Social work practice in health care: looking to the future with a different lens.

Social work practice in health care must change to better meet the needs of individuals and their families as the system of care changes from an acute care focus to a community based focus and as individuals seek more active participation in their own care decisions. Practitioners and educators must renew their partnership to create a practice based on the needs of individuals to move most effectively through a more complex system of care and back home again. A paradigmatic shift can redefine social work in health care for the future. Renewed leadership with vision is required.

Post-hospital support program for the frail elderly and their caregivers: a quasi-experimental evaluation.

This paper evaluates the Post-Hospital Support Program for the frail elderly and their caregivers using a quasi-experimental design. The program goals were to reduce stress in the caregivers, improve functioning and reduce mortality in patients, and reduce health service utilization in patients. Subjects were patients at the Johns Hopkins Hospital in Baltimore, Maryland, age 65 or over, who were returning home to the care of a non-paid caregiver and who had extensive post-hospital care needs which were expected to continue for at least one year. The 93 comparison group patient/caregiver pairs were discharged between May 15, 1983 and May 14, 1984. The 98 treatment group pairs were discharged between May 15, 1984 and May 14, 1985. Interviews were conducted with patients and caregivers at 1, 3, 6, 9, and 12 months after discharge. Results showed a slight reduction in caregiver stress and a substantial reduction in hospital days used by the treatment group. When confounding and history effects are taken into consideration, an average difference of 6.5 days per patients remains. The data also suggest that the treatment program may have postponed some deaths and nursing home placements. The results suggest that support services for the frail elderly and their caregivers can be cost efficient by reducing hospital length-of-stay. Savings were estimated at $4,585 per patient per year in this study. However, further work is needed to design programs which more effectively reduce caregiver stress.

Foster home care for the frail elderly as an alternative to nursing home care: an experimental evaluation.

This paper describes a program (Community Care Program) in which some elderly hospital patients who were candidates for nursing home placement were placed in foster homes. Caregivers were carefully trained and supervised. A total of 112 elderly inpatients were randomly assigned to placement in a nursing home or a foster care home. Patients and caregivers were interviewed at 3, 6, 9, and 12 months after placement. Community Care Program patients were more likely to maintain or improve ADL (activities of daily living) and mental status scores. They also had better nursing outcomes and were more likely to get out of the house than were nursing home patients. Nursing home patients had higher life satisfaction, and participated in more social and recreational activities. The Community Care Program was 17 per cent less costly than nursing home care. The results suggest that foster care may be a viable alternative for a segment of the nursing home population.

Costing for social work services.

This paper discusses the potential for the development of a cost accounting procedure that monitors both output of service and costs while allowing for though not insuring quality of output. Such a system of costing out can help answer questions of cost effectiveness of social work services. One possible model is utilized to express the process and demonstrate potential benefits to social work services. It offers way of defining and evaluating services with respect to standards of productivity. Necessary components of such a system are defined. It is suggested as a tool for the social work Administrator to consider as a way of clearly and effectively defining needs and defining and "marketing" the services to be provided by the department. It is presented here to encourage further exploration and refinement.

Development of an information system: a means for improving social work practice in health care.

The Johns Hopkins Hospital has developed a social work information system involving seven referral problem categories based on problems as identified by the referral source, ten problem categories for social work service, identified by the social work person after interview, and ten social work service categories similarly identified. The latter two categories include contracts with patients and expected outcomes together with categorization of actual outcome. Analyses of the coded data allow for more effective management of social work services and permit social work departments to compete for scarce resources, to comply with external regulations and accountability demands, and to assure quality service. In addition they provide a firm data base for research. The problem and service categories were tested for reliability by comparing the independent categorizations of 159 and 154 cases respectively by six social work persons, two each at three different levels of experience. Reliability levels were found to be satisfactory. The development of this system and the method of reliability testing are described and believed to be applicable to other systems.

Social work information and accountability systems in a hospital setting.

Information and accountability systems for departments of social work are a major concern for the profession, particularly within the health care sector. This paper describes the development of such a system within a large university hospital, the forces that led to its development, and the multiple expectations for its usefulness in planning and implementing social work services most effectively, within the lowest cost. It includes potential for building research projects and is utilized as a communication mechanism for recording. Collaboration within the profession is essential for implementing objective standards to be utilized in reviewing delivery of professional social work services.