Five things social work contributes to healthcare (and other professions)
Doing 'as well as we can'
A lot of people can’t quite make out what social workers do, and this is why some have doubts about whether there’s any point to social work.
One of the issues is that they can understand what a doctor, say, or a teacher does, but not how social work fits in with that. It’s mainly because they have experience of that but not of what a social worker contributes.
This is not new: I was recently looking at a 1921 report on these new-fangled social work departments in American hospitals, and it was trying to tackle this kind of hiccup in people’s knowledge and understanding.
I’m always grateful, therefore, when I come across someone who has sorted their ideas out about what a social worker contributes to another profession’s work. A now fairly elderly article (about the fairly elderly) by Paul Bywaters (1995) that I came across recently is an example.
We can all see that a doctor would have the education and experience to assess the health of an older adult. What does the social worker offer? Five things, he explains.
Health concepts. What is it to be healthy? A healthcare worker might think it’s not having symptoms of this and that, or an illness or disability.
And we all understand that a doctor comes at assessing health to see if they can find anything physical that’s out of kilter. But research says if you ask an older person themselves, they’re more likely to say that being healthy is about being having a positive experience of their lives, or being reasonably active or able to do the things they want to do. A social worker does not come at an older adult only looking for physical things.
I recently talked to a woman in her nineties, living alone, for example, who, astonishingly for someone that age, took no medication of any kind, could get around her house and do most things for herself. In the cold weather, though, she was a bit down.
Although someone did her shopping for her, she was a bit bored with the regular supplies, but now was not fit enough to wander round a shop and look for something to eat that was a bit new and interesting. Physically healthy but not really living a good life.
A doctor or nurse could identify and work on such things, but it’s not their priority, not what they’re there to do – given the pressures of their work, their priorities are elsewhere. A social worker can ask those questions and think out ways of doing something about it. It’s often a useful add-in to healthcare.
Health choices. People are not very good at ‘complying’ with medical advice. What happens is that they fit the things they are told to do about some medical treatment around the things that are important to them in life.
A simple example: my eye nurse would like me to put the eye drops in every twelve hours, but this doesn’t work for me, I use the fiddly eye-dropper thing when I go to bed and when I get up about eight hours later. I also know it’s not good for infection control if carry it around to do at other times. And I’m still doing OK. But my friend who has to do it every two hours, has an alarm on her phone, and we’re all used to her walking out to do the eye-dropping in the middle of anything she’s doing. She has rightly assessed that it’s serious stuff. People sometimes need help in making these slightly medically delinquent judgements, or in realising that it really is important, so you have to do it. Social workers to the fore again.
Meeting social needs. You have to look at the knock-on effects of an illness for both the patient and the people around them.
Do they have decent housing to manage their illness, do they have access to transport to get to see their children and friends, can they get to church or other social activities. Or, as their social worker, can you arrange for it?
I was once involved in end-of-life care for someone with cancer who lived with his wife in a studio apartment; that’s a living room and bedroom combined, often including the kitchen, too, with a bathroom. Cancer sometimes eats through your blood vessels, and this happened one evening when his daughter was visiting. It was a major artery, which proceeded to squirt blood across the room, as he lay dying in his daughter’s arms. The ambulance got there in good time but too late.
After his death, aside from the doctor sedating the traumatised daughter, they needed to be found somewhere to stay, everything in the apartment had to be junked and serious cleaning had to take place before it could be relet. They understandably moved on, they didn’t want to live there again.
Really, with this in prospect, you would want to arrange for someone in this position to be somewhere that would allow for managing such a crisis. But the shortage of housing being what it is, and with the wish of many people to be in their home as their life comes to an end, something like this happening is inevitable from time to time.
Often you can never tell in advance if it really is going to happen. But after it’s happened, you’re going to need someone to help sort out the consequences. Its likely to be a social worker who does that, rather than a doctor or nurse.
Lay or alternative health work. Social workers can encourage people to think about whether alternative health practices can help them.
This includes the formally alternative, like yoga, or the osteopath, that medical thinking approves of. But something like reiki, a Japanese complementary therapy, is appreciated by lots of people; it helps them relax and cope generally with life. Just having people to spend time with and listen to them also helps. Someone prepared not to think on the tramlines of what healthcare research has told you is effective is sometimes valuable.
Social inequalities. Social workers can also assess, and put into the healthcare treatment programme, factors in people’s lives such as pollution or prejudice that have contributed to their health condition or made their lives more difficult, and as a consequence made looking after themselves healthwise difficult, too. A chance to explain, talk about and have some action taken is another social contribution.
Social work can help people think about and give priority to what’s good in their lives: as Bywaters says:
manage the illness as well as they can,
manage everyday life (and relationships and support) as well as they can, and
plan for the future as well as they can.
Notice the ‘as well as they can’, it’s important. As you get frailer and a bit rickety, life may not be perfect but doing ‘as well as we can’ to make it better is a worthwhile contribution. Social workers helping with better plans, relationships and social links are worth it.
And I’ve talked about older adults and healthcare, but its just the same with young people and their teachers or youth workers, or families and their housing.
Bywaters, P. (1995). Assessing older people's health: What contributions from social work? Practice, 7(4), 31-42.