Why Long Term Care Settings Pose Unique Challenges for Social Workers

By Lina Becker

Social workers in long-term acute care hospital (LTACH) settings experience a range of challenges that are generally unique compared with those experienced by their peers.

The importance of their roles and functions in long term care (LTC) facilities deserves the industry’s utmost attention. Social workers are essential members of any health care team and serve in a variety of key capacities, including liaising between patients and care communities, to optimize patients’ quality of life and care.

The Roles of Social Workers in LTACH Settings
The roles of social workers in LTC settings will vary according to the ages, health statuses, and individual needs of their patients. Social workers in LTC settings can play the following roles:

assisting in patients’ transition from acute care hospitals into LTC facilities;
assisting patients in identifying the resources they need to meet their specific needs;
working with the families of patients to deal with certain aspects of illnesses and conditions that patients are suffering from;
preadmission and discharge planning; and
completion of part of the minimum information required for each patient.

LTACH social workers will also do the following:

contact and use community resources on behalf of patients in LTC settings;
help ensure that each patient’s emotional and social needs are being met;
ensure that each resident in the long-term facility has as much independence and autonomy as possible; and
participate in residential care planning as part of a skilled interdisciplinary team.

Challenges Faced by LTACH Social Workers
As we explore social workers’ key roles in more detail, we’ll delve into the unique challenges they face in LTC settings.

According to ResearchGate, social workers in LTC settings experience high levels of stress. Increasingly high workloads, poor working conditions, and the challenges posed by an aging world population cause stress.

Transitional Services
Many social workers assist people who are entering LTACHs to ensure that they make a smooth, low-stress transition. Once the patient has entered their new setting, the social worker continues to ensure that the patient’s needs are met by participating in planning for continued care.

This role alone can pose many challenges. Many patients are hesitant or resistant to enter LTC and are unwilling to communicate with social workers during the transition. They may experience trauma from the transition, especially if they suffer from cognitive or physical impairments.

Social workers are tasked with handling patients who are traumatized or resistant in a way that maximizes their level of care without impacting their autonomy or going against their personal wishes.

Identification of Resources
Social workers assist patients in identifying resources to meet their individual needs. They serve as patients’ advocates when dealing with insurance providers to ensure the best possible levels of coverage. Serving as a patient’s advocate is an important role for any social worker. But they can face many hurdles.

For example, it’s challenging to work with patients who are nonverbal or cognitively impaired; it may be difficult to identify their needs and the appropriate resources to fill them. Some patients are neither fully aware of these needs, nor able to communicate them.

Due to a variety of socioeconomic factors, some patients may have extremely limited resources at their disposal. This forces care workers to find alternate solutions or look to sources of external funding.

Liaising With Patients’ Families
LTACH social workers spend much of their time with patients’ families and friends. They help patients and their families to deal with many aspects of specific illnesses, including learning about them, the diagnosis, and steps in the recovery process.

Social workers offer steps that will ideally lead to a safe recovery. But they are also tasked with breaking difficult news, such as that of terminal or untreatable illnesses, or news of expensive treatment routes to financially strained families.

They may need to deal with family members who are estranged from the patient, or that poorly impact the patient’s wellbeing when present.

The Way Forward
In every case, a social worker endeavors to provide a physical care environment that’s supportive of a patient’s well-being. They do this while promoting a feeling of independence, encouraging healthy activities and social contact, and facilitating autonomous decision-making opportunities wherever possible.

Social workers face numerous challenges in LTACH settings. These range from liaising with patients who are nonverbal or cognitively impaired and identifying limited resources to meet the needs of the financially strained or impoverished to finding ways to meet patients’ social and care needs. All without working against their wishes or limiting their autonomy without cause.

Larger issues, such as political economic reforms and changing staff and resident populations, may affect social workers’ abilities to administer a consistent quality of care.

Ultimately, it’s crucial for workers’ employment agencies to equip them with the appropriate skills to deal with aging and ill populations, and to develop a sustainable and highly skilled LTACH workforce to optimize patient care for years to come.

— Lina Becker started her career in education as a remedial teacher. In 2012 she became a freelance editor, working with various media outlets where she covers topics ranging from education and productivity to self-care.