"Fix her for me, will you?"

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It seems like the general public’s perception of the social work profession is that we are around to solve everyone’s problems. I can’t tell you how many times a nurse has wandered into my office, handed me a patient’s file, rattled off a list of problems, and wandered back out. I don’t mean to be critical of nurses or of anyone else in these helping professions; Heaven knows we are all overworked and exhausted. But I am getting tired of the idea that I am the resident problem solver. This guy needs Medicaid, get it for him; this lady needs to stop spending her money on cat food and start spending it on medicine, make her do that (and get her the drugs she needs in the meantime); this family needs to pay their mortgage, get them the money. And be sure you do it by today because they might be dead by tomorrow.

I love the concept of Social Work. I love the idea of helping people acquire the resources they need to improve themselves. What I can’t figure out is how to navigate between coworkers expectations of “help” and a client’s idea of “help.” They are two different things.

Many people seem to think that a social worker is not doing a good job if a client still has a messy house, still lives alone, still has denial issues, still has an unpaid mortgage, etc, even whilst working with a social worker. What is not taken into account is the will of the person. I’ll happily help a client make arrangements for a housekeeper or a sitter, or I’ll help a client apply for financial assistance or Medicaid if they would like. But I can’t just go into their home and wave my magic wand and solve their problems for them. And even if I could, there is no section of the Social Work Code of Ethics that give us permission to use magical powers. If no one is in immediate danger, there is not reason to solve problems that clients don’t care about. On the contrary, social workers “enhance clients’ capacity and opportunity to change and to address their own needs.” (NASW Code of Ethics)

“Address their own needs.” Not address the needs that the nurses, the chaplain, or even the social worker think are important. But the client/family’s own needs. What has the client identified as important? What does she need help with? And what effort is she willing to make to get there? If I give her the resources and the support, can she give the effort? Those are some of the questions I ask myself when I am assessing a client.

Empowerment. Sometimes we forget this concept. Or maybe sometimes we think that to empower someone is to make them like us. To introduce them into our culture and our reality. To make them give high priority to the same things that we give high priority.

That doesn’t seem terribly effective.

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Posted in: hospice,social work ethics

Tis a puzzlement

So, here's an interesting tidbit. A patient of mine "Sally," was recently released from the nursing home rehab center after having surgery on her back. After her surgery, her family, which consists of a sister and some nieces and nephews really pushed for her to go into an assisted living home. Sally didn't want to leave the home that she owns and worked hard all her life for. So she went back to her home and has been under the care of our home health nurses for the last few weeks. Her nurse referred me to her after she started talking about how she doesn't have any food or money.

Sally is an interesting woman. She likes to have people take care of her, and she is very limited in what she can do, yet at the same time she insists that she does not need help. It's kind of a puzzlement to me. Sally was also very affluent in her earlier life, and she is used to having all kinds of luxuries that she does not have access to anymore. She is frustrated with herself for not being as independent as she used to be. Her family is frustrated with her for not listening to them and moving to an assisted living facility. Her nurses, occupational therapist, and I are all a little frustrated with the whole situation because she has a right to stay in her home if she chooses, but we can see how enhanced her quality of life would be if she chose instead to move to a place where she could get the care she needs. The nurses and therapists are ready to dscharge her, and once they are gone, I can't continue to see her. But I can't in good conscious leave her alone in her home with no assistnce or care. I don't think she'll realize how much help she really needs and make an effort to get it until we discharge her, but I don't feel good about discharging her until she has that help. But she won't ask for it until we're no longer making visits.

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Posted in: hospice,social work ethics