Home Care Social Workers Research Articles

Does Medicare Care About Anxiety: Views of Home Care Social Workers

This study addresses the lack of research on the perceptions of home care social workers as to how the Medicare home health benefit addresses anxiety. The findings are based on interviews of 44 home care social workers from five home health agencies in the New York City area. Four themes emerged. Social workers believe: (1) there is extensive anxiety among Medicare home health beneficiaries; (2) Medicare home health’s mandatory assessment for anxiety is limited and not done by social workers; (3) Medicare home health does not require treatment or coverage of anxiety; (4) the lack of coverage for patients assessed with anxiety creates and exacerbates mental and physical health conditions. Policymakers should modify the Medicare home health benefit to cover anxiety.

“They Are Measures Without Impact”: Home Care Social Workers Criticize OASIS-E

There is significant literature about the Medicare Outcome and Information Assessment (OASIS). A new OASIS Version E, effective January 2023, makes significant changes in assessing patient mental health. However, a literature review indicates no studies of the anticipated effectiveness of the OASIS-E on improving psychosocial care of Medicare home health beneficiaries. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 36 home care social workers from 5 different home health agencies in the New York City metropolitan area between August 1, 2022, and November 30, 2022. Four themes emerged from the study, namely that social workers believe the OASIS-E revisions: are an improvement over prior OASIS versions; are cumbersome and do not require administration by a social worker; do not impose specific guidance requirements on using new measures scoring results in making care decisions; and do not address coverage of specific interventions that address patients with significant mental health issues. Policymakers are urged to modify the OASIS-E guidance manual to require use of new mental health assessment scores in care planning and to expand coverage of evidence-based treatment interventions for patients with significant assessed mental health conditions.

They Live in an Isolation Chamber: Medicare Fails the Depressed Homebound Elderly

There is significant literature on the existence and adverse effects of social isolation and depression among the elderly, exacerbated by the recent COVID-19 pandemic. A literature review indicates no studies of how the Medicare home health benefit addresses social isolation and depression, including no studies of home care social workers’ perceptions of the nature and consequences of Medicare coverage. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 44 home care social workers from 5 different home health agencies in the New York City metropolitan area between November 1, 2021 and May 31, 2022. Six themes emerged from the study. Social workers believe: (1) extensive social isolation and depression exist among Medicare home health beneficiaries; (2) Medicare home health policy provides no systematic measure to detect or monitor social isolation and a limited measure for depression among the homebound elderly; (3) Medicare home health policy provides no coverage to treat either depression or social isolation; (4) effective interventions are available to prevent and treat depression and social isolation. Social workers also believe that: (5) the lack of social isolation and depression coverage results in additional mental and physical health conditions; (6) lack of social isolation and depression coverage exacerbates existing mental and physical health conditions. Policymakers are urged to modify the Medicare home health benefit to improve detection and monitoring of social isolation and depression as well as coverage of appropriate evidence-based preventative and treatment interventions.

“What Were They Thinking?”: The Exclusion of Medicare Home Health From Providing Supplemental Social Needs Benefits

There is significant literature on social determinants of health (SDOH) to improve health outcomes. In response, Congress and the Centers for Medicare and Medicaid Services (CMS) have expanded Medicare Advantage Plans’ ability to cover SDOH-related services through supplemental benefits and Special Needs Plans (SNPs). Congress has not authorized Traditional Medicare to cover such services. A literature review indicates no studies of Medicare home health social worker awareness of this dichotomy and their resulting perceptions of the impacts of the lack of such coverage. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 44 home care social workers from 5 different home health agencies in the New York City metropolitan area between November 1, 2021, and May 31, 2022. Results indicate social workers lacked awareness of the dichotomy in coverage of SNPs and supplemental benefits in Medicare Advantage Plans and traditional Medicare. Once made aware of the dichotomy, 4 additional themes emerged from the interviews: documented patient needs were being ignored; the supplemental needs coverage permitted for Medicare Advantage plans should be extended to beneficiaries receiving traditional Medicare; and the lack of such coverage increased the risk of onset of mental and physical health conditions, and revolving door-admissions and costs. Policymakers are urged to consider adding coverage of special needs and supplemental benefits covered in Medicare Advantage to traditional Medicare, through Medicare home health.

Painful Places: Medicare Fails Homebound Patients with Substance Abuse Disorders

There is extensive literature on the significance of substance use, misuse, and abuse among the elderly in the United States. A literature review indicates a paucity of information on the nature, significance, or impacts of the lack of substance use and abuse coverage in Medicare home health. This article presents background on the topic and an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 48 home care social workers between January 2013 and May 2015 in the New York City metropolitan area. Results indicate social workers believe substance use and abuse occurs frequently among Medicare home health patients; substance use and abuse is not assessed and treated professionally in Medicare home health; the lack of coverage in Medicare home health results in exacerbation of existing patient physical and mental health conditions, which, in turn, worsen substance use and abuse conditions; the homebound requirement and lack of coverage of transportation and personal care assistants limits home care patients ability to obtain outpatient substance use and abuse treatment; and lack of home-based assessment and treatment contributes to increased home care readmissions, re-hospitalizations, and increased caregiver burden.

