The critical role of social workers in home-based primary care.
The growing homebound population has many complex biomedical and psychosocial needs and requires a team-based approach to care (Smith, Ornstein, Soriano, Muller, & Boal, 2006). The Mount Sinai Visiting Doctors Program (MSVD), a large interdisciplinary home-based primary care program in New York City, has a vibrant social work program that is integrated into the routine care of homebound patients. We describe the assessment process used by MSVD social workers, highlight examples of successful social work care, and discuss why social workers' individualized care plans are essential for keeping patients with chronic illness living safely in the community. Despite barriers to widespread implementation, such social work involvement within similar home-based clinical programs is essential in the interdisciplinary care of our most needy patients.
a Icahn School of Medicine, Mount Sinai , New York , New York , USA.
Jennifer M
JM
Reckrey
Gabrielle
G
Gettenberg
Helena
H
Ross
Victoria
V
Kopke
Theresa
T
Soriano
Katherine
K
Ornstein
D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D006233:Persons with Disabilities; D006699:Home Care Services / Q000458:organization & administration* / Q000592:standards; D018577:Homebound Persons; D006801:Humans; D009519:New York City; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*; D024382:Professional Role; D012017:Referral and Consultation; D012947:Social Work / Q000379:methods / Q000458:organization & administration*