Despite a nearly 20-year-old legislation to strengthen social work (SW) coverage within nursing homes and decades of literature exploring the need for SW training, untrained and undertrained social workers dominate American nursing homes. Many persons who call themselves social workers are not educated as such, but nevertheless, must work in complex, conflict-ridden nursing homes without assessment and advocacy skills essential to address the symptoms and to fully respond to subjugated residents' needs. The call for more qualified social workers to be employed in nursing homes is a recognition that the residents' psychosocial needs are not being met. We examine how inconsistent national requirements, inadequate professional educational preparation, and work overload are all symptoms of a general societal unwillingness to recognize residents' needs. The authors utilize a morphogenic systems perspective to describe the open interaction between all disciplines, which can be unduly strained without properly trained workers. The social work literature is reviewed with a renewed interest in addressing the problem profession-wide.