Complications in discharge planning with Medicare patients

Discharge planning is a complex professional task that affects hospital fiscal health and the quality of posthospital care. A study of discharge planning found that social workers encounter many complications in working with patients, families, other professionals, and service providers in arranging posthospital care. The study found that several complications are associated with delays in discharge and less adequate discharge plans, assessed by social workers at the time the patient is leaving acute care and by the patient 1 month posthospitalization. Results suggest the importance of various skills for social workers in acute medical care.     

Hospital Social Work in Australia: Emerging Trends or More of the Same?

Social work in health care has been established for more than 100 years and is one of the largest areas of practice for social workers. Over time, demographic changes and growth in the aging population, increased longevity rates, an explosion in rates of chronic illness together with rapidly increasing cost of health care have created serious challenges for acute hospitals and health social workers. This article reviews the Australian health care system and policies with particular emphasis on the public hospital system. It then examines current hospital social work roles, including the continued role in discharge planning and expanding responsibility for emerging client problems, such as patient complexity, legal, and carer issues. The article concludes with a discussion of evolving issues and challenges facing health social work to ensure that social work remain relevant within this practice context.     

Key factors impeding discharge planning in hospital social work: an exploratory study

Despite its long historical tradition in Northern Ireland, there is a dearth of research studies on the role of hospital social work and the professional challenges involved at the health and social care interface. This is the first small-scale exploratory study in Northern Ireland that sought to identify the key factors that hospital social workers perceive as impeding their practice in the discharge planning process. A 15-item postal questionnaire was developed and distributed to 30 hospital social workers from four hospital social work departments in a city in Northern Ireland. The study group comprised social workers based in a range of hospital directorates who had differing levels of hospital social work experience. Data generated from the questionnaires suggested that deficits in community resources impacted most negatively on social workers' practice in discharge planning. The length of time respondents had been in their current post was also shown to influence their responses to the perceived impediments in their discharge planning role. The implications of the study and recommendations are discussed in relation to in-service training, social work practice and continuing education in Northern Ireland.     

Discharge planning and social work practice

Current health care practice discharge planning has emerged as a major professional function in hospital settings. To examine the tasks involved in discharge planning and how frequently they are being performed, 124 Alabama hospitals were contacted with a 72% rcsponse rate. Of the 178 surveys returned by discharge planners the core tasks were identified and ranked in terms of performance frequency. The results revealed that the tasks performed typically resembled that of generalist social workers. When specialization occurred, it was related to the populations served and not the specialized tasks or methods utilized. From this data recommendations are made for linking advanced generalist social work practice to discharge planning activities.     

The Social Work Advocacy Role in Discharge Planning

The social work role in discharge planning must include an advocacy function. This is important to facilitate discharge planning and can be carried out in three related areas: (1) political advocacy-to improve governmental programs, (2) resource development advocacy-to meet unmet needs; and (3) case advocacy-to ensure that programs are accessible and appropriate for eligible patients and families. This role is particularly suited for social workers because of their training and experience and should be included as part of their contribution to comprehensive health care.     

Social workers,nurses, or both: Who is primarily responsible for hospital discharge planning with older adults?

ABSTRACT

This study examines the profession primarily responsible for discharge planning in all hospitals serving older adults in Minnesota. Quantitative analyses determined that the majority of hospitals in Minnesota serving older adults are small, rural hospitals with critical access designations, are private nonprofit, and are affiliated with a health care system. Social workers are primarily responsible for discharge planning in half of the hospitals, nurses in a quarter and either a nurse/social worker team or both nurse and social worker separately in the remaining quarter. Multinomial logistic regression determined that in critical access hospitals nurses are more likely than social workers to be the profession primarily responsible for discharge planning.     

Computerized information systems for social workers in health care

Social workers' contributions to preventive medicine; discharge planning; and effective integration of hospital, family, and community resources are becoming increasingly important within the changing context of health care delivery. Information technology can be a powerful tool for developing efficient, accurate, and comprehensive patient records. In spite of the potential that information technology offers health care social workers, the actual use of computerized patient data has been limited and slow to develop. This article describes the development of a prototype information system that supports the diverse tasks of health care social workers in ambulatory care, shows how a shared computerized database can improve coordination of patient care among multiple health care disciplines, and addresses emerging issues as a growing number of social workers in health care use computerized information systems.     

