Gerald Beallor, Co-Chair, Health Care and Policy Practice Network
and Barbara Brenner, Past Chapter President
(November/December 1996)

Rampant changes in the health care delivery system are proliferating throughout New York City and are causing confusion and uncertainty among t including social workers.

Feelings of pain, outrage and loss have been expressed by social workers hose working in hospitals, as they learn of the reorganizations which will dramatically change their jobs and status in the system. The New York City Chapter of NASW is meeting with groups of social workers, seeking to help them cope with the changes. For the past four years, NASW, in coalition with other organizations, has been seeking to prevent deregulation of social work in hospitals and to project a role for the profession in the managed care era. The current transformation of health care follows a political script based on power and money, with policies requiring draconian changes in the great voluntary and public hospitals of New York. The immediate rapid changes are taking place because Medicare and Medicaid rates have been lowered, and bed occupancy has decreased. The regulation of hospital rates through NYPHRM will end on December 31, 1996 and hospitals will have to negotiate rates with each and every payer and managed care company. Downsizing, reorganization and consolidation are the order of the day. Many hospitals will go out of business. The impact on social work is a consequence of these trends. It is not only social work facing change - the entire hospital system is in turmoil.

Bulwark against lower standards

It was NASW's hope that regulations for social work could be maintained as a bulwark against deprofessionalization and lowered standards of patient care. However, in April of 1995, the Governor sought the removal of the requirement for social work departments in hospitals and other standards. The Coalition to Save New York Social Work was rapidly formed by NASW and Local 1199, with participation of the Society of Social Work Administrators in Health Care, the Deans of New York Schools of Social Work, the Council of Nephrology Social Workers and the Discharge Planning Association.

Following a massive letter-writing campaign to preserve the requirement for hospital social work departments (the Chairman of the State Hospital Review and Planning Council reported that the Council had never received as much correspondence on any issue); an Albany bus trip of several hundred social workers to bring the issue to members of the Legislature; the production of a video called "Social Work Works" by 1199 and NASW that was sent to the Governor and all members of the Legislature; and legislative hearings on hospital and nursing home deregulation, members of the Coalition began a series of meetings with the Commissioner of Health and her staff to identify if a compromise could be reached. The actions we took resulted in a deferral of a vote by the Codes Committee and State Hospital Review and Planning Council on the proposal to deregulate social work departments in hospitals.

Our objective with the Commissioner was to preserve and/or gain the highest standard or qualifications for the provision of social services to hospital patients. While the Hospital Code continued to require that hospitals make social services available to their patients, the direction the Governor and Commissioner seemed to be going in was to remove all requirements or credentials as to who should deliver or supervise the delivery of service, giving the decision to hospital administrators. During this period, several voluntary hospitals in New York City and upstate eliminated social work titles and their departments of social work, substituting instead a title of case manager.

Alternative language

From August through November, 1995, discussions continued between NASW and the Department of Health (DOH) on alternative language that would establish standards for the delivery of social services while allowing DOH to remove the requirement for a social work department. The alternative language that members of the coalition eventually agreed to support would require that "...social services be provided that reflect generally accepted professional social work standards and under the direction of an individual who holds a masters degree in social work from an accredited school of social work. The director's responsibility would include but not be limited to supervision of social work/social services staff, social work case management and implementation of measures to monitor and optimize patient outcomes."

The alternative language would apply to all hospitals in the State, not just urban hospitals. Directors of social work without MSW's would be grandfathered in, but their successors would have to meet the standard.

The Commissioner of Health finally placed the alternative in the State Register in November, 1995 with a vote to be taken by the Codes Committee in January, 1996. We were aware that during our discussions, the Health Department was in communication with an entity called the Governor's Office of Regulatory Reform (GORR) and that this office was putting obstacles in the way of the Commissioner's desire to come up with alternative language. In the final analysis, the Commissioner came down on the side of preserving professional standards for the delivery of social services in hospitals. We assumed that this meant that the Governor's office was supporting her alternative.

Shifting control

In November 1995, Coalition to Save New York Social Work members spoke before the Codes Committee of the State Hospital Review and Planning Council and communicated our support for the alternative language. Four days before the alternative was to be adopted by the State Hospital and Review Council in February. GORR informed the Commissioner that promulgation of the new regulation could not go forward because it did not meet the criteria of Executive Order #20, which the Governor signed in December, 1995. In the meantime, the existing regulation that requires Departments of Social Work is still in the Hospital Code.

However, after making a series of complaints to the New York State Department of Health, NASW has concluded that as long as there are social workers providing services to hospital patients, the requirement for the department will not be enforced by DOH.

Executive Order #20 essentially moves control over hospital/health care regulation from the Commissioner of Health and the State Hospital Review and Planning Council to the Governor, whose interests appear to be in creating a more attractive business climate, not in assuring the quality of health care services. Executive Order #20 and how it is implemented also has implications for all regulation in the State.

The New York City Chapter of NASW has joined with seven organizations as plaintiffs in a suit against the Governor seeking to have Executive Order #20 declared unconstitutional. That lawsuit is now in progress. (See Currents, September '96).

Efforts continue

Meanwhile, efforts to reorganize hospitals continue. The regulations which protect patient care and social work in New York State do not exist anywhere else in the country. The National NASW standards for social work service delivery in health care settings are the only commonly accepted standards, but they are voluntary. However, in some instances, hospitals are using those standards when they are brought to the attention of the administrators.

Since the changes taking place are legal and backed by current government policy, social workers are in the position of having to negotiate the role and status of social work on a hospital by hospital basis. Local citizen advocacy groups, elected officials, and members of allied professions can be engaged in helping the hospital maintain a strong patient care base.

Most departments of social work have strong and dedicated social workers who can work together to influence the changes in the direction of effective patient care. Despite the panic reaction of many hospital administrations, most hope to maintain quality of care despite the need for downsizing. Social work leaders can help point the way to better solutions if they can gain the ear of the hospital administration.

The Chapter, through the Health Care Policy and Practice Network and its coalitions, responds to requests for assistance and invites hospital-based social workers to participate in the Network. Continuing efforts are underway to develop research projects on social work effectiveness, to obtain the assistance of elected officials and to develop alliances with other professions and disciplines.