More Than ‘Value-Added’ Pieces

Elizabeth J. Clark, Ph.D., ACSW, MPHFrom the Director

Jane Addams said, “The good we secure for ourselves is precarious and uncertain until it is secured for all of us and incorporated into our common life.” Recently, when I had an early morning medical appointment, I was reminded of this quote.

Like many people who have worked in health care, I have an aversion to “patienthood.” I toyed with the idea of calling and rescheduling — putting it off until the following week or even the next month. I knew that would simply make my schedule more difficult, so at the appointed time I was sitting in the waiting room. I had easily driven the mile or two in my air conditioned car. It was one of those hot, humid days that we all hate in D.C.

As I sat there, another woman arrived. She appeared to be in some distress. She explained that her car wasn’t working, nor was she. She was out for three months on unpaid medical leave and couldn’t afford to get her car fixed. She had given birth to her fourth child about five months ago, and she experienced a heart attack right after delivery. She spent a month in the hospital and didn’t get to hold her baby until she was discharged. Her diagnosis was congestive heart failure and she was at the doctor’s office because of swelling in her ankles.

As we chatted, she told me that she had taken a bus to the appointment, but the bus stop was quite some distance away, and she had walked to the medical office. Given her diagnosis and the heat index, her physical distress was easy to explain.

As I listened to her story, I felt a bit ashamed that I was considering canceling my appointment simply because I found it inconvenient. I didn’t have to arrange child care. I had a working car with air conditioning, and no one at work would complain if I came in a bit late.

The discrepancy in our situations and in our resources made me think about health care disparities and the fact that insurance is only one part of the issue. My co-patient had health insurance. She even had family medical leave, but her paid leave had been exhausted with the birth of her baby and her own hospitalization.

Granted, she had a serious medical condition, but that morning her social issues were the major stressors. There is often a spiraling effect. A woman can’t find child care or transportation, or money for co-pays and prescriptions. An appointment is missed. The condition worsens. All of the problems are magnified and the cycle begins again.

The Affordable Care Act has an emphasis on keeping patients from being readmitted to the hospital within 30 days of discharge. When patients leave, they are generally medically stable and they are usually given adequate health information including directions for follow-up care. Yet, too often, no one asks the important practical questions: Can you afford your medications? Do you have a way to get to your appointments? How can we help you adhere to your treatment regimen so that you can regain your health?

This is the role for a health care social worker or a social worker in a case management or patient navigation role. We have always looked at the “patient-in-environment.” Our assessments are broad and include a biopsychosocial approach. We understand the many barriers to optimal care and the difficulties individuals face in trying to access and afford that care. In the act of helping others, we also put in motion a process that can ultimately create widespread, systemic change that can improve the entire health care system.

As health care reform moves forward, social work needs to move backward and reclaim its place of importance in both the hospital and the health clinic, on inpatient floors and outpatient settings. We have data to show our effectiveness in a variety of places that provide health care such as hospitals, dialysis and oncology centers, palliative care units, nursing homes and hospices.

In recent years social workers have been mistakenly considered “value added” in health care. That has never been the case. Now we have not only an opportunity but an obligation to help individuals like my co-patient prevent, manage and recover from illness.

Social workers are integral components of a system that has been broken for too long.