Social Work in Health Care:

1
Social Work in Health Care

• Many Settings, Great Need

2
How prevalent are social workers in health care
settings?

• Health care is the SECOND largest setting in
  social work practice (after children and
  families and mental health)
• Veterans Administration hospitals are one of the
  largest employers of social workers veterans are
  at high risk for a variety of social problems
• As the need to hold health care costs down
  becomes increasingly necessary, social workers
  become more critical to the enterprise.

3
Health care It affects all Americans

• 16,000,000 residents live in 18,000 nursing
  homes. 2M patients served by hospice, home health
  care agencies (2001 census).
• 32.1.M patients discharged from hospitals after 5
  day length of stay (op.cit)
• 108M visits to ERs in 2000 (CDC)
• 1/6 Americans have inadequate access to health
  care (NCHW, 2001)
• 46M Americans live in underserved areas
• It is VERY EXPENSIVE!!! ..

4
Why is it so expensive?

• Pressure to produce new and costly medical
  technologies, products, and services
• Aging of the boomers (continuing)
• Higher cost of prescription drugs (probably
  accounts for most of the increase in health
  costs)
• Higher physician fees
• Excessive medical testing (and concomitant rising
  cost of malpractice insurance)
• Heroic lifesaving measures

5
How does this translate to all of us?

• The case of General Motors
• It was announced last year that, at the
  beginning of this year, GM would lay off 30,000
  workers, and close down nine plants.
• The high cost of health insurance for GM
  employees, retirees, and their dependents adds
  1500.00 to every new GM car, making the company
  a health insurance company that manufactures
  cars (Dingell, 2005). To a large extent,
  employee health insurance drives up the cost of
  many consumer goods that we have come to see as
  necessary.

6
The high cost of health care is changing our
country in unpredictable ways Examples

• In Nevada, some doctors had to pay gt200K for an
  annual malpractice insurance policy, more than
  the annual take-home pay of most Nevada doctors.
  So theyre all moving (2002). This makes for
  uneven distribution.
• Citizens with access are leaving the country for
  less expensive health care procedures

7
SoWhat is social works contribution to the
health care enterprise?

• Social workers reframe the approach to health
  care under the medical modela deficit model
  based on disability, sickness, and dependencyto
  a wellness or holistic model, which promotes
  social, mental, environmental well-being, and
  seeks to empower individuals to take control of
  their own health, in accordance with the value of
  self-determination.

8
Roles for Social Work in Health Are they
consistent with social work values?

• In hospitals
• Psychosocial assessment SWs write assessments
  based on patients coping skills, support
  structures, as well as struggles and challenges,
  e.g. cultural/language barriers, financial
  issues. This leads to.

9

• Discharge Planning in which the social worker
  helps patients transition out of acute care
  facilities. They assess medical needs following
  acute care, determine formal and informal
  supports, and devise a plan to promote healing
  and well-being. Discharge planning is related
  to.

10

• Utilization Review the process of comparing
  requests (to insurance companies) for medical
  services ("utilization") to treatment guidelines
  that are deemed appropriate for such services,
  and includes a recommendation based on that
  comparison.
• UR employ formulae to come up with the number
  of days that a patient may be hospitalized for
  certain procedures. Social workers work with UR
  officers to ensure appropriate discharge
  arrangements.

11
Roles in acute care facilities (contd)

• Research (Lieberman, Davidson, and Dail)
• Post-op outcomes on
• Crisis intervention e.g. mortality cases,
  natural disaster cases
• Case management a shared role with nurses, for
  patients who require coordination among multiple
  specialities, and/or a variety of services

12
Roles in LTC facilities

• Includes nursing homes, rehab facilities,assisted
  living residences, hospice care facilities,
  patient homes
• Family counseling and mediation
• Grief (or thanatological) counseling
• Secondary prevention (e.g. diabetes mgt)
• Education and advocacy an example of which might
  be

13
Medicare, Part D Greek to but a few

• In general, Medicare prescription drug plans
  provide insurance coverage for your prescription
  drugs. If you join the Medicare Part D there will
  be a monthly premium of approximately 37.00.
  Prescription costs will vary depending on the
  particular drug plan you choose. In more detail
• Medicare Part-D will provide choices for
  prescription drug coverage plans with an
  estimated average monthly premium of 35-37.
• The plans have an annual 250 deductible.
• After the deductible is met (the insured has paid
  the first 250), Medicare will pay 75 of the
  covered prescription costs up to 2000.
• The insured person must then pay the remaining
  25 of the next 2000.
• After the 2000, the insured person pays the 100
  of the next 2850.
• The insured person then has a co-payment
  thereafter of 5.
• Benefits may vary depending on income levels.
• Premiums may increase annually.

14

• Smoking cessation, addiction education and
  training using behavior modification and other
  models to assist people in quitting cigarette
  smoking, and helping people understand the
  psychology of addiction.
• Policy development and analysis on health care
  access for minorities, women, the uninsured.

15

• Health care in social work/ social welfare is a
  field with virtually unlimited potential for the
  interested, enterprising practitioner, with
  interests in primary and secondary prevention,
  social justice, health and wellness, and
  crisis/trauma.