By Priscilla F. Cutler, MSW, LICSW
Introduction
Peterborough, New Hampshire: A typical day for a hospital social worker may begin on the Intensive Care Unit with her trying to help a patient who attempted a drug overdose and is willing to stay in the hospital for psychiatric treatment as recommended. It’s the social worker’s job to find the patient a place to receive treatment and finding an available spot for can be time consuming and difficult. Many psychiatric facilities are often fully booked and cannot accept new patients.
First, the social worker contacts the patient’s insurance company to get pre-certification for the psychiatric hospitalization. Next, she contacts local psychiatric intake departments to check if they can accept a new patient. Later, she will discuss the options with the patient and the family. The entire process of securing a place for the patient takes hours.
The social worker may then assist another Intensive Care Unit patient’ s family with end-of-life decisions. The social worker will provide them with emotional support and talk to them about helpful resources they may know nothing about such as the hospital’s Financial Grant Program or the Medication Assistance Program.
Next, the social worker may meet with another family to discuss changes in level-of-care required for their parent with dementia. This time she will help a family find a nursing home.
A Patient With Dementia
The social worker discusses the family’s options, which may include information on how to obtain a Durable Power of Attorney for Healthcare or a legal guardian. (A Durable Power of Attorney allows you to appoint an agent to make health care decisions if you are unable to do so. A legal guardian is appointed by a judge to oversee an incapacitated person’s affairs.)
By late morning the social worker heads to another ward in the hospital to see a post-operative 67-year-old gentleman who had a hip replaced and therefore, may require in-home services upon discharge. He is the caretaker for his wife, who has dementia. A family meeting with his daughters is arranged for the following morning. Topics to discuss include:
- Can the father be driven to outpatient rehabilitative services or will he require physical therapy in the home?
- Will he require meals on wheels?
- Will the mother need adult day care?
Before the social worker completes her psychosocial assessment for this family, she
receives a page. The Emergency Department needs a psychiatric consultation for a patient.
A Suicidal 16-Year Old
In the Emergency Department, the social worker assesses an actively suicidal 16-year-old Cambodian boy in the Observation Room. The young man’s English isn’t very good so his consultation with the social worker is translated via a telephone language line. The social worker then discusses her concerns with the teenager’s mother and aunt. She also confers with the Emergency Department doctor and nurses, and determines that an in-patient hospitalization is required for the young man.
Next, the social worker confers with the covering psychiatrist via telephone and proceeds with the same placement procedure she used for the Intensive Care Unit patient at the start of the day. Unfortunately, the Cambodian teenager is becoming frustrated with all the waiting. Three hours and four intake-reviews later with area psychiatric units, a hospital agrees to accept the teen.
A Pregnant Teen
By mid-afternoon, the social worker is off to the Obstetrics/Birthing Unit. A six-months pregnant teenager has been sent directly from her doctor’s office for admission for fetal monitoring. Her parents are quite distraught and she’s upset, too. She’s thinking about adoption for the baby. The social worker meets with the parents and teen to provide support and gives the family information about local adoption agencies.
At the end of the day with direct patient care complete, the social worker returns to the Social Services Office. Each social worker has to write-up statistics for the day’s work, answer calls from facilities and patient families involved in the coordination of her patients’ care, complete documentation of her work, and prepare for tomorrow.
