Key Takeaways
- Hospital social workers facilitate discharge planning, connect patients with resources, and provide psychosocial support
- Hospice social work focuses on end-of-life care, grief support, and helping patients and families navigate the dying process
- Health disparities are systematic differences in health outcomes based on race, ethnicity, socioeconomic status, and other social determinants
- Advance directives (living wills, healthcare proxies, DNR orders) document a patient's wishes for end-of-life care
- Interdisciplinary teams in healthcare include physicians, nurses, social workers, case managers, and other specialists
- Discharge planning in healthcare settings must address continuity of care, medication management, follow-up appointments, and home safety
- Social determinants of health (housing, food, transportation, education) significantly impact health outcomes
Healthcare Social Work
Healthcare social work is one of the largest and fastest-growing areas of social work practice. Social workers in healthcare settings serve as advocates, counselors, care coordinators, and connectors between patients and the resources they need. The ASWB exam tests your knowledge of healthcare settings, interdisciplinary practice, health disparities, and end-of-life care.
Hospital Social Work
Hospital social workers (also called medical social workers) play a critical role in acute care settings. Their primary responsibilities include:
Key Functions:
- Psychosocial assessment: Evaluating the emotional, social, and practical needs of patients and families
- Discharge planning: Coordinating a safe transition from hospital to home, rehabilitation, skilled nursing, or hospice
- Crisis intervention: Supporting patients and families during medical emergencies, new diagnoses, and end-of-life situations
- Resource linkage: Connecting patients with insurance, financial assistance, transportation, housing, and community services
- Patient advocacy: Ensuring patients' rights, preferences, and cultural needs are respected
- Grief and loss support: Helping patients and families cope with diagnosis, disability, or death
- Advance care planning: Facilitating conversations about end-of-life wishes and advance directives
- Ethics consultation: Participating in hospital ethics committees to resolve complex ethical dilemmas
Hospice and Palliative Care
Palliative care focuses on improving quality of life for patients with serious illnesses, regardless of prognosis. It can be provided alongside curative treatment.
Hospice care is a specific type of palliative care for patients with a terminal prognosis of 6 months or less (as certified by a physician) who have chosen to focus on comfort rather than cure.
| Aspect | Palliative Care | Hospice Care |
|---|---|---|
| Prognosis | Any serious illness, any stage | Terminal, 6 months or less life expectancy |
| Treatment | Alongside curative treatment | Comfort-focused, no curative treatment |
| Setting | Hospital, outpatient, home | Home, inpatient hospice facility, nursing home |
| Coverage | Insurance-dependent | Medicare Hospice Benefit covers most costs |
| Eligibility | No specific eligibility criteria | Physician certification of terminal prognosis |
Social Work Role in Hospice:
- Providing emotional support and counseling to patients and families
- Facilitating family meetings and communication about end-of-life preferences
- Assessing and addressing psychosocial needs (grief, anxiety, family conflict)
- Connecting families with community resources and bereavement support
- Helping with advance directive completion and understanding
- Supporting caregivers and addressing caregiver burden
- Providing bereavement services to families after the patient's death (typically for 12-13 months)
Advance Directives
Advance directives are legal documents that allow individuals to express their wishes for medical care in the event they become unable to communicate or make decisions.
| Type | Description |
|---|---|
| Living Will | Specifies what medical treatments the individual wants or does not want at end of life (e.g., mechanical ventilation, tube feeding, resuscitation) |
| Healthcare Proxy / Durable Power of Attorney for Healthcare | Designates a trusted person to make medical decisions on the individual's behalf if they become incapacitated |
| Do Not Resuscitate (DNR) / Do Not Intubate (DNI) | A medical order (not just a directive) that instructs healthcare providers not to perform CPR or intubation |
| POLST/MOLST | Physician/Medical Orders for Life-Sustaining Treatment — a portable medical order that translates patient wishes into actionable orders |
Key Legal Principles:
- Advance directives are governed by state law and vary by state
- The Patient Self-Determination Act (1990) requires healthcare facilities that receive federal funding to inform patients of their right to create advance directives
- Social workers should facilitate advance care planning conversations proactively, not just during crises
What is the PRIMARY difference between palliative care and hospice care?
Health Disparities and Social Determinants of Health
Health disparities are systematic, preventable differences in health outcomes that are closely linked to social, economic, and environmental disadvantage. Social workers play a crucial role in identifying and addressing the social determinants of health — the conditions in which people are born, grow, live, work, and age.
Major Social Determinants of Health:
| Category | Examples | Impact on Health |
|---|---|---|
| Economic Stability | Poverty, employment, food security, housing stability | Poverty is the single strongest predictor of poor health outcomes |
| Education | Literacy, language, educational attainment | Higher education correlates with better health behaviors and outcomes |
| Healthcare Access | Insurance coverage, provider availability, cultural competence | Uninsured individuals delay care and have worse outcomes |
| Neighborhood/Environment | Housing quality, transportation, safety, pollution | Environmental hazards disproportionately affect communities of color |
| Social/Community Context | Social support, discrimination, incarceration history | Social isolation and discrimination increase morbidity and mortality |
Racial and Ethnic Health Disparities:
- Black Americans have higher rates of maternal mortality, infant mortality, hypertension, diabetes, and COVID-19 mortality
- Hispanic/Latino Americans face barriers related to language, immigration status, and insurance coverage
- Native American/Alaska Native populations experience disproportionate rates of diabetes, suicide, substance use, and historical trauma
- Asian American populations are diverse, with significant variation in health outcomes across subgroups
Social Work Role in Addressing Health Disparities:
- Screening for social determinants using standardized tools
- Connecting patients with resources that address basic needs (housing, food, transportation)
- Advocating for policies that reduce health inequities
- Promoting culturally responsive care within healthcare systems
- Conducting community needs assessments and developing programs to address identified gaps
- Participating in research to understand and address disparities
Interdisciplinary Teams in Healthcare
Social workers on interdisciplinary teams collaborate with:
- Physicians: Medical diagnosis and treatment decisions
- Nurses: Patient assessment, medication management, care coordination
- Physical/Occupational therapists: Rehabilitation and functional assessment
- Pharmacists: Medication review and education
- Chaplains: Spiritual support and end-of-life care
- Case managers: Care coordination and resource linkage
- Dietitians: Nutritional assessment and counseling
Social Worker's Unique Contribution: The social worker brings a unique perspective to the team by focusing on the person-in-environment — understanding how social, cultural, economic, and family factors affect the patient's health and recovery. Social workers advocate for the patient's psychosocial needs, facilitate family communication, and address barriers to care that other team members may not identify.
According to research on social determinants of health, which factor is the SINGLE strongest predictor of poor health outcomes?
A healthcare social worker's UNIQUE contribution to the interdisciplinary team is:
Which of the following are types of advance directives? (Select all that apply)
Select all that apply
The federal law that requires healthcare facilities to inform patients of their right to create advance directives is the __________ Act of 1990.
Type your answer below
A hospital social worker is arranging services for a patient being discharged after hip replacement surgery. The patient lives alone and needs assistance with daily activities. The MOST appropriate referral is to:
A patient with a terminal diagnosis of 4 months to live wishes to focus on comfort and quality of life rather than curative treatment. The MOST appropriate referral is to:
Which racial/ethnic group experiences the highest rates of maternal and infant mortality in the United States?