Understanding organizational reengineering in health care: strategies for social work's survival

Confronted with decreasing reimbursement and managed care, hospitals across the country have been "reengineering" in an effort to streamline processes and enhance revenue. Because of the financial implications of discharge planning, hospital social workers and their departments are typically examined and realigned in some way during a reengineering process. To survive in this environment, social workers must understand the principles of reengineering; its hoped for and actual impact; be able to identify opportunities to contribute; and have the capacity to cope with an evolving professional role. This paper presents a general overview of reengineering and its adaptation to the health care environment. Specific challenges for medical social workers are described along with strategies for surviving in a reengineered health care system.     

Research agenda for discharge planning

With increased competition over diminishing resources in health care today, discharge planning has become a key element for hospital survival. The sudden high status now attached to this traditional social work function has caused major power struggles for control over discharge planning. Social workers have up to now succeeded in being undisputed leaders in this area because of tradition and demonstrations of clinical competence. Continued success and status in the future will require arguments and organizational design based on scientific research and hard data. This paper describes the main questions that need to be examined and proposes manageable approaches for conducting practice field studies.     

The legal clinic: helping social workers master the legal environment in health care.

The social environment for all is becoming increasingly legalized. This fact is evidenced in the extensive entitlement regulations and ethical decision-making processes surrounding health care consumers and professional providers. The authors of this paper describe a program designed to educate social workers in an acute care hospital to the legal issues and considerations that influence decision-making and interventions in social work practice. The purpose of the paper is two-fold: to highlight the program planning process in establishing and institutionalizing a Legal Clinic for social work, and secondly to stress the significance of legal content in the knowledge base of social workers in health care settings.     

Hospital Social Work: Contemporary Roles and Professional Activities

Since its inception in the 1900s, hospital social work has been impacted by the ever changing hospital environment. The institution of Diagnostic Related Groups (DRGs), the era of reengineering, and the constant struggle toward health care reform make it necessary to evaluate and substantiate the value and efficacy of social workers in hospital settings. This study identifies current roles and activities carried out by social workers in acute hospital settings from across the nation in the aftermath of reengineering. Findings suggest the primary role of respondents in this study to be discharge planning with little to no involvement in practice research or income-generating activities.     

Time management in health care social work

Health care social workers face significant problems in controlling and managing time. Among the causes are increased demands for service, economy measures in health care, and the concurrent responsibility which social workers often have for both ongoing case management and crisis coverage. Individuals and social work departments can increase productivity through streamlining case management, increasing use of available resources, and generating new resources. With planning and preparation, many emergencies can be moved into the expected work flow. The social work profession needs to address time management problems and expectations in a more realistic and systematic way.     

The Use of Single-Group Sessions in Discharge Planning

ABSTRACT

In recent years we are witnessing a growing demand in the health care system for improved economic efficiency and reduction in length of hospital stay. These facts have increased the pressure for planning effective short-term therapeutic methods that will assist the patient's return to family and community life. This situation led the social workers in the internal medicine units to initiate one-session group meetings for patients and families that would provide a response to the distress of primary caregivers and increase access to social work intervention of families with discharge needs.

A model of single-sessions intervention, which had been experienced for the first time in the Sheba Medical Center at Tel-Hashomer, will be presented and evaluated. The presented intervention enabled to reduce anxiety and increase the capabilities of family members to organize and cope with the situation. The intervention also enabled to identify families in need, to emphasize more on the discharge planning as part of the social work function in the hospital setting and help the multi-disciplinary team in the discharge process.     

Hospital social work: contemporary roles and professional activities

Since its inception in the 1900s, hospital social work has been impacted by the ever changing hospital environment. The institution of Diagnostic Related Groups (DRGs), the era of reengineering, and the constant struggle toward health care reform make it necessary to evaluate and substantiate the value and efficacy of social workers in hospital settings. This study identifies current roles and activities carried out by social workers in acute hospital settings from across the nation in the aftermath of reengineering. Findings suggest the primary role of respondents in this study to be discharge planning with little to no involvement in practice research or income-generating activities.     

