An Evaluation of the Service Intensity Add-On Payment Policy Reform in the Medicare Hospice Benefit

In 2016, the Centers for Medicare & Medicaid Services (CMS) implemented the Service Intensity Add-On (SIA) payment, which incentivized skilled nurse and medical social worker (SN/MSW) visits in the last seven days of life. Little is known about the impact of this initiative. Using 100% Medicare hospice claims, we identified a 10% random sample of Medicare hospice beneficiaries utilizing routine home care service during calendar years 2012-2018. We compared the provision of SN/MSW visits on service dates before and after the SIA’s implementation relative to beneficiaries’ date of death. We also determined hospice providers’ success in providing SN/MSW visits in the last days of life and categorized all providers into quintiles according to the average rate of these visits in the period prior to the SIA’s implementation. Cumulative over the last seven days of life, we calculated an increase of 15.7 SN/MSW minutes (95% confidence internal [CI] 14.9-16.5 minutes) per beneficiary after the SIA was implemented. The per-minute increase was greatest on days nearer to death (4.0 minutes day of death, 95% CI 3.6-4.2). There was no detectable visit increase on days which were ineligible for the SIA. Additionally, those providers in the quintile providing the lowest rate of SN/MSW visits pre-SIA exhibited a 14-percentage point increase in rates of these visits, the third, fourth, and fifth quintiles exhibited little change over time. Further monitoring is needed to ensure beneficiaries receive adequate end-of-life care.

FAMILY INTERVENTIONS TO DEAL WITH PSYCHO SOCIAL PROBLEMS OF CARETAKERS OF PERSONS LIVING WITH CANCER – CASE STUDY

Family has a central role at the time of crisis. When an individual suffers with terminal illness like Cancer it definitely becomes more supportive. But in a crisisful situation like such, the family requires supportive interventions. This article presents a case study of primary caretaker of a cancer patient who undergoes severe psycho social challenges. Aim of this paper is to highlight the need and effectiveness of family intervention by Medical Social Worker through a case study. Psycho education to family, team work, utilizing the resources has shown remarkable results in reducing the psycho social problems of caretaker. Family environment plays a very significant role in psycho social support of its members. Positive environment and family socialization experiences enhances one’s ability to cope with stress and anxiety. Hence family interventions for caretakers of persons living with cancer can support both care givers and patients. Multidisciplinary approach in cancer care is the need of the hour. It can build a proper support mechanism for the person suffering from cancer and his family. The most important implication of the current study is the unveiling of the need for Medical Social Workers in oncology settings and the interventions they can deliver. A professionally trained medical Social Worker, equipped with psycho social skills to work with caretakers, patients and their families can be a effective oncology Social Worker

Diabetes Education and Counseling Using Solution-Oriented Questions

Solution-focused brief therapy (SFBT) utilizes the client’s strengths and resources to the fullest to achieve what the client wants, rather than looking at the client’s problem pathologically and digging deeper into analysis. Therefore, in this article, we would like to introduce a SFBT that can be usefully applied to the education and counseling of diabetic patients in the clinical field. Pre-session change questions, rewarding questions, miracle questions, exception-finding questions, scaling questions, relationship questions, and coping questions used in SFBT consist of the questions that allow the client to answer positively. In this process, a medical social worker pays full attention to remarks that suggest clues to the client’s potential for change, the change the client wants, past experiences that have been successful, and what has already been attempted to make the situation better. Also, when setting goals, it’s important to target positive behaviors rather than eliminate the problem and what’s important to the patient and small, specific, clear, and actionable things. SFBT no longer focuses on or talks about the client’s problem. The client has the resources and strengths to solve the problem. Rather than exploring the cause of the problem, it is important to find a clue to the solution and connect it to actual action, so you can use the solution question techniques to get the client to practice using their strengths. In the treatment field, we recommend that the client remember and ask a few questions with the belief that they can solve them on their own.

COVID-19 Social Work Scope and Intervention in A Tertiary Care Hospital

The novel coronavirus has hit the routine life of the people crossing countries and not spared anyone in existence. In terms of screening and treatment of the infected a multidisciplinary team in full force is working around the world. Social Work, a profession that has an understanding of the psychosocial intricacies of people is also at the frontline. In this article, the author who himself a Medical Social Worker attempts to elicit the scope and possible interventions for the COVID-19 victims

The Medical Social Worker: A Neglected Ally in the Management of Patients with Burn Injuries

Burn injuries come with enormous challenges and devastation to the victims. The consequences get worse when multiple members of a family are involved. Social supports are necessary, especially where health financing is mainly through out-of-pocket expenditure. The use of Medical Social Workers (MSW) in burn care in our region is limited, and their roles are poorly or inadequately reported. This study appraises the role of MSW in the multidisciplinary management of burn patients. We report the management of an impoverished family of five who sustained varying degrees of burn injuries, and the role MSW played in their care. Beyond being a routine discharge planner, the MSW provided social support, psychotherapy and rallied community support, which translated to an improved outcome for the patients. Involving MSW in burn care provides great benefit to patients. Burn surgeons are therefore encouraged to use the added value of MSW on their teams. Keywords: Burn, Injury, Medical social worker, Healthcare financing

BURNOUT OF SOCIAL WORKERS AT Dr. HASAN SADIKIN BANDUNG CENTRAL HOSPITAL

The high workload can cause burnout. Burnout makes the worker not pay attention to the person he helped, thus reducing the quality of service. The research method used is descriptive research method with qualitative approach. The informant consisted of 11 people, two medical social workers, three medical social worker partners, and six medical social worker patients. The result of the research showed that: a) medical social workers experiencing burnout with the most emerging aspect of emotional exhaustion, b) depersonalization aspects, medical social workers showed apathetically and acting callous at work, c) medical social worker feel they can't work optimally but in the reality, they have good performance based on Indeks Kinerja Individu (IKI), d) Medical social worker can keep working with good performance because of their love to the profession, e) The burnout shown by medical social workers has no effect to the helping process to the patient in Dr. Hasan Sadikin General Hospital. The main factors of burnout of medical social workers is a barrier in their career, which leads the medical social worker can't get their rights based on their performance and education.

Osteoporosis Patients with Fall-Related Injuries in Residential Environments: Challenges for Social Work

The study describes the osteoporosis patient’s need of support from medical social workers because of risks and injury events in residential environments. The study includes qualitative interviews of patients and a survey of medical social worker visibility in the media. Findings show that patients feel a lack of knowledge, recognition, and moral respect from the environment. Support from a medical social worker is significant, and activation in a patient association and an osteoporosis school is seen as employing valuable information channels. However, these have a fairly limited visibility in the media, when it comes to describing support opportunities and preventive work.