Medicare and other third-party payers are moving toward a pay-for-performance system, also known as a value-based purchasing system. This means that clinical social workers and other providers may be paid for the quality of the service rendered rather than a fee for service. The quality of service may be determined by the use of specific measures in practice.

What’s your opinion about pay for performance, and how do you think it may affect clinical practice?

Culture change—the shift from institutional models of care toward consumer-directed, socially oriented models—is a growing movement in long-term care communities across the United States and beyond. Culture change, also known as person-centered care, presents new opportunities and challenges for social workers, especially those working in nursing homes. Although many social workers have written about culture change and, indeed, have been involved in implementing culture change in nursing homes, little has been written about the social work role in culture change. Moreover, although some social workers embrace culture change because of the congruence between social work values and culture change’s focus on self-determination and quality of life, others are concerned that culture change may diminish their professional roles.

Is the setting in which you work implementing culture change? If so, what model is being used?

How has your role as a social worker been affected by culture change? Are you taking on new leadership roles? Have you taken on non–social work responsibilities or turned over social work functions to non–social work staff? Do you have any ethical or legal concerns about changes in your role?

How do you think the social work profession can position itself as a leader in culture change while preserving the integrity of the professional social work role in nursing homes?

NASW RESOURCES RELATED TO CULTURE CHANGE

Read NASW’s Aging Specialty Practice Section article, De-Institutionalizing an Institutional System (2003), to learn more about culture change.

Learn about NASW’s contribution to an interdisciplinary issue paper addressing the role of nursing in culture change.