The social worker's role in the hospital: seen through the eyes of other healthcare professionals

Social workers in hospitals necessarily work alongside other healthcare professionals, and the perspectives on social work held by doctors and senior nurses are relevant both to their relationship with social workers and to the smooth running of the hospital. An exploratory investigation in the East Anglian Region has produced profiles of perceived social work practice in six different patient-care categories: surgical and orthopaedic, accident and emergency, medicine for the elderly, psychogeriatric medicine, psychiatry and paediatrics. The social worker's functions are recognized as including statutory responsibilities in child protection and mental health, and there are some secondary roles that often reflect a social worker's personal interest or sphere of expertise. The social worker's primary role, however, is deemed to be that of discharge planning - a task which has been given statutory force under the National Health Service (NHS) and Community Care Act 1990. The nurses and doctors interviewed rated the quality of social work practice predominantly by the extent to which the social worker was seen to identify unambiguously with the hospital and its ethos; but they also set great store by the presence and easy accessibility of a social worker, and they preferred regular contact with the same person. They saw the social worker as a key agent within the health care framework, and acknowledged that the social care role and the social worker's link with the community were crucial components of good hospital practice.     

A systematic approach for providing concrete services and discharge planning based on using information handouts

While information handouts are commonly used in healthcare education, this paper is about social workers systematically developing and using them to provide timely, efficient, and ultimately better patient care for concrete services and discharge planning. How to identify topics and suggestions for composing user-friendly handouts are discussed. Many clinical uses for handouts are considered including: engaging, assessing, and empowering patients, groups, and families. Related uses are considered such as educating the treatment team and students. How handouts can be a crucial bridge to developing a comprehensive, focused social resource database is considered. Follow-up survey results with an inner city VA social work staff (N= 41) confirm that social work discharge planners and non-discharge planners find systematically developed handouts valuable for providing efficient, better patient care.     

Evaluating social work discharge planning services for elderly people: access, complexity, and outcome.

The discharge planning role of hospital social workers has become increasingly important in services to elderly people. This article examines three issues: (1) the extent to which elderly people most in need receive social work services, (2) the extent to which the discharge planning performed is a professional task, and (3) the effectiveness of discharge planning for those who return to their homes after hospitalization. The study focused on 1,100 elderly patients from five Baltimore hospitals. Data were gathered from their social workers, from the patients themselves (by phone after discharge), and from medical records. Results show that only a minority of elderly patients who return to the community after hospitalization receive social work services while in the hospital but that those who do are likely to have posthospital needs. In most cases, the discharge planning uses professional skills, but 28 percent of cases are fairly routine. Finally, social work services were effective in reducing the level of unmet needs in the areas of nursing, medication, and physical therapy.     

Differences and similarities between social work and nurse discharge planners

Historically the tasks involved in discharge planning have been a part of the practice of social work as well as the field of nursing. Based on this history and need for collaboration, a study conducted in 1998 measured the responses of 178 nurses and social workers who practiced discharge planning in 58 different hospitals in Alabama. According to the information gathered in this sample, it was clear that social workers as well as nurses continued to be important service providers in the area of discharge planning. Demographic data, work setting, caseload, and task difference were compared and significant differences were reported. This article makes recommendations for social work's participation in advocacy, policy, and outcome research in discharge planning.     

A Systematic Approach for Providing Concrete Services and Discharge Planning Based on Using Information Handouts

Abstract

While information handouts are commonly used in healthcare education, this paper is about social workers systematically developing and using them to provide timely, efficient, and ultimately better patient care for concrete services and discharge planning. How to identify topics and suggestions for composing user-friendly handouts are discussed. Many clinical uses for handouts are considered including: engaging, assessing, and empowering patients, groups, and families. Related uses are considered such as educating the treatment team and students. How handouts can be a crucial bridge to developing a comprehensive, focused social resource database is considered.

Follow-up survey results with an inner city VA social work staff (N = 41) confirm that social work discharge planners and non-discharge planners find systematically developed handouts valuable for providing efficient, better patient care.     

Life care planning: a role for social workers

Life care planning is a method of assessing future care needs and associated costs for the lifetime of individuals who have experienced catastrophic injury or have chronic health care needs. The culmination of the life care planning process is a document known as the Life Care Plan. Social workers, especially medical social workers, because of their education and health-related experience are excellent candidates for becoming Life Care Planners upon meeting certification requirements. This article describes life care planning and how social workers can enter this field.