Pre-existing Inequality II: Social Workers Assess Impact of COVID-19 on Medicare Home Health Beneficiaries

There is significant data on the adverse impact of COVID-19 on persons who were poor, minorities, had compromised physical or mental health, or other vulnerabilities prior to the COVID-19 pandemic. A significant portion of the Medicare population has such vulnerabilities. The Medicare home health beneficiary population is even more vulnerable based on gender, race, income level, living alone status, and number of chronic conditions. A literature review indicated there were no studies on the impact of COVID-19 on Medicare home health beneficiaries. In a previous issue of this journal, the author addressed the literature gap by presenting a study on home care nurses’ perceptions of the impact of COVID-19 on Medicare home health beneficiaries. The current study is a companion qualitative study to the nurses’ study. It is based on interviews of a convenience sample of 52 home care social workers from 11 different home health agencies in New York City between April 1 and September 30, 2020. Seven major themes emerged, 6 of which were identical to the themes identified by the nurses. The only new theme was limits on the ability to provide psychosocial interventions had more severe consequences. The 7 themes were: need for social service supports increased; loneliness and depression increased among patients; physical and mental health conditions became exacerbated; substance use and abuse increased; evidence of domestic violence against patients increased; there was limited staff and equipment to care for patients; and limits on the ability to provide psychosocial interventions had more severe consequences.

Social Workers Assert Medicare Home Care Ignores Social Determinants of Health

There is significant literature on the importance of addressing social determinants of health (SDOH) to improve health care outcomes. In response, the Centers for Medicare and Medicaid Services (CMS) has expanded Medicare Advantage plans ability to cover SDOH-related services. Medicare home health does not cover SDOH-related services. A literature review indicates no studies on the nature, significance, or impacts of the lack of SDOH coverage in Medicare home health. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 29 home care social workers between January 2013 and May 2014 in the New York City metropolitan area. Results indicate social workers believe the lack of SDOH coverage, including social work, in Medicare home health results in exacerbation of existing patient conditions; creation of new, additional patient conditions; increased home care readmissions and rehospitalizations; increased caregiver burden; and exacerbation of patients’ mental health and substance abuse needs. Policymakers are urged to consider adding coverage of social work and SDOH to Medicare home health.

HOME CARE SOCIAL WORKERS CLAIM MEDICARE IGNORES PATIENT NEEDS

There is significant literature on the importance of addressing social determinants of health (SDOH) in order to improve health care outcomes. In response, the Centers for Medicare and Medicaid Services (CMS) has expanded Medicare Advantage plans ability to cover SDOH-related services. Medicare home health does not cover SDOH-related services. A literature review indicates no studies on the nature, significance, or impacts of the lack of SDOH coverage in Medicare home health. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 29 home care social workers between January 2013 and May 2014 in the New York City metropolitan area. Results indicate social workers believe the lack of SDOH coverage in Medicare home health results in exacerbation of existing patient conditions; creation of new, additional patient conditions; increased home care readmissions and re-hospitalizations; increased caregiver burden; and exacerbation of patients’ mental health and substance abuse needs. Policymakers are urged to consider adding coverage of SDOH to Medicare home health primarily through expanded social work coverage.

Revaluing Social Work in Home Care: Lessons From Innovators, Rebels, and Hospice

The Medicare and Medicaid home health benefits are extensive programs covering more than 4 million persons, costing $13 billion annually. However, these benefits have limited social work coverage, representing only 1% to 2% of all Medicare and Medicaid home health visits, and social work is not a required service under Medicaid. There has been limited research addressing home care social workers' frustrations with unmet patient needs but no research on coping strategies social workers use to deal with the devalued status of social work in home care. This article presents the results of an interview-based pilot study of the topic, using a convenience sample of 14 home care social workers in New York City interviewed in 2006. Policy makers and practitioners should take guidance from the innovator and rebel social work types and from the Hospice Medicare Benefit and create a more robust social work—based psychosocial care component in Medicare and Medicaid home health care.

Actualizing “Professional Altruism”

The Medicare home health benefit and the Medicare Hospice Benefit (HMB) differ significantly in social work coverage, with social work being only 1%-2% of national Medicare home health visits compared to about 10% of national HMB visits. There has been some research on the frustrations of home care and hospice social workers. However, there is no research that compares home care and hospice social workers. The article presents results of convenience sample interviews of 34 home care social workers and 42 hospice social workers in New York City from August 2006 to October 2007. The analysis finds that, in contrast to home health social workers, hospice social workers feel more able to actualize their altruism professionally; their professional training is more relevant to actual practice; their patients and caregivers have fewer unmet psychosocial needs; and their care is less constrained, and actually enhanced to a great extent, by payer requirements.

The FACES Project

This article reports on a research partnership between a community-based hospice and a graduate school of social work. The purpose of the collaboration was to design and test a tool for assessing caregiver strain and resources in families caring for older adults receiving hospice home care services. Eighteen hospice home care social workers interviewed 162 caregivers for the study and provided their own assessment of the tool's clinical utility. Both strengths and challenges of the collaboration are evaluated and implications are discussed for social work practice and research, particularly academic-community research partnerships.

Social work in psychiatric home care: regulations, roles, and realities.

Home care services for people with psychiatric diagnoses are increasing in popularity with consumers, providers, and insurance companies. Traditionally, home care social workers have not provided in-home clinical services because of restrictive regulations and industry culture. This article presents strategies for establishing a clinical role for social workers in a psychiatric home care program that meets Medicare, Joint Commission on Accreditation of Healthcare Organizations, and NASW standards. A discussion of skills requirements, appropriate case assignment, professional role clarifications and differentiations, and marketing strategies is presented.