Social Services, Admission

and Discharge

Main Focus of Social Services

To help people cope and adapt to situations that arise in complex social exchanges

Other Common Roles

• Conflict resolution

• Linking the facility to its external environment through exchange relationships with key agencies

• Overseeing a patient’s stay from admission until discharge

Main Qualification of a Geriatric Social Worker

• Minimum BSW (although not all states specify this degree or license social workers)

• Understanding of aging• Desire to work with the aged• Compassion• Professional maturity• Knowledge of community resources• Trustworthiness

Skills and Competencies - 1• Engagement (human relations) skills

– built on respect– common disrespect is infantilization

• Assessment skills– physical and psychosocial functioning– economic need– family relationships– race and cultural factors

Skills and Competencies - 2

• Communication skills

– simple and straightforward language

– clear diction and slow pace

– touch

– proximity

– listening and repeating

– using patient’s name frequently

Skills and Competencies - 3 • Interviewing skills

– essentially, focused communication involving specific issues

• Documentation skills – complete record of a patient’s

history, assessment, care plan, progress, interventions,

and discharge

Gerontology

Study of the aging process and special problems related to aging

Age and Aging

• Age 65 has traditionally marked entry into old age

• But, different people age differently– Personal attitudes about one’s own aging– Behaviors – Culture

Theories of Aging

• Activity theory

• Continuity theory

• Labeling theory

Ageism

Prejudicial treatment of the elderly based on stereotypes and misconceptions

Misconceptions About Aging• Getting old means becoming ill and disabled• Most people will need to be in nursing homes in

later years of their lives• Getting old leads to inactivity• Physical exertion is harmful for the elderly• The elderly lose their sexual desires• Dementia naturally accompanies aging• The elderly cannot learn new skills • The elderly like being dependent on others

Social Service Roles

• Information

• Case management

• Coordination

• Enabling

• Intervention

• Advocacy

Informational Role• Provide information to potential clients • Provide information to community health care and

social service agencies• Give information on the facility and its services• Give information on Medicare and Medicaid• Give information on long-term care issues and

community resources

Case Management Role

• The process of matching client needs with the most appropriate services

• Assessment, plan, follow-up, and reevaluation

• Procure services that enable the facility to render total care

Coordination Role

• Case management involves coordination

• Coordination of admission and discharge

• May coordinate the resident council

• Coordinate family support groups

• Outreach programs

Enabler Role

• Social worker acts as a facilitator

• Help residents adjust

• Help family members cope

Intervention Role

• Conflict resolution

• Therapeutic intervention if needed

Advocacy Role

• Educate patients and staff on patient rights

• Monitor and enforce patient rights

• Address patient rights issues with the administration

Ethics Committee

• A multidisciplinary forum

• It allows different insights and viewpoints when dealing with complex issues

• Issues are resolved in view of what is best for the patient

Pre-admission Inquiry

• An inquiry delayed is an admission lost

• Information and case management roles are essential

• Matching the patient’s needs to what the facility has to offer

• An opportunity to make a sale or referral to another service

Handling Inquiries

Have written procedures

• Designate intake personnel

• Outline the main steps to follow

• Provide training

• Establish after-hour and weekend protocols

The Inquiry Process

Four main phases:

1. Initial interview

2. Facility tour

3. Concluding interview

4. Follow-up

Admission• The importance of a personal visit with the

patient and family members before admission

• Preparations and coordination with the facility’s staff

• Transfer of medical records• Admission agreement, patient rights and

responsibilities, monetary deposit

Discharge Planning

• Continuity-of-care planning with discharge goals

• Begins at admission

• Assessment and care planning foresee discharge outcomes

• Multidisciplinary input

Resident Council

• Independent self-governing body (free from control by nursing home personnel)

• Open to all residents

• Empowers residents to have a say in the facility’s operations

Family Management - 1• Family is a secondary client• Unrestricted visiting hours• Understand patient-family dynamics before

and after nursing home admission• Social worker plays a supportive role in

which family members learn to come to grips with their own feelings and frustrations

Family Management - 2

• The social worker can assist with visitation skills

• Support groups and educational seminars

• Clarify realistic expectations

Hospice• End-of-life option that requires consent to

suspend life-prolonging interventions • Covered by Medicare when life expectancy

is less than 6 months• A cluster of services • Services can be delivered in the nursing

home• Emphasis on palliative care