MDS Alert

"Coming from a social work perspective, one of the most important things to assess is the person's cultural background and what that means to the person," adds Battisti, principal of Battisti Networks in Binghamton, N.Y. "Unfortunately, people tend to believe that one's culture only relates to one's ethic background. But cultural background includes social/economic status, spiritual/religious beliefs, gender, age, and other areas that define the individual's unique qualities," he adds.

"It's not only what has happened to the person but how they perceive what happened," Battisti continues. "As Erik Erikson hypothesized, a major task in older age is achieving a sense of integration versus a sense of alienation. You can only help people integrate their experience if you understand the perspective they have of those experiences," says Battisti.

Example: "I'm a consultant to a couple of nursing homes that care for veterans and some of [the veterans] want to talk about their backgrounds and find a lot of meaning in that -- but others, especially if they are suffering from PTSD ... really don't want to talk about it," Battisti observes. "So if the facility makes a big deal out of Veterans Day, there may be some veterans who don't want to make a big thing out of it. The facility may have a celebration and give out flags but when you practice resident-centered care, you go to each resident and find out if they want to participate -- and how they want to participate in the facility-wide activity," he adds.

Tip: Battisti says he thinks "more counseling for residents needs to be available in the facility. The social work staff, with the proper credentials, could be an excellent resource for such services. If this is not possible, a number of long-term care organizations contract with off-site social workers and psychologists to offer this service," he adds.

More: "The psychosocial history should also look at the person's cognition, mood, behavior, and discharge potential and issues," adds Battisti.

Marie Saunders, BSN, RN, BC, notes that her company's software for nursing facilities has a psychosocial assessment that "documents the person's support systems and characteristic traits -- for example, shy, indecisive, private, or fearful, which may be why they don't do well on the BIMS [Brief Interview for Mental Status]. It may be more their personality than cognitive ability," adds Saunders, director of Saunders Associates in Appleton, Wis.