Social workers' responsibilities in heart transplantation programs

Abstract

H EART transplantation is a demanding and stress-filled journey for patients and family members. It has memorable and distinctive milestones including the work-up period to establish eligibility for a new heart, the waiting period for a donor, readmission to the hospital for transplantation, and postdischarge recovery. Social workers help individuals to meet and pass through each milestone in a way that is manageable and, whenever possible, growth-producing.’ The coinvestigators of this article are affiliated with Columbia-Presbyterian Medical Center (CPMC) of New York City, which started its heart transplant program in 1977; University of Wisconsin Hospital whose program began in 1973, and after a 4-year hiatus, resumed in 1984; Milton S. Hershey Medical Center of Pennsylvania, whose program was also launched in 1984; and St Luke’s Episcopal Hospital of Houston, TX which resumed its program in 1982. (The program at St Luke’s was initially begun in 1968 and discontinued 17 months later because of poor long-term survival rates, precyclosporine.) As of midwinter 1987 to 1988, CPMC had 110 heart recipients; University of Wisconsin Hospital had 39 since 1984, Hershey had 45, and St Luke’s had 157 recipients. CPMC and St Luke’s offer transplantation to adults and children. At CPMC, social work was written into the heart transplantation program by the head of surgery, Keith Reemtsma, who started the program. Reemtsma is of the opinion that coordinated efforts of many disciplines are needed to successfully manage patient care in the heart transplantation program. The purposes of such a collaboration are to provide comprehensive services for patients and family members and to manage staff tensions. Social work services are perceived as being useful and essential. The Health Care Financing Administration (HCFA) of the Department of Health and Human Services mandates social work services as one of the institutional commitments that heart transplantation programs must meet to be eligible for Medicare coverage.’ Social workers involved in transplant programs are always eager to upgrade practice skills so as to meet effectively the needs of patients and family members. As of midwinter 1987 to 1988, 80 social workers on a master’s level joined the National Clinical Network for Social Workers on Heart Transplants (organized at CPMC) to advance social work practice and promote standards of excellence in the provision of psychosocial care to patients and family members.3 Richard Cabot, a physician from Massachusetts General Hospital, started hospital social work in 1904. He saw the need for social workers to alleviate the social problems that interfered in the me&al treatment plan.4 In collaboration with an interdisciplinary health care team, social workers today offer patients and their family members individual, family, and group counseling on an intrapsychic, interpersonal, and intersystemic level to address the psychosocial concerns that accompany illness, hospitalization, and that debilitate coping. As need be, social workers help provide appropriate community resources, ie, home care, vocational rehabilitation, to maintain or increase the patient’s emotional and physical well-being in the community. In heart transplant programs, the majority of patients do not require home care or institutional services upon discharge. They go home to the care of their families. The diagnostic related groupings (DRGs), the recent federal costcontainment measures, have had no significant impact on the length of hospital stay for heart transplantation recipients. The DRG code is 103,