MSW in the Acute Setting

karlitob

Hi all,

Wanted to get your opinions on this:

Are MSW necessary in an acute hospital?

Now before everyone gets very upset with me - let me explain. Without attempting to belittle the role of the MSW in the acute setting, I see that a referral is made for the majority of reasons to MSW to; increase supports at home (beginning/increasing home help, meals on wheels), linking in with community services (alcohol support groups for our alcohol excess patients), determining family/home set up, facilitating family meetings. Giving out information - Nursing Homes, Fair Deal, Medical Card, etc - but the MSW do not complete these - its simply information to family who must complete and submit to the relevant body.

I guess my point is that MSW are skilled in patient/family relations and counselling. Is it undervaluing the role and inefficient for our MSW to be performing the above roles. An OT and a discharge planning coordinator are extremely effective in facilitating discharge and have a greater knowledge of medical conditions.

For example, I wish for my patient to go to rehab hospital and its very difficult for this to happen as the patient is under 65. I had to ring the MSW who rang the bed manager (in this case, and often, a former nurse) who can get onto the rehab facility. She had difficulty understanding the clinical reasons for this and wanted me to meet with bed manager. It seemed, it is, an unnecessary step.

The majority of my patients (stroke) are having huge difficulties coming to terms with their condition - would counselling from the MSW be better for the patient rather than planning a discharge than can be done from other.

Now dont attack me - I'm just putting it out there and happy of course to be wrong.

locum-motion

Might help if you were to tell those of us who don't know what MSW stands for.

sillymoo

locum-motion wrote: »

Might help if you were to tell those of us who don't know what MSW stands for.

I'm guessing its a social worker of some sort but not 100% sure. Read it as MSU in the title first when I first saw it and that made the post very confusing!

karlitob

locum-motion wrote: »

Might help if you were to tell those of us who don't know what MSW stands for.

Medical Social Worker.

I assumed that if you didn't get what I was speaking about then you may not be able to comment - sorry about that.

Hope that doesn't sound smart-arsed - not meant to be

karlitob

sillymoo wrote: »

I'm guessing its a social worker of some sort but not 100% sure. Read it as MSU in the title first when I first saw it and that made the post very confusing!

Medical Social Worker.

Mid-Stream Urine would confuse this post! Apologies

locum-motion

karlitob wrote: »

Medical Social Worker.

Thought it might be something like that.

karlitob wrote: »

I assumed that if you didn't get what I was speaking about then you may not be able to comment - sorry about that.

Well, as it happens, I don't know anything about medical social workers, but not knowing the acronym doesn't automatically mean a person wouldn't have an opinion on it.

karlitob wrote: »

Hope that doesn't sound smart-arsed - not meant to be

It does, but I'll get over it!

karlitob

No one biting on this topic?

sunbeam

As a former carer of an elderly parent (now deceased), I have to say that my experience of dealing with a MSW a few years was very negative. My mother, who had Parkinson's disease (and many other ailments) was admitted to hospital after her condition deteriorated dramatically. After several very traumatic weeks, the MSW contacted me in order to discuss a discharge plan.

I was astounded to find out after talking with her for 15 minutes that she had no idea what was actually wrong with my mother. My mother had been in relatively good health up to this and I had hoped that given the right support she might have been able to come home. With the experience of hindsight, she was deteriorating so fast that this would never have realistically been a possibility, but I had no prior experience of Parkinson's disease and did not know this.

The MSW informed me that if I took my mother home, we would have to wait ten days to be assessed for home help. She did not seem to understand that it would be impossible for me to care for my now almost completely immobile mother on my own for that length of time with no help at all-and did not seem to care. As far as she was concerned, I wanted my mother to go home, that was the discharge plan. I reluctantly told her that without any help, nursing home care would be the only realistic option. MSW made a big deal of saying that this could only happen if my mother agreed it to it (which she did). Fair enough, I suppose, but what would have happened to her had she not agreed? She then gave me a copy of the Fair Deal booklet and told me to come back to her with any questions. She also asked me if I wanted counselling and offered to arrange some for me.

When I met her the next day it became glaring obvious that the MSW did not understand the Fair Deal Scheme and it appeared that she had not even read the booklet properly. She insisted to me that 'an asset is what you have in the bank' and that land was not an asset. When I politely disagreed she just fobbed me off and told me to ring the Fair Deal Section if I had any other questions. I was now in a very distraught state and asked again about counselling to be told 'could you not just go and talk to your friend?' I had previously told her that I had little support from family and just one good friend who was supporting me through that very traumatic time. Then off she tottered and that was the last I heard from her.

