Social Work and Clinical Services in Geriatric Healthcare
Introduction
This paper presents a case study conducted on a 60-year old Caucasian female patient admitted to the hospital with breast cancer for a double mastectomy. The woman had been diagnosed with cancer earlier that year, and her husband and two grown children were having trouble with the prognosis. As a social worker working under an interdisciplinary team in the hospital, I was tasked with understanding and innovating a strategy for the patient’s family. As a social worker in the Neonatal Intensive Care Unit (NICU), my specific area of expertise was dealing with infants and problems concerning babies. However, due to the new policies innovated by the hospital’s strategy team, an interdisciplinary team was created, comprising of nurses, social workers, and specialized medical professionals. This team would observe and infer strategies to improve preventive measures and promote healthcare away from the hospital setting.
As a NICU social worker, my area of expertise is neonatal care for ill and premature children. Therefore, observing the social needs of a geriatric patient with chronic illness was a completely new experience for me. However, recent research in primary healthcare provision has proved that optimal team-based healthcare needs to include researchers with specialties in other disciplines. The ever-evolving landscape of geriatric healthcare has seen a shift from centralized care in the 90’s to the ambulatory care in the first decade of the new millennium (Mitchell, Wynia, Golden, McNellis, & Okun, 2012). This kind of research had existed for 40 years based on practices leading the efforts on the ever-changing healthcare landscape (Berkman, 2011). A social worker in my position became part of the team, innovating new strategies for mitigating high costs of healthcare for geriatrics and infants due to my experience in social work and infant intensive care.
My role in the team was to observe the similarities and other adjacent factors that influence the cost of healthcare due to social, economic, and policy inequalities. This strategy was adopted to improve the efficiency of the systems that govern universal healthcare by enhancing quality and reducing costs. The United States (US) has been trying to provide equitable healthcare at lower prices throughout the country, but external factors always interfere with long-term goals. Through collaboration between various fields in the healthcare sector, a collaborative approach towards universal healthcare passed during the Obama presidency. This decision came after the realization that the traditional model that used physicians and nursing aids was failing to address the needs of a cross-section of the population (Dando & Finlon, 2003). In recent times, researchers have discovered that healthcare is a team-based process that requires the view of the factors from various dimensions to understand the entire system. Donald Kent’s research on the link between healthcare, aging, and policy has advanced over the years culminating in the policies implemented during the Obama era.
As stated above, the team comprised of experts and practitioners from various sectors in the healthcare department, including social work, which is my main field of focus. As a social worker specializing in NICU, my role was to observe the similarities between the factors that increase the likelihood of frequent hospital visits. Drug abuse and alcohol are some of the recurring problems identified among geriatric that increase this frequency (Dando & Finlon, 2003). Researchers noted that the most constructive strategies arose from a collaborative effort between medical and nursing practitioners with input from other professional services considered less medical. These fields include social work and other financial professions, such as accounting. My team consisted of a medical doctor, an advanced nursing practitioner, a social worker, a hospital administrator, and an accountant. We were each tasked with the responsibility of observing and recording the factors that affected quality assurance in the healthcare of geriatrics from different perspectives in the organization. The results were collected and analyzed by a team of strategy experts to innovate new cost-saving measures from a three- or multiple-dimensional view of the problem.
The medical doctor was the leader of the team since they have sworn an oath to uphold the needs of the patients above all other health. Since quality assurance is one of the key pillars in our final objective, a medical doctor ensured that the ultimate goal of the team was in alignment with this original policy. Other team members acted as observers representing the different viewpoints in the hospital and state Medicare system. I expressed the views of social workers on the current Medicare system and how certain factors affect the quality and cost of healthcare across all age groups. My area of expertise would represent the uniqueness of neonatal intensive care practitioners and their point of view on universal healthcare in a setting with the reverse type of patient. The patient chosen at the facility was a 60-year old Caucasian female with breast cancer, the reverse of a neonatal infant with complications.
