Trends in Health Care Will Impact Social Work Service Delivery
By Gerald Beallor, CSW, Co-chair Health Care and Policy Network
(April 2002)Social work graduates preparing to work in the health care field are faced with unprecedented changes in health care delivery and financing. They can expect to find new challenges with both difficulties and opportunity. Those that are already in health care, or have already been there may wonder what further changes there can be. Let's look at the trends that will result in change.
First of all the rapid increase in the aging population is placing pressure on the system from all directions. People's life expectancy has increased significantly to well over 76 years. With that change comes the increased prevalence of diseases and conditions of aging. Most are chronic and call for long-term intervention to maintain quality of life.
Chronic illness is not what the system is set up to handle. And, of course, besides the illnesses of aging there are HIV/AIDS, asthma, hypertension, heart disease and others.
While most of those affected will spend some time in the hospital, the care goal is to keep them at home, in the community. But, most social workers in health care are in hospitals and receive their training there. Where they are needed is in long-term care centers, home care agencies and in ambulatory care centers and clinics. However, hospitals continue to consume the largest portion of the health care dollar and ambulatory and community based care remain under financed. In fact, increasing numbers of physicians in primary/ambulatory care are refusing to accept new Medicare patients because the MC reimbursement rates have been decreasing while the cost of providing care is rapidly increasing. (Read The NYT of March 17, 2002)
Will the Jobs Be There?
Helping the patient and family get connected to an appropriate level of care becomes a challenge in this environment. From what venue can the social worker perform this task? Will there be jobs out there that will make it possible for the social worker to carry out an appropriate care plan? At present, there are some positions that did not exist a few years ago. They usually involve some form of case management. Surprisingly, there are a significant number of vacancies that agencies are finding difficult to fill. Salaries may not meet standards, but the jobs are there. For some of the community-based positions there is a dilemma - how and where will the social worker obtain supervision? Working independently as a social worker, but in a team with others in various disciplines, is becoming the new norm for practice in health care. Question: How will social workers qualify for advanced credentials under these circumstances?
Challenges and Opportunities in Mental Health
An increasing need for mental health services has been noted in many quarters. Here is an area for which social workers are particularly well suited. However, funding for mental health has declined by almost fifty per cent during the past decade. Managed care organizations providing access services for both private and public insurance have adopted strict guidelines for medical necessity determinations that make it difficult to obtain reimbursement for mental health care. In the New York City area there are, nevertheless, job opportunities in mental health.
Social workers seeking careers in health and mental health will need to develop skills required to meet the needs of the specific populations they will serve and the systems in which they will work. The needs of the aged, for example, and the array of services required to maintain them in the community, require a large database of knowledge of physical and mental conditions and the services the community provides. This is certainly true of AIDS/HIV and other chronic conditions. The value of the social worker to the patient and family and to the health care team depends on the breadth of the social worker's knowledge.
The service system in which the social worker will operate is undergoing considerable change driven by technology and financing. Health care delivery is becoming evermore sophisticated as new treatments, drugs and devices make it possible to sustain people in their communities for long periods of time. However, these treatment modalities are expensive and the managed care world is dedicated to keeping costs down. The members of the care team are therefore called upon to justify their plans and actions. Social workers must work as members of multi-disciplinary teams, and must function with little or no supervision or direction from other social workers. Preparation for "autonomy" of this kind is vital.
Trends and Implications
According to the Final Report of the Social Work Education for Practice in Health Care Project of the New York Academy of Medicine, the trends in care with implications for social work practice are:
Support at NASW
As social work students move into their careers in health care in this rapidly changing field, there will be a need for support, guidance, and further educational opportunities. The writer of this article, Gerald Beallor and the co-chair of the NASW Health Care Policy and Practice Network, Terry Mizrahi are working with many members to improve the capacity of NASW to meet some of these needs. Recent discussions of the social work role can be found on the web at www.naswnyc.org.
In addition, the Chapter is seeking to improve working conditions through changes in law and regulation governing social work in health and mental health care. There are continuing efforts to achieve licensing for the protection of the public and the status of social work.
All social workers that have joined or are intending to join NASW are welcome to become participants in the Health Care Policy and Practice Network. Questions and concerns can be addressed to us through the Chapter.