“Medical social work: why is it underutilized in home health care?” This was Susan Lee Robilotta Jacobs’ master’s thesis at California State University, San Bernadino. The year was 1993. Nearly 30 years later, social workers are still asking this same question. Jacobs believes ignorance is a key reason for these professionals’ skills being overlooked: people cannot ask for what they don’t know about, and unfortunately that extends to healthcare.
What does a social worker do?
I have always thought of social workers as the “sweepers” in healthcare, which is a nickname that refers not to what we are supposed to do, but often what we end up doing. We sweep up messes. We clean out the cracks.
Yet if our nickname reflected our intended purpose, it would be a bit different. The job description is more proactive and less reactive.
Social workers assess emotional factors related to an illness, medical requirements or financial concerns; recommend short-term services and community resources; explore non-medical options; and review the patient’s compliance with current treatment. It often surprises people that our work is not limited to patients; we are also a resource for co-workers in need, be it mental, physical or financial guidance.
We listen and discover what people need, we anticipate who they should speak with, and we leave them better than we found them. This would be the ideal … if only we could put down our brooms.
Including social work in your home health agency
Home health organizations should Include social workers in patient care conferences. Hospices provide holistic care to their patients in large part because of interdisciplinary group work and meetings. During these meetings, a doctor, nurse, spiritual counselor and social worker review each patient’s plan of care as a team for a well-rounded perspective. Why shouldn’t home health do the same?
Because we are trained differently, we recognize signs others might overlook, and are a huge help with continuity of care. Value-based care revolves around the right care at the right time in providing what is best for the patient. A social worker is trained to have difficult conversations, such as asking about transitioning to hospice care, or about how a patient might consider palliative care while they will still receive home health.
A big misconception is payment for services provided. With the Patient-Driven Groupings Model (PDGM), the emphasis is on value, not cost. Reimbursement is given regardless of who provides the service, as long as it follows the patient’s plan of care, so social workers can play a valuable role. Our job is to make sure your patient receives the right care at the right time. Only when home health agencies include social workers in their PCCs will we have the freedom to be proactive in helping achieve positive patient outcomes, as team collaboration is vital to patient care.
The hidden value of social work
Social workers often are brought on a case in crisis mode. Yet because we are not typically included from the start, our patients are given to us late. I have experienced it time and again, with many of these late instances leading to re-hospitalizations.
I have had patients re-hospitalized because they did not take their prescribed medications because it was too expensive and were too embarrassed to talk to the staff about this. So they were labeled non-compliant. Sadly for them, this leads to higher costs, more medications and a healthcare experience that results in poor patient outcomes and dissatisfaction.
With Home Health Value-Based Purchasing (HHVBP) on the horizon, now is the time for all home healthcare agencies to learn and understand the value of social work.
For example, take a situation when medications were not filled due to high cost and it led to an avoidable rehospitalization.
Many would say the nurse should have been aware, and, sure, they most often catch patients before they stray too far from the prescribed path for a successful healthcare journey.
But while nurses and aides protect their patients from harm, their focus is mainly on the medical and physical concerns of their patients. They may not see or review the biopsychosocial factors that are present.
In the real world of home healthcare, this often means many patients do not feel comfortable admitting to their caregivers that they cannot afford the medicine that will, for instance, regulate their blood flow. Patients often do not know what social workers can do to help them and sometimes will decline services because of this. It is imperative that nurses and therapists explain the role of the social worker to the patients, so they agree to visits. It is the social worker who is invested in the patient’s whole being, not just their health.
Our job is to consider every aspect of their situation: physical health, mental health, living arrangements, family and friends. Social workers get to know the patient, earn their trust and figure out the best plan of action to get them back on their feet.
If the patient in the example who could not afford her medicine had a social worker assigned to her from the start of care, the social worker likely would have been aware of her financial constraints and would assist with needed resources to try to adhere to the plan of care and avoid letting her end up in the hospital again.
Let’s take a page from the hospice IDG format and work as a team for our patients. In doing that, the healthcare industry can benefit from the full value a social worker provides.
I’m hopeful that in another 30 years, a prospective social worker will submit a master’s thesis and call it, “How Medical Social Work Helped Transform Value-Based Care.”
Amy Garlett Smith is a licensed clinical social worker (LCSW) and product analyst on the Axxess hospice team. She has multiple years in social work and hospice operations that she leverages to help build the hospice solution for Axxess.