The other team members also played a similar role, but with a slightly different viewpoint. The hospital administrator identified organizational factors and other factors that affect the cost of healthcare in the hospital. Universal medical care had become one of the largest government spenders due to the limited view on the social, behavioral, and environmental factors that affect the frequency of admission for elderly patients. Most researchers attribute the variations in this phenomenon to the patient’s environment, such as difficulties with family life and inability to follow the guideline provided post-treatment (Berkman, 2011). Financial problems also affect the elderly patients, especially in ethnically minority communities, making the view of the question clearer from an administrator’s viewpoint.
The accountant’s job was mainly balancing the accounts to ensure that the hospital did not lose the cost-cutting objective in search of enhanced quality. The accountant acted as a check and balance for the other team members to ensure budgetary regulations and policies maximize the reduction in the cost of treatment. His viewpoint was supposed to conflict with the medical practitioner’s when the strategies innovated support more quality healthcare than can be afforded by the hospital. The nursing practitioner was the primary caregiver in the team. Their role was to cater to all the needs of the patients and the family. Although their viewpoint may seem to coincide with the medical practitioners’, it was worthwhile to note that the number of tasks performed by the nurse grows exponentially with each new patient. This variation in workload impacted the viewpoint of the nurse, making her primary concern the enhancement of patient-care efficiency.
My interaction with the rest of the team started awkwardly, with the mandate of each team member requiring clarification from the team leader. The team leader explained the need for interdisciplinary collaboration in the case study, despite the variation in professional backgrounds. As a social worker, it was my responsibility to monitor the social factors as well as environmental factors that increase the cost of care among the elderly. Consequently, I examined these social and ecological factors and related any variation in the treatment policies that increase or decrease the price or quality of care, respectively. These findings correlated the observations made by my teammates and compiled by independent strategists in terms of significance. Common factors identified by a majority of these independent strategists are marked as urgent and scheduled for immediate review.
During the case study, I encountered some challenges that might have influenced my observations and inferences from the study. The medical practitioner’s opinion may have overshadowed my views during some complex procedures due to my inexperience in the field. However, the diversity of the team ought to have covered for this shortcoming. The study required high levels of honesty for the inferences to have a significant impact on the quality of health provided to older people (Mitchell, Wynia, Golden, McNellis, & Okun, 2012). The observations and inferences influenced by the other practitioners would become immediately visible due to the uniformity of the sample data provided to the strategists. A final review of my notes before forwarding them up the chain would also help in identifying opinions that feel coerced or forced in any way. Incentives are also great motivators for patience and honesty. The hospital had special incentives for medical doctors and nurses who listened and contributed to the observations made by members of other departments.
In the case study, the medical doctor advised each member of the team concerning the severity of the situation. The doctor told each member to brace for any eventuality due to the severity of the patient’s diagnosis. The woman had been diagnosed with breast cancer and was to undergo a double mastectomy procedure in the hospital. The family of the patient kept looking for answers and alternatives. The task of informing the family on the best methods to handle the shock and grief fell to me as a social worker who had experience notifying families of neonatal infants of poor diagnoses. Since the patient was in a whole different demographics, I had a lot of help from the doctor and the nurse on the best approaches for the situation. My perspective of the patient as changed, and I learned to look at the facts of the case and make decisions based on facts, but my experience also made me well equipped to handle the emotions of the confused family members.
A social worker in this area, therefore, needs access to cultural and social sensitivity training to ensure that their motivation for providing their services is not overwhelmed by the morbidity rampant in hospitals. Our patient was in remission by the time I had finished my practice at the hospital. However, observations from similar cases forced me to face the reality of illness, despite providing social services. The inferences made from the study, however, would serve as a guide for fellow social workers following the same path in an interdisciplinary medical team. The diversity and different viewpoints advanced by the team also helped all the team members understand the importance of diversity, regardless of the social, ethnic, or environmental factors that influence this variation. Future studies in universal healthcare and the provision of social services to elderly populations should include team members for different fields to increase the number of inferences made at each step.
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