This article was reproduced with permission from the authors. Original article from geriatric-ed.com.
Rebecca is a social worker at Mount Sinai Emergency Department. 40% of her clients are 65 and older. She is an important part of the interdisciplinary team of our senior-friendly emergency department.
The first time Rebecca Detje heard about geriatric emergency medicine was when she was working in the in-patient unit. She started receiving patients from the ED with incredible GEM nurse notes. “Those notes were the best! Insightful notes! I wished that all my patients would have seen a GEM nurse prior to seeing me because I would understand them a lot better”.
This gave her a small flavour of what was going on in the ED in terms of geriatric care.
Geriatrics was always a personal interest of hers and she specialized in it at school. For all those reasons, she ended up working in the ED and is now an active member of the geriatric interdisciplinary team. In the ED, a social worker has different hats. They do a lot in terms of resources counselling, application to rehabilitation, work with caregiver distresses, managing mental health and addiction issues and very unique situational crisis.
“For example, their own life falling apart, services not being put in place properly, acute change in their functional status, seniors evicted from their home and now homeless, primary caregiver’s death, etc.”
Social workers have a very strong resources counselling focus and that is what they bring to the table. Rebecca brings support to the patient and their family by connecting them with different useful resources but also to help them navigate the system.
“Not that this is unique to social work but it is complimentary to the team so other professionals can do their job”.
How do they know keep up with the knowledge of the community services? You build it over time, you make the connection, you share with colleagues inside and outside the hospital, you use Google! She wants to make sure that everybody has access to the same thing.
A social worker can have a great impact on the geriatric population. When they come in the ED, they are often lost and stressed about whatever is going on with them. In these circumstances, Rebecca is a great help for counselling and reassuring by talking to them on their own level. She is a guide to help them navigate the health care system and the community services.
Although her work task is broad, she wishes to do more. One thing that is critical in geriatric care and that the actual health care system does not encounter enough is future planning. Medicine, and especially emergency medicine is reactive to the acute issue.
“I feel like there is some room to expand our prevention care by counselling families about the trajectory of an illness, or things to expect, what are the next steps, making preparation for what is down the line that may help prevent emergency visits and readmission”.
It is true. Patients often end up in the ED because they do not know where else to go and it would be ideal to be more proactive in terms of health promotion and education in the community.
Here is a success story of hers:
“It was a couple. Unfortunately, the wife, who was the primary caregiver for her husband with advanced Alzheimer, had a fall, broke her ankle and needed surgery. The EMS made a right call by bringing in the husband who could not be left behind. My role was to help them to figure out a plan that aligned with their wishes and the acute situation crisis. We ended up coordinating 24-hour care for the husband at home while she was recovering from her injuries with peace in mind. It took us 2 full days of organization but this was the right thing to do for both of them — and ultimately avoided an admission.”
Rebecca is obviously passionate about her work. “It is really fulfilling to get a chance to talk to this population. I love hearing the stories, there is so much variety! I feel like they have a diversity in knowledge and experience and it is a real pleasure to help them. I find it very rewarding”.