assistant administrator and director of social services at Oneida Center in Utica, NY. Oneida Center belongs the Centers Health Care continuum of nursing homes and rehabilitation centers.

The Social Services Department within a Skilled Nursing Facility (SNF) represents the psychosocial well-being of the residents and families we serve here at Oneida Center in Utica, New York.  Oneida Center is a 120-bed nursing and rehabilitation facility that is part of one of the largest family of skilled nursing facilities in the country, the largest in the northeast, Centers Health Care. Social Workers are a single point of contact for essential responsibilities such as admission to the facility as well as discharge planning. Additionally, Social Workers routinely monitor and assess for changes in resident’s cognition, mood, and in some cases mental health.These are critical elements when developing a Plan of Care (POC) with the Interdisciplinary Team (IDT), as well as determining the resident’s ability to care for themselves by making informed decisions.

SNFs, sometimes referred to as Nursing Homes, have drastically shifted in image from what the general public may believe they are. Many facilities still admit cute grandparents to live out their final years; those same facilities also offer short-term rehabilitation when recovering from illness or injury. However, many facilities in heavily populated areas regularly admit residents with mental illnesses, drug addiction and homelessness. While this may seem unusual to some, it is quite common for those in the field to see a high percentage of a SNF census with diagnoses such as bipolar and schizophrenia. This is likely the case due to a recent push to close institutional level care for the mentally ill and replace with community living and appropriate services.

The uses of Tele-Health, such as video conferencing or Remote Patient Monitoring (RPM), are not new since the onset of Covid-19.  SNFs have been moving towards the use of electronic versions of established practices for many years prior to 2020. Because Covid-19 was unprecedented, the timetable to move to electronic practices was grossly accelerated.

As stated earlier, an area of concern for the Social Work department within SNFs is psychosocial well-being and this has been especially the case during the Covid-19 pandemic due to visitor restrictions, social distancing and an overall disruption to everyday routine. In New York State, residents have not had in person visitors in over 4 months and this restriction may not improve anytime in the near future. While this mostly applies to family and loved ones, this also applies to some specialists such as psychologists and psychiatrists which are not usually deemed medically necessary. This is not only detrimental for the residents and families on the most basic human level, but it is also destructive to a POC. Often times, residents have established rapport with their psychiatric providers and the inability to maintain their scheduled, in-person visits can be a major setback to recovery. To foster ongoing visitation and promote Psychosocial Well-Being, many facilities invested in the use of iPads, or similar devices, which allows “in person” visits while still maintaining social distancing regulations.

The University of Rochester hosts a virtual program titled Project ECHO, Extension for Community Healthcare Outcomes (ECHO®),which is funded by NYS Office of Mental Health  in which a team of clinicians presents a didactic presentation for purposes of education on a bi-weekly basis. Additionally, facilities are invited to present an anonymous, challenging case in which the IDT needs additional supports. This is especially useful for facilities who have increased cases of unmanageable behaviors and aggression from residents and these behaviors may be impacting the quality of life for those around them.  This is particularly relevant during this unprecedented time in SNFs because of the amount of changes imposed on operators and also the drastic change in structure, consistency and routine that our residents require.

As a Director of Social Services/Assistant Administrator of Oneida Center, our unique culture of residents and our surrounding community continues to teach me to look beyond the immediate needs we believe people require. For example, discharge planning following a common procedure, such as a hip replacement, is pretty straight forward: home care services, family education, follow up with PCP, order DME (Durable Medical Equipment). However, many of us take for granted the basic fundamentals of life in order to recover from a major life event. Food, clothing and shelter are essential aspects of life that all too often, people suffer and go without. How well will the same hip replacement recover if there is no home to go to, no loved ones for physical and emotional support and limited food to eat? How can we reasonably expect someone to make well informed decisions when they have a crippling mental illness?

The staff who represent Oneida Center epitomize the ability to look at others beyond their diagnosis. Our work has deep meaning and our staff have a purpose. I have fond memories of a husband and wife’s last dance before one died, all because Oneida Center therapy staff cooked them a special dinner and played their favorite music. I remember a woman years ago who suffered an unspeakable tragedy, and it was our nurses who held her hand and helped her walk again. A dying man’s last wish was to visit his favorite casino again; it was a Physician’s Assistant who made it happen. Our goal at this facility is to leave people in a better place than we found them.