I realise that it may have been impossible to arrange counselling for me at short notice, but was I expecting too much for her to have actually read up on the basics of the Fair Deal Scheme, which she would have to advise family members about every day of her working life? For all the help I got from her, I may as well have just been handed a copy of the forms by a nurse and told to get on with it. My mother died soon after, so it turned out that the nursing home application was not needed after all.

Perhaps I was just unlucky-I'm sure that there have to be many better medical social workers than the one I encountered. After my mother's death my mental health deteriorated and I've been in contact with a mental health social worker in the community who has been absolutely wonderful and gone out of her way to help me.

karlitob

Hi

Thanks for your reply. You don't seem to have had a very professional or empathetic experience with the MSW. From my experience this is a rarity, but please let me go through your post and highlight what her thinking may have been and consider why MSW are unnecessary in the acute setting.

sunbeam wrote: »

I was astounded to find out after talking with her for 15 minutes that she had no idea what was actually wrong with my mother. My mother had been in relatively good health up to this and I had hoped that given the right support she might have been able to come home. With the experience of hindsight, she was deteriorating so fast that this would never have realistically been a possibility, but I had no prior experience of Parkinson's disease and did not know this.

This is one of my main points - MSW have no knowledge of clinical conditions or what requirements patients may have because of the condition. A nurse, as a discharge planning coordinator (DPC), is much better placed.

sunbeam wrote: »

The MSW informed me that if I took my mother home, we would have to wait ten days to be assessed for home help. She did not seem to understand that it would be impossible for me to care for my now almost completely immobile mother on my own for that length of time with no help at all-and did not seem to care. As far as she was concerned, I wanted my mother to go home, that was the discharge plan. I reluctantly told her that without any help, nursing home care would be the only realistic option. MSW made a big deal of saying that this could only happen if my mother agreed it to it (which she did). Fair enough, I suppose, but what would have happened to her had she not agreed? She then gave me a copy of the Fair Deal booklet and told me to come back to her with any questions. She also asked me if I wanted counselling and offered to arrange some for me.

MSW can only forward your details onto Home Help for their assessment - why cant a DPC do this? The MSW either knew that you would not be able to care for your mother but since she cannot effect a faster response time from the home help she just didn't care or again, she has limited clinical knowledge and unaware of patient requirements at home.

sunbeam wrote: »

When I met her the next day it became glaring obvious that the MSW did not understand the Fair Deal Scheme and it appeared that she had not even read the booklet properly. She insisted to me that 'an asset is what you have in the bank' and that land was not an asset. When I politely disagreed she just fobbed me off and told me to ring the Fair Deal Section if I had any other questions. I was now in a very distraught state and asked again about counselling to be told 'could you not just go and talk to your friend?' I had previously told her that I had little support from family and just one good friend who was supporting me through that very traumatic time. Then off she tottered and that was the last I heard from her.

Depending on when you interacted with the MSW this may not be too unreasonable. I remember when the Fair Deal came out there was zip information circulated. It was extremely hard to find any information on it so she may not have been aware of the ins and outs. Her lack of knowledge of an asset is again an example of a lack of knowledge regarding financial aspects as well as clinical but of course, one should contact their solicitor in all financial aspects.

With regard to counselling - again, one of my points, they are so busy doing stuff they need not do they could be better placed providing counselling. The only proviso is that she should only provide counselling to your mother, as a patient of the hospital, and not to you. But of course, forward details to an appropriate person to carry on your care. You obviously experienced considerable carer burden.

sunbeam wrote: »

I realise that it may have been impossible to arrange counselling for me at short notice, but was I expecting too much for her to have actually read up on the basics of the Fair Deal Scheme, which she would have to advise family members about every day of her working life? For all the help I got from her, I may as well have just been handed a copy of the forms by a nurse and told to get on with it. My mother died soon after, so it turned out that the nursing home application was not needed after all.

Another point - again, she can't advise - only provide information. A DPC can do that. Why the need for a MSW.



Anyone elses thoughts are appreciated.

sunbeam

Thanks for your reply.


