Harbor:Social work

Social Work Consultation Guidelines

Generally, please call Social Work early if you anticipate any issues so they can get things during business hours and get to families before they leave. Consult by placing a social work order in Orchid (documents consult time).

1. SW Order Indications

Choose the indication that best fits your clinical need/question. Special instructions are helpful.

Lack of Resources

Those who need help connecting with resources (financial, placement, housing, food, transportation, etc)

  • Community resources - food banks, gov benefits
  • Disability - how to apply for disability (not for filling out application itself)
  • Discharge planning/placement - when a patient needs placement to a facility of lower acuity than an acute care hospital (not to be used if homeless)
  • Homeless - for housing/resources. If patient has chronic physical and mental health problems, ask for patient to be signed up for Housing for Health.
  • Hospice - still need to place a home-health order (only if going home on hospice, not a care facility)
  • Transportation - transportation home or to appointments, see section 1.2
  • Crisis/Trauma - SW is consulted automatically for all TTAs. Ask for referral to Violence Prevention program if victim of violent crime (shooting/stabbing, etc)
Poor judgement/Substance Abuse
  • Behavioral issues
  • EtOH related trauma - SW provides a screening & brief intervention
  • Non-compliance
  • Poor communication
  • Positive toxicology screen - mainly used in peds
  • Refusal of treatment
  • Substance abuse - SW will provide screening & brief intervention
Psychosocial Support

This category has a lot of overlap with psychiatry.

  • Adjustment to illness - for psychosocial assessment by SW, help provide coping skill
  • Anxiety
  • Crisis/trauma - see above
  • Depression
  • End-of-life issues - for family or patient, help with GOC discussions
  • Family conflict
  • Grief/bereavement
  • HI
  • Mental health - SW can provide more resources than just the DMH list, provide full assessment of patient's financial abilities and other social factors
  • New diagnosis - overlaps with Adjustment to Illness
  • Poor coping
  • SI
  • Teenage pregnancy - provide resources & support
Regulatory/Legal Issues
  • Adoption
  • Advanced directive
  • AMA
  • Domestic Violence
  • Reportable pressure ulcer - Stage 3+ ulcers upon presentation. SW will contact adult protective services (if coming from home) or ombudsman (if coming from a health care facility).
  • Suspect child abuse
  • Suspect elder/dependent elder abuse
  • Unidentified person
Nonspecific
  • Other
  • Assessment

J Singh 7/7/17

2. Transportation home:

  • bus:
  1. during day 8-4:30 - send to s/w office / page s/w for bus fare voucher
  2. nights/wkends/holidays - call nursing's supervisor @ x3434 to approve bus token and then pt can pick it up from ER registration
  • taxi:
  1. If pt is UNINSURED - limited number of vouchers - if MEDICALLY necessary (ie can't take bus for medical reason) - s/w can help with this
  2. If pt is INSURED (including medi-cal) - some insurance companies will pay for taxi (pt may have to wait a few hours) - consult s/w and they can help figure it out
  • ambulance: for patient's that have a medical necessity (cannot ambulate, here w/o wheel chair, etc) and medically cannot take a taxi
  1. If pt is INSURED (including medi-cal) - the insurance company will pay for an ambulance home
    1. UR can help with insurance specific contact info for coordination of ambulance
    2. May be limited by patient's home location (i.e. LA vs Torrance, etc)
  2. If pt is UNINSURED (including restricted medi-cal) - use county transport to get an ambulance home
    1. If pt lives outside of LA County, call nursing supervisor or SW as they may need further authorization

J Singh 5/9/17

  • kids without car seats: For kids who arrive (usually by ambulance) w/o a car seat, we do not have car seats available. however, options are:
  1. take the bus home (no need for car seat)
  2. have someone bring a car seat and pick them up or go home in a taxi with the car seat that is brought
  3. if a. or b. will not work, can try arranging for ambulance (see section above)

3. Patient who are homeless:

a. Homeless Task Force - looking for patients with chronic illness (HTN, diabetes, psych, etc) who have had 2+ visits. Put in s/w consult and choose "Homeless" under reason for consult, NOT "Discharge planning/placement". If eligible - they will help sign up the patient - however, they may be on a waitlist for days to months. If an potentially eligible patient is stable for discharge, you may refer them to contact the Homeless Task Force with the following number: 310-848-3325.

b. Patients discharged overnight who are not safe to go out into the night CANNOT wait in the ED lobby. However, they can wait in the main hospital lobby in front of the social work offices to speak with social work for resources on housing in the AM. However, please try to consult SW during the ED visit if possible as there is overnight staff available.

J Singh 7/15/17

5. Patients whom family is no longer able to take care of

Please page social work asap - before family leaves - s/w will work with them to see if:

a. IN HOME SUPPORT SERVICES (IHSS) - Medi-Cal program - can either be started or have hours increased (to help with supervision, cooking, bathing, grocery shopping, other ADLs)

b. other community resources are available

c. help family brainstorm other ideas

d. if family dumps patient and doesn't respond, s/w may file an adult protective services report

e. if the patient truly needs to be placed and resources and strategies of a/b/c do not work, per Dr. Wu, please place in obs and the inpatient team will work on placement from there

6. Pt/family not happy with current skilled nursing facility (SNF)

a. generally, this is not an appropriate use of the ED - the family needs to work with the SNF s/w to facilitate transfer to another SNF, exception point c. below

b. if actual abuse, s/w at Harbor can help with ombudsman report

c. APPROPRIATE if pt needs a HIGHER level of care b/c of medical needs - then s/w at Harbor can help

d. Different levels of care are outlined in slides (attached) - shelter vs respite vs board and care vs SNF vs ?

7. Clothing rack / clothing for patients

a. s/w has a small stash in ED - consult/page to get access

  • Located behind double doors in ambulance bay. NA-7 key for access.

b. volunteers office has another stash but only open 8-5 M-F

ED stash is in need of donations for men's pants, flip flops, sweat pants, sweat shirts

J Singh 5/9/17

8. Patients who need PT/OT for placement

a. place the patient in obs for placement and PT/OT evaluation - this way the hospitalist can then admit the patient from obs if they cannot get PT/OT (which they more likely than not cannot) - this is needed to document the need for PT/OT so we can get resources (it shows how many avoidable admissions there can be as the ED hospitalists are collecting this data manually).


See Also

References

Authors:

Ross Donaldson