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171_7-1.pptxSWU 171 Intro to Social Work
Dr. Hilary Haseley, PhD, MSW, ACUE
Overview
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Chapter 7
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Health
Health: A state of complete social, mental, and physical well-being
Illness: A disease or period of sickness impacting the body or mind
Western medicine tends to focus on identifying and healing disease or infirmity
Complex relationship between health and social factors
Chronic exposure to environmental and social stressors impacts health
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Threats to Health in the United States
Leading types of chronic diseases occurring in the United States: heart disease, cancer, chronic lung disease, stroke, Alzheimer’s Disease, diabetes, and chronic kidney disease
Some chronic diseases are preventable with lifestyle changes
Less advantaged people experience more chronic illnesses due to structural and environmental factors
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Threats to Health in the United States
Heart Disease
Includes angina, coronary heart disease, and congestive/congenital heart failure
Leading cause of death for women and men worldwide and in the United States
Differences in overall heart disease risk factors are pervasive across racial and ethnic groups
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Threats to Health in the United States
Stress
Stress is our response to change and can be healthy or unhealthy
Can impact a person’s thoughts, feelings, mood, body
Eventually can harm sleep patterns and overall health, leading to chronic diseases
Higher levels of stress add health concerns to burdens of minority communities
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Health Disparities and the Uninsured
Central principle of public health: Every individual should reach their full health potential
Health disparities are gaps between population groups in key health data
Major contributor: Access to health insurance
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Health Insurance
Typically pays for medical, surgical, prescription drug, and sometimes dental expenses
Managed care: A health-care system with administrative control over primary health-care services in a medical group practice. The goal is to reduce costs and eliminate redundant facilities and services
Health maintenance organization (HMO): A comprehensive health-care program and medical group that offers services for a fixed annual fee. HMOs typically have their own medical care facilities, staffed by health-care professionals
Preferred provider organization (PPO): A health-care plan that generally does not require copays but instead requires that patients cover a deductible (a preset sum for any service) for any benefits are provided
Point-of-service plan combines features of PPOs and HMOs
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Health Insurance
Public health insurance plans include Medicare and Children’s Health Insurance Program
Health care has historically been a major focus for US presidents
Clinton administration led to Health Insurance Portability and Accountability Act (HIPAA), created to ensure individuals and their families continuity of health insurance despite job changes and possible unemployment
George W. Bush implemented Medicare Part D, which is a prescription drug benefit
Medicare Part D: Prescription coverage, passed in 2007 under Bush
Obama introduced Affordable Care Act
Created a federal health-care mar
ACA made it illegal to deny coverage or raise rates due to a preexisting condition
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Affordable Care Act
Comprehensive health-care reform law
Expands health insurance coverage
Improves health outcomes
Controls health costs
Improves the US health-care delivery system
Expanded Medicaid as a public option
Insurance companies cannot deny coverage due to preexisting conditions
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Affordable Care Act
Young adults can remain on parents’ insurance until age 26
Yearly limits on coverage are barred
After the initial enrollment period, must pay tax penalty if you don’t have insurance
All insurance plans were to offer preventative care with no copayments and no deductibles by 2018
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Health Care Trends
Integrative medicine: Healing-oriented medicine that considered the body, mind, and spirit of people
Seeks to care for the whole person
Principles:
Partnership between client and practitioner is important
Preference for natural, effective, and less invasive interventions
Education about the importance of self-exploration and self-development
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Health Care Trends
Prevention and wellness
Often easier to prevent illness than to treat it
Encouraging healthy lifestyles and proactive health care
Recovery, rehabilitation, and resilience
Social workers can help patients reduce risk factors and increase protective factors
Aim to increase resilience: a patient’s ability to “bounce back” from difficulties
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Health Care Trends
Prevalence of autoimmune related diseases
Acute inflammation occurs in immediate or short-term aftermath of a disease, with symptoms designated by PRISH (pain, redness, immobility, swelling, heat)
Chronic inflammation lasts for months/years as a result of autoimmune disease, chronic irritant, or prolonged presence of a particular cause
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Health Care and Social Work
Social workers have long helped people cope with acute illness and terminal illness
Health social workers are part of an interdisciplinary team and must be familiar with medical concerns
1905 at Boston Massachusetts General Hospital—first medical social worker
First subset of social workers to organize as professionals
Engage in support and advocacy for patients in medical system
Also educate community about health issues and advocate for safer, more health-supportive living conditions
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Health Care and Social Work
Ensure high-quality, family/client-centered care
