Helping Hearts

Home health social workers in the community

BY: KATE COLLINS and DEBRA BROOKER

Social workers serve with a helping heart and aim to transform the lives of those they interact with. We hold many roles that impact the community in different ways. One example is advocating for rights and services for individuals. Another role is brokering services, linking clients to a service they may benefit from. Social workers also conduct case management to locate and access services for clients.

One important aspect of social work is educating families and individuals on the myriad of available options, services and benefits. Social workers ofhelp families of nursing home resi

ten facilitate groups aiming toward the development of the community and self, such as policy change and therapy groups.

There are many settings in which social workers impact the community, including schools, hospitals, prisons, nursing homes, home health agencies and hospices. Home health social work is often the only link a homebound patient and his or her caregivers have with the community and its resources.

Patients come with a spectrum of existing support structures, including no support at all or a friend/family providing caregiving. Social workwithin the community to ensure holistic care for the patient and caregivers. It is the role of the social worker to instill the caregivers with hope and confidence, so they remain steady and strong through positive care of the patient.

Social workers at AAdi Home Health & Hospice take the time to listen to the specific needs of patients and their families. We help address the health issues that are often impacted by psychosocial factors, such as economic concerns, a patient’s lack of support with daily activities, difficulty coping with illness, making tough decisions including health and end-of-life decisions and difficulty communicating with community services.

We meet face-to-face with our patients in their homes or in facilities (when feasible, with some restraints imposed by COVID-19) and build rapport. Social workers can help assess needs and make appropriate referrals to local and state resources, as well as assist with referrals to community resources for help with food, utility assistance and other economic needs. We also troubleshoot problems with initiation and gaps in services, assist with advanced directives, provide information on resources to help with mental illness and educate on disease processes and factors of aging. One of the most common concerns we address is the need for interventions when patients are no longer able to care for themselves. Developing a relationship and observing the home environment assist in understanding the patient’s lack of ability to manage their activities of daily living, including health needs and personal hygiene. Nursing staff and social workers work as a team to communicate observations and concerns related to that patient to the physician.

Often, family members are not able to assist their loved ones due to living and working in other states or other parts of Texas. AAdi social workers can ers in home health collaborate with agencies

dents, who have been unable to visit their loved ones, learn about relocation programs that may make care in the community possible.

Social workers with AAdi participate in weekly meetings with the nurses, chaplains and physicians to better understand the needs of patients and their families, in order to address any psychosocial concerns. We play a vital role in the interdisciplinary focus at AAdi to ensure that the needs of our patients and families are met.

Kate Collins, LMSW, and Debra Brooker, LBSW, are medical social workers at AAdi Home Health & Hospice. They may be reached at kcollins@aadihh.com and dbrooker@aadihh.com, respectively. For more information, call AAdi at 361-452-3384.