Unfortunately, what was once an opportunity for sensible discussion has now been sullied by partisan bickering. Health care reform in America is a highly polarized topic, and both sides are pumping so much misinformation into the atmosphere that the real solutions seem light years away. Social workers involved in the health care system are on the front lines of this crisis. They work face-to-face with patients who need help accessing the health care system. The medical social worker’s role changes as frequently as Medicare guidelines do. Before we can examine the role itself, then, we have to pay credence to the environment that molds it.

How America’s Health Care System Impacts Social Work

This isn’t a nod for universal health care, but it doesn’t take much research to uncover the exploitative tendencies of private insurance companies. Take the “age tax,” for example, that many of these companies charge beneficiaries between the ages of 50 and 64. As it stands currently, if you’re between the ages of 26 and 65 and you don’t have work-sponsored health insurance, you could be paying upwards of $1500 a month for a family plan.

Health care in America is big business – a business that has grown in its worth from $24.7 billion in 1960 to 3.5 trillion today. The costs have become so prohibitive, in fact, that more than ten million Americans travel internationally for medical care every year.

What does all of this mean for medical social workers in the United States? For starters, it means that many of their clients (about 44 million in the United States will be uninsured. Those who are insured may still refuse necessary medical treatment because they can’t afford deductibles and copays.

Even if money is not an issue, dozens of social and cultural determinants can affect one’s willingness or ability to access health care. Social workers must be able to identify and address these determinants, or their interventions won’t have staying power. On the topic of interventions, let’s review what exactly medical social workers do.

How Medical Social Workers Promote Change from Within the Health Care System

Increasing a client’s access to health care services requires a personal approach that the politicians, lobbying groups and insurance companies can’t provide. This is why social workers interface with clients on a one-to-one basis so often, though they can work for organizations as well. In either case, let’s break down their primary roles.

Assessment

Whether the medical social worker is in a private outpatient clinic, a government agency or a hospital, a psychosocial assessment is absolutely critical. Assessments give social workers the information they need to refine care plans for maximum impact. They comprise the main advantage of being in the one-on-one environment. Depending on the environment, an assessment can take many forms.

In general, a medical social worker’s assessment should seek to identify gaps in the patient’s support network as it contains to their overall health. This can vary on the setting. Social workers who coordinate with respiratory specialists, for example, may screen for nicotine addiction in their assessments so they can connect patients with effective smoking cessation programs.

Counseling

Medical social workers with master’s degrees (MSW) may directly provide counseling to patients in health care settings. This care would depend heavily on the psychosocial assessment, as mentioned. Patients with terminal illnesses and traumatic injuries especially may begin to display “malingering” attitudes (exaggerated depression and avoidance behaviors) during their long-term care that they did not demonstrate in the beginning, so a watchful approach is key.

Counseling can happen on an individual basis or with a group. Social workers in health care environments can lead group therapy sessions, outings and activities. They can provide support on a consultation basis for patients considering high-risk or otherwise important treatment options. Medical social workers can also act as intermediaries between patients and their families when appropriate. The specifics of the role vary depending on each case, but counseling is at the heart of it.

Care Coordination

Oftentimes, medical social workers help to coordinate care within a multidisciplinary team. For example, if a patient with post-concussion syndrome enters an inpatient therapy wing of a hospital, they will likely be treated by several professionals. The patient may see a primary physician, an occupational therapist, a physical therapist, a speech language pathologist and a social worker.

The flow of information is a two-way street for each clinician in this case. The medical social worker can draw important assessment data from the other clinicians’ documentation, and they can contribute to the plan of care by documenting their own assessments and interventions. This perspective allows a more comprehensive view of the patient, whose mental and physical health are related, by the entire care team.

Discharge Planning

Regardless of the medical setting, continuity of care is an absolute must for the majority of patients, who very often require more care after discharge from a medical facility. For this reason, social workers act as discharge coordinators in many cases. A social worker may assist with home visits, for example, to make sure that the patient’s home offers a suitable environment for the post-discharge needs. Additionally, social workers can mediate between patients and outpatient rehab programs. These programs can be directly related to the medical condition (i.e., a Parkinson’s rehab program) or a contributing factor (earlier example of smoking cessation program).

Discharge coordination can be more logistical in nature, too. A social worker may simply set up transportation services or grocery delivery for a patient who will no longer be driving. The more services the social worker has access to, the more helpful they can be in ensuring continuity of care.

The Future of Health Care Reform and Medical Social Work

As concerns surrounding the rising costs of health care and the number of uninsured Americans grow, health care reform proposals are placing greater pressure on the system. In the conventional model, wherein a patient visits a doctor at their office for a one-on-one consultation, many doctors cannot afford to give the patient more than ten or fifteen minutes of attention. In an effort to streamline costs and improve care, reform initiatives are proposing the following changes:

  • Phone, email and web conferencing consultations
  • Group visits
  • Concierge medicine (monthly retainer fee for patients)
  • Greater emphasis on team-based care
  • Greater reliance on tech (e-prescribing, augmented reality, electronic recording)

It’s highly likely that medical social workers will encounter more than one of these care models during the trial window. Each situation outlined above will bring its own set of changes to the medical social worker profession, but most of them involve a greater reliance on remote communication and group environments. The medical social worker will be able to examine the patient’s psychosocial well-being in the group context. They will have a more comprehensive view of communications between patients and medical providers (because of the emails and videos versus personal visits). Opportunities for one-on-one counseling, however, may be affected. However the instrumentation changes, the concepts are the same: assess the patient, provide the appropriate interventions, and follow through.

Tim Kalantjankos

B.S. Sociology| University of Nebraska at Omaha

A.S. Physical Therapy | Clarkson College

September 2019

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