By: Kanako Fukuyama
When COVID-19 hit Southern California, the Iyashi Care team modified the way we provide palliative care. Many patients, their caregivers, and families transitioned to virtual meetings and conversations with our staff. The experience so far has been both helpful and challenging.
Despite these new changes, to me, palliative care still remains in some ways the same: to help people ease their pain whether it’s physical or emotional. My role on the team as a social worker is to help ease the emotional pain, as well as to assist with other forms of support that the family and the patient need.
As a social worker on the team, I see this new shift caused by the virus outbreak as just one piece in a bigger puzzle of what care looks like for older adults accessing care through the Iyashi Care program.
Here is my typical day as a social worker:
I start my mornings by checking any messages and reading the overnight reports, which are taken from patients calling our call center during the previous night.
The Iyashi Care team huddle begins. This is currently a virtual meeting with the rest of the staff, which includes our doctors, nurses, other social workers, and a program manager. And this can be a really intense meeting to begin the day.
We review anywhere from four to eight patients each morning, discussing what’s happening and what changes we may need to make in order to update everyone’s care plan.
9:30 a.m. – 5:00 p.m.
Following the huddle, I check my schedule and make any follow-up phone calls that I make that day. Usually, I have 20 follow-up calls each week and they can vary from a routine check-in to a conversation with a new patient.
Here is one typical day:
9:30 – 10:00 a.m.
I called one patient’s daughter who was struggling to provide care for her parent. Assessing her situation, I suggested a private caregiver. At the end of the call, I gave her the list of culturally-sensitive caregiving agency list.
11:00 – 11:30 a.m.
I checked in with another patient who was feeling lonely due to COVID-19. This patient is in an assisted living facility and has not been visited by his children or grandchildren. I called to see how he is managing his difficult situation.
1:00 – 1:30 p.m.
I called another patient who may be at risk of isolation. I am calling this patient more frequently to check in due to COVID-19. She lives on her own, but she doesn’t go out because her local community center is closed right now. Through the call, I assess her stress level and look for signs of possible depression caused by isolation and keep close watch.
2:00 – 2:05 p.m.
I called a patient’s spouse to provide ongoing caregiving support as she cares for her husband who has advance dementia. She reported changes in husband’s sleeping patterns, appetite, and mood. I reported that to Iyashi Care nurse and doctor and was able to schedule a visit with the doctor to assess the decline.
2:30 – 3:15 p.m.
I called a recently enrolled patient’s husband regarding different levels of care that are available for the future if his wife’s condition worsens, and can no longer stay at home. Although they did not need it immediately, he was appreciative of the information so that he knows his options when needed.
3:30 – 4:00 p.m.
I handled a referral for the program. I contacted the family, listened to their situation, and assessed they will be eligible to enroll. I further explained the next steps such as getting a doctor’s referral.
4:15 – 4:45 p.m.
I called a patient with chronic pain to provide emotional support. During the conversation, she mentioned that she has not had bowel movement for a few days. I collaborated with the Iyashi Care nurse who then was able to call the patient to provide education on how to manage constipation.
During each call, I document the conversation. I also take this time to manage the referrals for the Iyashi Care program. I make the initial contact with the prospective patient or their family member and make sure we have everything we need for a first visit in order to enroll them into the program.
After making each call and documenting experiences for other Iyashi Care team members to review, I log off. After this point, calls directed to me will be received by our call center. The staff will then take these messages which will be reviewed by me the next morning.
This is the time when self-care is important. It could be exercise, meditation, or a hobby to help separate work from my personal life. In the past, I was always tense and tired. It took me a while to realize it was because I saw my patients in a lot of pain. I was feeling their pain and this made my job really difficult because I didn’t know how to unload their pain at the end of the day but still be compassionate. After some time though, I made effort to take care of myself and create a balance, trying to be more open minded and have a mindset of going with the flow.
My Job as a Social Worker on the Iyashi Care Team
During the Iyashi Care team huddle, each team member brings different perspective to each patient’s care plan. Medically-trained team members will cover our patient’s physical needs. Meanwhile, as a social worker, I will address their emotional needs, as well as anything else that a medical staff member may not look at.
For example, when we manage symptoms of pain from cancer, they will review and make recommendations for prescriptions or therapy. As a palliative care social worker, I look at the effects of the diagnosis on other aspects of their lives from relationships to their job and their mental health.
There is never one solution to helping someone. Instead, during a review, each patient is addressed individually with specific recommendations. Before COVID-19, I would schedule about one or two in-person follow-up appointments per day. Right now, follow-up appointments are made over Zoom or FaceTime, with each call taking anywhere from 30 minutes to an hour. The special occasions where I have to go in-person are limited, and safely done.
When it’s my time with a patient, their family, or caregiver, I listen to their personal challenges and experiences, on how health concerns make them feel and how they affect them in other areas of their lives. This helps to see the full situation, and listen to what they’re struggling with and then try and see what their true needs are.
For some patients, just being present and listening to them is helpful. Sometimes a patient, a caregiver, or a family member just needs validation, or someone acknowledging that they are doing and trying their best. As a social worker, I also identify the resources and services that they might or could benefit from and connect them to what’s available. These recommendations can range from how to find a caregiver, a family lawyer, travel services, or meal assistance.
Overall, my role and goal I feel is to give patients and their family members a peace of mind, to let them know that I’m available to give them what they need, like resources, that they find it as helpful.
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