Abstract
Social work has made a significant contribution to the health care of older people for the last 60 years. At any one time, older people make up a significant number of our inpatient population in public hospitals. Social workers have not only had an integral part to play in discharge planning of this vulnerable population but also have played an important advocacy and support role with the patient and their families. Indeed, social work is traditionally the discipline that links the medical world to the patient’s world in the community. Recent data indicates the average length of stay (ALOS) in public hospitals is continuing to decline. Between 2001 and 2010, total ALOS decreased from 4.4 days to 4.1 days and in medical wards from 3.9 days to 3.5 days (Ministry of Health, 2011). (MOH).Ward managers have traditionally relied on social workers to provide safe discharges, particularly for older people who are vulnerable, but the pressure to concentrate on this service has increased as the pressure to manage very high bed occupancy also grows. Anecdotal evidence indicates that some social workers have been directed to attend to discharge planning only and any other issues that are identified are to be referred to their community colleagues. This demanding environment poses challenges for social work and raises the question whether more effective social work intervention for older people could be achieved in the community. Where should social workers concentrate their efforts in order to have the most effective outcomes? Would health social work be more effective if placed in the primary care sector? This article examines the skill base of health social workers in relation to working with older people, and argues that a move into primary care would result in a more effective use of our skill base which is after all centred in family work.
Highlights
IntroductionSocial work in health settings has been in existence for more than 100 years (Auslander, 2001)
In New Zealand, social work in health settings emerged from nursing, with first published references made to social work in health care found in 1939 (Beddoe & Deeney, 2012)
Social work in health care has often staked its claim to territory in the health system on its expertise in the ‘psychosocial’ aspects of illness, based on a persistent view that other health professions limited their focus on physical factors and treatment of service users in health systems (Beddoe, 2011)
Summary
Social work in health settings has been in existence for more than 100 years (Auslander, 2001). In New Zealand, social work in health settings emerged from nursing, with first published references made to social work in health care found in 1939 (Beddoe & Deeney, 2012) For much of this time social workers have been based in hospitals where their main role has been to provide a bio-psychosocial assessment and intervention service in the midst of a medical setting as well as providing emotional support to patients and their families as they. In a recent study looking at the professional identity of health social workers in New Zealand, Beddoe (2011), found that health social workers felt a lack of status in comparison to doctors and nurses, and often used ‘battle metaphors to describe their venturing into the medical world’ (p.8) This concern that we measure and articulate our contribution clearly is intensified in recessionary times (Briggs & Colhoun, 1990; Phillips, 1999). The focus for health social workers in the community has appeared to narrow to being involved with older people and their families around episodic crises, often following an admission to hospital, rather than working in areas of prevention with such issues as isolation, depression and anxiety, grief work and early identification of dementia, issues which often flag a visit to a GP
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