I didn't actually ask her for counselling. She asked me if I needed it (as part of a long round of quickfire questions at our first meeting) and just gave me a number of a place with a three to four month waiting list. At that stage my mother had been through nearly two months of an horrendous hospital experience and I was close to a nervous breakdown. The social worker offered to see if she could get an earlier appointment for me. I can fully appreciate that this may not have been possible, but she just totally fobbed me off the next day, leaving me shaking and practically in tears. It's not the fact that she couldn't help that bothered me (I went back to my GP who was just wonderful) but her totally dismissive attitude. She didn't tell me if she'd actually bothered to contact the place at all-just told me in an offhand way to go talk to someone else. I hadn't even sought her out that day either-she had come looking for me.


The Fair Deal Scheme was formally announced eight months before my mother's hospitalisation and was in the pipeline for a few years before that. As a carer I had been under enormous pressure during the last few years of my mothers life, caring for her on my own 24/7, often with only two or three hours sleep. Yet when within a couple of hours of the scheme being formally announced, I managed to download the basic patient information from the web (can't remember if it was from the Departmental website or the HSE), as well as the formal legislation. It had been well publicised in the media that the scheme would take into account the applicants home, plus any land they owned. I did not actually ask the social worker anything about the scheme, just mentioned my concerns about this to her in passing and was very condescendingly and repeatedly told that this was not the case as land would not be taken into account. She just didn't seem to be aware of the basics. Once again my local GPs and public health nurse were far more informed.


From my very limited and hopefully atypical experience, I would definitely have preferred to have dealt with a nurse, as a discharge planning coordinator (DPC). I just feel that the particular MSW I dealt with was rather out of her depth.

karlitob

sunbeam wrote: »

Thanks for your reply.


I didn't actually ask her for counselling. She asked me if I needed it (as part of a long round of quickfire questions at our first meeting) and just gave me a number of a place with a three to four month waiting list. At that stage my mother had been through nearly two months of an horrendous hospital experience and I was close to a nervous breakdown. The social worker offered to see if she could get an earlier appointment for me. I can fully appreciate that this may not have been possible, but she just totally fobbed me off the next day, leaving me shaking and practically in tears. It's not the fact that she couldn't help that bothered me (I went back to my GP who was just wonderful) but her totally dismissive attitude. She didn't tell me if she'd actually bothered to contact the place at all-just told me in an offhand way to go talk to someone else. I hadn't even sought her out that day either-she had come looking for me.


The Fair Deal Scheme was formally announced eight months before my mother's hospitalisation and was in the pipeline for a few years before that. As a carer I had been under enormous pressure during the last few years of my mothers life, caring for her on my own 24/7, often with only two or three hours sleep. Yet when within a couple of hours of the scheme being formally announced, I managed to download the basic patient information from the web (can't remember if it was from the Departmental website or the HSE), as well as the formal legislation. It had been well publicised in the media that the scheme would take into account the applicants home, plus any land they owned. I did not actually ask the social worker anything about the scheme, just mentioned my concerns about this to her in passing and was very condescendingly and repeatedly told that this was not the case as land would not be taken into account. She just didn't seem to be aware of the basics. Once again my local GPs and public health nurse were far more informed.


From my very limited and hopefully atypical experience, I would definitely have preferred to have dealt with a nurse, as a discharge planning coordinator (DPC). I just feel that the particular MSW I dealt with was rather out of her depth.

I accept those points Sunbeam - thanks for sharing. A difficult time for you and I hope an isolated experience.

I dont think anyone else is interested in this topic. Not sure why = just keen to know any opinions

cambridge

karlitob wrote: »

Hi all,

Wanted to get your opinions on this:

Are MSW necessary in an acute hospital?

Now before everyone gets very upset with me - let me explain. Without attempting to belittle the role of the MSW in the acute setting, I see that a referral is made for the majority of reasons to MSW to; increase supports at home (beginning/increasing home help, meals on wheels), linking in with community services (alcohol support groups for our alcohol excess patients), determining family/home set up, facilitating family meetings. Giving out information - Nursing Homes, Fair Deal, Medical Card, etc - but the MSW do not complete these - its simply information to family who must complete and submit to the relevant body.

I guess my point is that MSW are skilled in patient/family relations and counselling. Is it undervaluing the role and inefficient for our MSW to be performing the above roles. An OT and a discharge planning coordinator are extremely effective in facilitating discharge and have a greater knowledge of medical conditions.

For example, I wish for my patient to go to rehab hospital and its very difficult for this to happen as the patient is under 65. I had to ring the MSW who rang the bed manager (in this case, and often, a former nurse) who can get onto the rehab facility. She had difficulty understanding the clinical reasons for this and wanted me to meet with bed manager. It seemed, it is, an unnecessary step.

