Wednesday, January 22, 2014

Models of Social Work Practice in a Hospital

Social Work Practice in a HospitalIn my short career, I've been fortunate enough to work at various hospitals as a medical social worker.  Doing so has helped me hone my social work skills and learn about the various community resources in different locales.  Additionally, I've been able to see first-hand the true versatility of this profession, as demonstrated by how the social work role differs at each hospital.

I've practiced two main models of hospital social work practice: pure social work and social work/discharge planning.  In this post I will elaborate on these two practice models and discuss the pros and cons of each.

Pure Social Work
Pure social work focuses exclusively on the psychological and social barriers that affect a patient's well-being and hinder a safe discharge home.  Social workers practicing this model focus on completing comprehensive psychosocial assessments, providing brief counseling/crisis intervention services, assisting with end-of-life situations, finding shelters for homeless individuals, placing individuals who cannot return home for social reasons (i.e. no family support), and evaluating patient safety (i.e. abuse assessments, domestic violence intervention).

Social Work/Discharge Planning
This model takes pure social work and incorporates elements of discharge planning.  Social workers who practice this model take on the medical barriers that interfere with a safe discharge home.  Tasks include placing patients in skilled nursing homes, ordering durable medical equipment, arranging home health care, making transportation arrangements to other facilities, and addressing any other post-hospitalization needs (i.e. medication, follow-up appointments) in order to reduce the likelihood of patient readmission.

Pure Social Work Pros
-A slightly smaller caseload means more time to interact with patients, develop rapport, and go above and beyond to address their needs.  When I have the time to get to know my patients, I can better anticipate their future needs and provide resources/interventions as necessary.
 -Hospitals with a pure social work focus usually have a dedicated social work department headed by a social worker.
-I find myself having more autonomy on the job than when I'm at hospitals that use the social work/discharge planning model.
-The bulk of my time is spent practicing social work, which is what I went to school to do.

Social Work/Discharge Planning Pros
-Compared to pure social work, discharge planning requires a more expansive knowledge of insurance requirements and medicine/nursing.  I feel that this helps me better address patient needs and makes me a more effective clinician overall.
-I interact a lot more with other disciplines, such as nurse case managers, nurses, discharge planners, physical therapists, occupational therapists, etc.
-I get a sense of fulfillment and closure from coordinating patients' discharge plans from the moment of admission to discharge.

Pure Social Work Cons
-Social work cases are usually extremely emotionally draining.  Sometimes I like having the occasional straightforward home health or skilled nursing referral to get a mental break.
-Social work cases also tend to be the most complex, with no simple solutions.  There have been many instances where I've had absolutely no idea how to fix a patient's problems.  Anyone who has ever said that social work doesn't involve advanced problem solving skills has never worked a day in our shoes!
-With regard to the interdisciplinary team approach, I feel more like a consultant since I typically only get involved in more challenging situations.

Social Work/Discharge Planning Cons
-Social workers who function as discharge planners have job duties that overlap with nurse case managers. This often results in situations where staff members confuse us as nurse case managers and vice-versa.  Because of this confusion, social workers are often asked to do things outside their scope of practice, such as analyze test results, predict discharge date, and provide updates on medical status.  I've definitely felt stupid more than once for not knowing things that are basic to nurses/doctors.  Not my training!
-Having higher case loads mean less time spent with patients.  Patients who have discharge orders have first priority, meaning patients with mental health problems needing support sadly may not be seen.
-Case management departments tend to be focused more on metrics and the bottom line.  The goal of discharge planning is to discharge patients in a quick, safe manner and prevent readmission. This is not always compatible with social work practice.

Honestly, I am not sure which model of hospital social work practice I like the best.  I suppose this is part of the reason why I continue to split my time between various hospitals.

What do other medical social workers think of how social work is practiced in a hospital?  Comment away!

