When patients with COVID-19 began arriving, Michigan Medicine social workers moved quickly to adapt. Here’s how they helped patients

By Audrey I. Houttekier, LMSW, C-ASWCM and Gariann Brock, LMSW, ACSW, C-ASWCM

Care Management Social Work at Michigan Medicine provides inpatient clinical social work and discharge planning services in inpatient, observation, and emergency settings for pediatric and adult patients of Michigan Medicine.

The challenge of COVID-19 has presented new needs for patients who are positive for the novel coronavirus which social workers have been uniquely skilled to address.  The past four weeks have been a journey of creating new best practices, increased workloads, and challenges of balancing individual anxieties and fears of social workers working on the front line.

In mid-March, Michigan Medicine began admitting its first COVID-19 positive patients.  With this, three volunteer Master’s Prepared Social Workers volunteered to staff our 50-bed Regional Infectious Containment Unit (RICU).  These social workers partnered with local public health departments, Michigan Medicine’s Infection Prevention and Epidemiology (IPE) Consult Team and provider and nursing teams to create and implement best practices in the care of patients hospitalized at Michigan Medicine with COVID-19.

These practices were implemented and expanded to the broader team of 65 Care Management Social Workers at Michigan Medicine, allowing them to provide consistent and high-quality care to all COVID-19 patients bedded in any unit within our health system.

Social workers key in working with COVID-19 patients, families to get vital information

Maintaining safety in many health systems during the COVID-19 pandemic includes restricting visitors from coming to the hospital to be with their loved ones. When a patient arrives to the hospital without family, ensuring medical decision making is clearly assessed and documented is imperative to the medical team’s ability to provide efficient and patient-centered care.

Since many patients with the novel coronavirus struggle with shortness of breath, sometimes requiring intubation and sedation, the social worker is key in working with the patient and family to obtain family contact information, assess whether the patient has an advocate, and document this assessment in the medical record.  Care Management Social Work at Michigan Medicine has successfully established this documentation within the first 24-48 hours of admission for COVID-19 Patients.

Partnerships were also created with our Office of the General Counsel’s legal team to ensure a method to document and complete the appointments of a surrogate decision makers without the need for physically witnessing/signing a paper document, as this would break isolation precautions. This has been a highly valued and efficacious process for the provider teams and nursing staff caring for COVID-19 patients as the usual method of updating families and advocates at the bedside is not possible.

After hospitalization, social workers keep patients on road to recovery

Through the highly skilled clinical care of Michigan Medicine providers and nurses, many patients successfully recover from their hospitalizations and discharge home to the community.  This presents several logistical challenges for patients in quarantine: How will they pick up their medications? Do they have food in their house? Should they go to the grocery store if they are contagious? If their family members are also ill, or if they do not have family, how do they get home from the hospital?

Care Management Social Workers begin planning for the answers to these questions with patients and families at the beginning of admission.  These are often questions that many patients and families may not think to consider in the midst of the crisis of being diagnosed. Care Management Social Workers also connect with patients the day prior or day of discharge to ensure that patients and families have been able to find answers to these questions.

Some of our most vulnerable patients do not have the supports necessary to successfully quarantine and provide for themselves at home post hospitalization. For these patients, Care Management Social Work has partnered with local public health departments across many counties as well as with community service organizations and medical transportation providers to help patients obtain groceries, discharge transportation, medications, and housing.  For the homeless population, partnerships have been created through the Departments of Public Health and local hotels to provide temporary food, lodging, and basic needs to patients needing to quarantine. Helping individuals experiencing homelessness to safely quarantine limits further community spread and increases the likelihood of positive health outcomes.

Bereavement Support

Sadly, some patients do not survive COVID-19.  Social workers are highly skilled in providing compassionate and empathic end-of-life care and these skills shine in times of crisis.  Visitor restrictions mean that many patients may die alone, without family present, or even without family having the opportunity to say their goodbyes.

Care Management Social Workers collaborate with families and medical teams to assess who in the family is symptom free and able to visit at end of life.  If families are unable to visit, social workers attempt to work with nursing and families to arrange for virtual connections through phone calls, FaceTime, or Skype to provide closure and sense of connection in these times of social distancing.  Social workers provide bereavement support to patients and families as well as psychoeducation regarding funeral arrangements and after death processes, ensuring families are able to navigate the final steps of caring for their loved ones after their passing.

When our normal rituals of mourning and community have been dismantled, complicated grief is also something that social workers are uniquely attuned to assess. Care Management Social Workers’ role at end of life strives to mitigate the incidence of complicated grief, and to provide resources to families for supports in the community.

During this time when Michigan Medicine has been adapting to the needs of a new population of patients experiencing the novel coronavirus, the innovation, dedication, and tireless work of Care Management Social Workers has made significant and lasting impacts on the patient care experience for those with COVID-19 and their families. This group of social workers has risen to the challenge of meeting the unique needs of this population as well as caring for themselves and one another during these unprecedented times.

Michigan Medicine is proud of the Care Management Social Workers and all our clinical staff in this time of crisis.  Hail to the front line.

For resources, visit the National Association of Social Workers’ Coronavirus Disease (COVID-19) webpage.