The majority of my patients (stroke) are having huge difficulties coming to terms with their condition - would counselling from the MSW be better for the patient rather than planning a discharge than can be done from other.

Now dont attack me - I'm just putting it out there and happy of course to be wrong.

what are you trained to work as?

cutymonalisa

In Ireland, the work of a Medical Social Worker and potential to add to a holistic model of care is underdeveloped and undervalued. Go to any other western country and the MSW is an integral component of the team. Having said that, many of the MSW's in our hospitals have been there years, see themselves in handy numbers and have no will to push the importance of a patients social wellbeing and all the components outside of actual medical care and treatment that go towards overall recovery and wellbeing. Is it any wonder, thus, that often medics (i.e docs / nurses) see the MSW as an 'airy / fairy' sort of job?

karlitob

cambridge wrote: »

what are you trained to work as?

I'm not sure that would add to the conversation. I think it obvious that I am biased. I wanted to put the argument out there and get opinions on that.

karlitob

cutymonalisa wrote: »

In Ireland, the work of a Medical Social Worker and potential to add to a holistic model of care is underdeveloped and undervalued. Go to any other western country and the MSW is an integral component of the team. Having said that, many of the MSW's in our hospitals have been there years, see themselves in handy numbers and have no will to push the importance of a patients social wellbeing and all the components outside of actual medical care and treatment that go towards overall recovery and wellbeing. Is it any wonder, thus, that often medics (i.e docs / nurses) see the MSW as an 'airy / fairy' sort of job?

Thanks for your post.

I guess thats my point - MSW is underdeveloped and under supported. They should be more valued for their holistic approach and counselling. Therefore, is their any need for an MSW to review home help, fair deal, organise family meetings etc etc when a DPC can do it and do it better, IMO.

Surely, the MSW should not even be on the ward. Patients/family members should be brought to the MSW office for an appointment. Better use of time etc.

cambridge

you are criticising a health care professional from the perspective of a health care professional

For example, I wish for my patient to go to rehab hospital and its very difficult for this to happen as the patient is under 65

therefore it's pretty important to know what your actual job is. i'd speculate you're a student anyway.

karlitob

cambridge wrote: »

you are criticising a health care professional from the perspective of a health care professional



therefore it's pretty important to know what your actual job is. i'd speculate you're a student anyway.

Actually, as I say, it shouldn't matter what my job is.

I am a health care professional working in an acute hospital. I have many years of experience. I would have thought that that was self-evident as I am questioning the role of a MSW within the acute setting from the experiences that I have had over the past number of years.

Now please stay on topic, attack the post and not the poster, as per forum rules.

I have set out a motion that I feel that the MSW is a wasted role in the acute setting as their job has been undervalued to a place where they only provide information about home help, support services, fair deal and organising family meetings. My point is that this can be done more efficiently by a DPC who has clearly more clinical expertise than a MSW will ever have and that a MSW clear role is to provide counselling and other such services that my patients crave and need and MSW are not in a position to provide that service as they are performing the above mentioned role. I go on to say that surely the better alternative is to have DPC on every ward within every directorate and keep MSW in their offices where patients can be wheeled down to them for a counselling session thereby improving and developing the role of the MSW and maximising the time they can spend with patients.

If you have something constructive to say, I would love to hear it. If you want to tell me that I'm biased - well, I have acknowledged it a number of times. Get over it.

kwearykoru

To Sunbeam I are sorry you had such a negative experience. I wonder if you have tought about amdking a formal complaint. Complaints should be looked at as opportunities to reflect and learn. If it was HSE service you will find information on their website aboout the complaints procedure.

cutymonalisa

OP, an MSW is not a counsellor although emotional support is part of the role. Your assumption is similar to saying a physio is a chiropractor.......

sam34

karlitob wrote: »

Now please stay on topic, attack the post and not the poster, as per forum rules.

If you have something constructive to say, I would love to hear it. If you want to tell me that I'm biased - well, I have acknowledged it a number of times. Get over it.

leave the modding to the mods please

karlitob

sam34 wrote: »

leave the modding to the mods please

<Snip>
Please, please leave the modding to the mods
.

karlitob

cutymonalisa wrote: »

OP, an MSW is not a counsellor although emotional support is part of the role. Your assumption is similar to saying a physio is a chiropractor.......

Then what is the role of the MSW.