Wednesday, January 15, 2014

2014 Spending and Savings Goals

Yesterday, I was looking at my account, which I signed up for over the summer to better track my spending.  Let's just say that after getting the account, I probably visited the site a total of 5 times between then and yesterday.  Looking at the charts from the past six months, I was horrified to find out that in the span of half a year, I had spent over 35% of my annual pre-tax earnings.  I know I'm not cheap, but I didn't realize I had spent that much!

Fortunately, upon further inspection I noticed that was adding my total credit card charges to the totals on my credit card statement, making it look like I spent a lot more than I did. also counted several transfers to savings accounts as spending.  In the end, I computed that I actually spent 29% of my pre-tax earning in the span of a WHOLE year.  Still not that great, considering I live at home, but not as terrifying as the idea that I spent more than I made.

Here are a few more things I pondered as I worked on my 2014 budget:
-Due to the ACA I am now paying $3000/year in healthcare premiums, double what I paid last year.  I am also budgeting $200/month for gasoline, and due to my long commute to work I will likely go over that amount.  Adding the two, it looks like I will be spending over $5000 on healthcare premiums and gas alone!
-Reading through an old post about the costs of moving out (written before studio prices rose above $1000) and number crunching, I know for sure that I would be broke if I moved out in 2011.  I suppose this is one perk of being part of a family who believes in living at home until you 1) get married or 2) buy a house.  Since 2011, I've been able to travel extensively, shop, help my family, donate to charity, contribute to a retirement fund, and set aside a down payment to be used when the housing market calms down.  Absolutely no way I could accomplish all of that living in a shabby studio.
-My cheap boyfriend told me that I should be only be spending $1000 a year on non-essentials (i.e. shopping, travel, eating out) because I live at home.  Considering my travels plans alone for this year, I conclude that he's crazy.
-I spend WAY too much money on shopping and need to work on this... maybe.

Anyway, here are my main spending and savings goals for 2014:
1) Spend no more than 25% of my projected pre-tax earnings.  This basically covers shopping, food, drink, presents, travel, health insurance, gym membership, gas, and a $708 emergency fund.  I plan on using to track my monthly spending.
2) Max out my Roth IRA ($5,500) and HSA ($3,300) contributions, a total of $8,880.   Since I work several per diem jobs I don't get a 401K.  Fortunately, my HSA provides a helpful deduction for my federal taxes.  I really need to do some research and look into alternatives to 401Ks so I can start another retirement account, though.
3) Split the leftover money between retirement savings, house down payment, and rainy day fund.

That's pretty much it!  I think these goals are definitely achievable, though my boyfriend might complain that 25% is way too high.  Hey, I'm a social worker, and 25% of my salary is lower than 25% of his tech salary!  Overall, I hope that setting these goals will help me be more cognizant of my spending, yet leave me some breathing room to enjoy my money as well.  We'll see how the year goes!

Friday, January 10, 2014

2014: Another New Start

It's been a while since my last blog post.  Between work, travel, and general writer's block, I've really haven't written very much lately.  Hence, I really feel like my already mediocre writing skills have diminished even more!  This year, I'm hoping to change that by making alterations that facilitate more frequent posting and allow me more practice in writing.

The first major change is streamlining my blogs.  Looking through my archives, I noticed that I was cross-posting many of my posts to my other blog.  Instead of having two infrequently updated blogs, I figured it would be best to consolidate everything into one blog.  I will still keep Adventures of a (not so) Cheap Social Worker up for now, but all the posts from there can now be found on this site.

Postings on this site will pertain to my job, the social work field, anything remotely social work/healthcare related, money related issues, and my attempts to make the most of a social worker salary.  Like the title of this blog states, I am NOT cheap, but will try (and probably fail) so as to make the most of my money while having the most fun.

I have another infrequently updated blog that documents my daily like and things I like to do for fun, which is to travel.  I think of it as my escape from social work.  I'll probably post a link once I've fixed it up a little.

To end this post, here are my goals for 2014, which I will elaborate on in future posts.  I will keep the list short to increase the likelihood of meeting them all:
1) Blog more frequently
2) Travel more
3) Earn more money that I did last last
4) Spend less than I did last year

Wish me luck!  Happy 2014 everyone!