Advocate for clients’ rights, self-determination, informed consent, and confidentiality
Encourage social work involvement in developing/implementing best practices
Encourage participation in policy development regarding health care
Educate policymakers and public about social work’s role in health care
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Health Care and Social Work
Emergency room trauma and urgent care centers
May have long waits and high staff turnover, along with high costs
Uninsured people may rely on ERs
Social workers are cost-effective members of ER teams, helping keep costs down through advocacy, crisis intervention, and assessment, as well as assisting staff
Comprehensive role of social worker in the emergency room
Referral reasons received by ER social workers
Problems assessed and managed by ER social workers
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Health Care and Social Work
About 62% nonprofit, 20% government-owned, 18% for-profit
May integrate physical and mental health services
Most of a hospital social worker’s job is direct care: counseling and crisis intervention
Presentation title
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Health Care and Social Work
Veterans Affairs Hospitals
Largest health-care delivery system in the United States
Telehealth programs are helping to increase access to care
VA has been working to add mental health staff
Home health care
Both public and private
In-home nursing, therapists, and social work may all be a part of it
Demand expected to increase significantly for these services in coming years
Struggles with recruitment and retention during COVID-19 pandemic
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Health Care and Social Work
Long-term care
Often synonymous with nursing home care
Care that is too difficult for family/friends to provide
Law requires nursing homes with 120+ beds to have a social worker on staff
Social workers in these facilities make home visits, perform intakes, handle discharge planning, facilitate family meetings, and more
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Health Care and Social Work
Hospice, end-of-life, and palliative care
Hospice: Not a place but a concept implying comfort care for a patient diagnosed as having 6 months or less to live
Palliative care: An approach that improves quality of life for patients and their families who face issues connected to a life-threatening illness, through prevention and relief of suffering by early identification and excellent assessment and treatment of pain and other physical, psychosocial, and spiritual problems
Allows patients to die quietly, with dignity, rather than battling an inevitable end
Focus on caring rather than curing
Care can occur in a facility or at the person’s home
Presentation title
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Health Care and Social Work
Rehabilitation refers to helping a patient return to normal functioning after injury or illness
May refer to physical, mental health, or addiction-related recovery
Clinics
Doctors sharing offices, support staff, and equipment
May be public or private
Public clinics may be connected to hospitals, employ social workers
Some clinics are pro bono (free, for poor/uninsured people)
Public health services
Social workers in these sites focus on community health, educating the community about health concerns
These services provide vaccinations and other health needs
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Class and Health Care
Upper class has health-care advantages
More preventative services, better access to high-quality care
Higher education leads to better access to and understanding of health-care system
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Diversity Intersections in Health Care
Women live longer, are more likely to seek medical treatment for illnesses
Men are more likely to have chronic conditions, women acute conditions
Young gay/bisexual men have higher rates of several STIs
Adolescent lesbian/bisexual teens more likely to get pregnant
LGBTQ+ people are more likely to smoke and to be sexually assaulted
Important for social workers to know language/terms used by this population
Significant barriers to health care for LGBT populations
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Diversity Intersections in Health Care
Age
Greater demands, increased costs
Older population growing faster
Medicare and Medicaid costs rising
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Dynamic Advocacy with People Experiencing Health-care Challenges
Insurance can be confusing for people to access due to lingo and jargon
Social workers can help clients understand the system and meet their needs
Bureaucracy can prevent the recognition of chronic disease
Private and public hospitals differ in service delivery
Administrative costs and premiums vary, usually higher for private facilities
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Dynamic Advocacy with People Experiencing Health-care Challenges
VA must provide veterans with needed services by law
Social workers may particularly work with homeless and poor veterans
Social workers can also help VA patients access special programs they may not be aware of for easier care access
Social–environmental factors play major roles in health outcomes
Poverty is particularly malicious in its effects
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Dynamic Advocacy with People Experiencing Health-care Challenges
Rural health care is harder to access, and there are fewer choices available
Urban/Suburban residents have easier access to technology and often seek out care before a condition gets too serious
Accessing services may still require the help of a social worker to navigate the system
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Dynamic Advocacy with People Experiencing Health-care Challenges
Not everyone has equal access to care
Personal choice is important to people seeking care
Social workers can be important advocates for patients
Assumption of one optimal weight or BMI for all people by Western medicine
Importance of careful consideration of family history, cultural background, and previous attempts at dieting before urging weight loss or weight gain plans
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