COVID-19 and the Social Work Response — The Need for Long-Term Solutions

By Dawn Whitten, DSW

The COVID-19 pandemic of 2020 has forever changed life as we know it here in the United States and around the world. Long-held traditions such as shaking hands and greetings of hugging and kissing have now become taboo. Entire countries have been shut down along with business and day-to-day activities. Sports events, weddings, religious gatherings, and practices have all been cancelled. Fear, panic, and loneliness are now daily occurrences for many individuals, groups, and communities. Life has changed and with it the climate of health care and behavioral health care in the United States has been forever altered. The new normal is upon us and many helping professions have had to learn how to assimilate swiftly and efficiently to serve their clients well.

Rethinking Service Delivery
Social workers in all areas of the profession have had to rethink service delivery options to accommodate a life in quarantine. Behavioral health has been thrust full throttle into telemental health in efforts to help clients cope with this significant life disruption. Urban hospitals and other urban settings have been incorporating telemental health services for some time now. Unfortunately, many rural community hospitals, extended care facilities (ECFs), and community agencies still rely heavily on traditional face-to-face consultation, evaluation, and treatment methods. Health care settings are experiencing extraordinary numbers of patient admissions, and with it escalating extended patient stays. These traditional methods have left them hastening to provide service to the surrounding communities. The following are just a few domains that have been impacted by the current health care emergency.

Extended Hospital Stays
The COVID-19 pandemic has forced helping agencies to reconsider their policies and procedures when faced with large community and worldwide crisis situations. Hospital social workers now have amplified discharge planning delays due to community agency requests for testing of potential clients/patients in need of their services. For example, ECFs are requiring that a new patient referral for their rehabilitation unit have two negative COVID-19 tests prior to admitting them to the facility. The fear is exposing their long-term residents to the virus. This request, however, has caused extended transfer delays in hospitals already taxed with increasing admission rates. Obtaining two negative COVID-19 tests can delay a transfer a minimum of 48 hours to seven days, depending on the facilities access to rapid testing services. These delays have caused significant gridlock in hospital settings.

Efforts to accommodate increasing patient admissions and alleviate gridlock has steered many urban hospitals to transfer patients temporarily to other hospitals to await a bed opening in an ECF for short-term rehabilitation. Extended hospital stays impact patient and family emotional well-being. Hospitals and ECFs have halted all visitation from family and friends, contributing to patient feelings of isolation, anxiety, and depression. Hospitals have rapidly developed alternative ways for patients and families to communicate. Many are relying on electronic means of communicating. FaceTime, Zoom, or some other form of video communication service are being utilized to help families feel connected to one another. There are entire teams being dedicated to identifying vulnerable patients and families in need of additional support. Many hospitals offer remote counseling services and guided meditation services for staff, patients, and families. New ideas and services are being generated daily to help individuals cope. Vulnerable populations are of great concern during this pandemic.

Protective Services and Vulnerable Populations
Protective service agencies for vulnerable populations such as children, families, and older adults have had to adapt to using personal protective equipment when providing service to their client populations. Many social workers required to enter community homes are now burdened with their own fears of infection and transmission of the virus to clients and loved ones. High-risk families are now especially volatile due to immense emotional strains on parents. The stress of homeschooling children and pressure to pay bills now that they are without work due to quarantine guidelines in many states have families struggling to maintain their emotional stability. Unfortunately, these additional social strains place increasing numbers of children at risk for abuse and neglect due to deterioration of parental mental health.

Likewise, the elder population is suffering from increased isolation from family and friends. Community gatherings are postponed, and even religious gatherings have halted. These socialization settings are what often keep this vulnerable population connected to the larger world. Adult children are now fearful of transmitting the virus to their parents, causing them to limit or eliminate visits. The quarantine has left older adults so isolated and disconnected from human contact that mental health and cognitive decline can be exacerbated. For many elders, there is a rise in somatic complaints, increasing their risk of self-medication with drugs such as opiates, benzodiazepines, and alcohol (National Institute on Alcohol Abuse and Alcoholism, 2013).

Alcohol Use/Homelessness
As a medical social worker, I have experienced increased hospital admissions for alcohol-related illness during this pandemic. This may not be the case in all facilities, but I suspect that other hospitals are also having similar experiences. Some liquor and package stores have remained open in some states because have been deemed essential. Quarantine has increased isolation and boredom for many individuals; for those with alcohol use disorder, this can contribute to escalating alcohol consumption and levels of frequency, particularly in older adults (National Institute on Aging, 2019). Studies have linked excessive alcohol and drug use to exacerbation of chronic medical conditions such as diabetes, gastrointestinal disorders, cardiac issues, and pulmonary illnesses (National Institute on Aging, 2018). The increase in substance use coupled with families quarantined together for extended periods of time has tipped the tolerance levels for many families.

I have experienced an increase in both inpatient and outpatient requests for treatment and resources. Some individuals have even been asked to leave the home as family members are no longer tolerating the behaviors associated with addiction. Individuals turn to the emergency departments nationwide for assistance. For those who agree to inpatient detoxification and/or rehabilitation, there is difficulty with finding facilities accepting new referrals, as again there is fear of bringing the virus into the treatment facility. These agencies are having extended stays as well, due to discharge planning issues. For instance, families refuse to have the individual with a substance use disorder return home, due to irreparable damage to the family unit. This often leaves the agency social workers with the task of finding housing for these individuals. In pre–COVID-19 days this could be a daunting task even on a good day. With an active pandemic, this task has become nearly impossible, again leading to extended stays. Shelters throughout the country are at capacity with displaced individuals. Many individuals experiencing homelessness are being placed in hotels/motels to maintain social distancing guidelines. Many communities have had to pass emergency legislation to accommodate this increase.

Long-Term Change
The COVID-19 pandemic has shed light on the inadequacies of our health care system and has compelled leaders to explore new alternatives in providing care. Policies and regulations that have long been the source of barriers of care are now being examined with vigilance. The traditional ways of conducting day-to-day work have forever been replaced by innovative approaches to care. Linking vulnerable populations to health care and mental health services has become a priority. Many professions that have traditionally been deemed nonessential have now attained essential status.

Social work is a profession that has historically experienced significant reductions in local and federal domains. The unique expertise and skills possessed by these helping professionals during this crisis have established a distinct demand for their unique services, acknowledgement, and respect. Social workers have been navigating new and innovative ways to provide care to individuals and communities for decades and we will continue to do so, pandemic or not.

The impact of the COVID-19 pandemic will have lasting effects for years to come. The hope is that health care leaders can come together and make long-lasting, positive changes to the way our nation provides health care and behavioral health services.

— Dawn Whitten, DSW, is a medical social worker at Sharon Hospital-Nuvance Health.

References
National Institute on Aging. (2018). Older adults and alcohol: You can get help. https://order.nia.nih.gov/sites/default/files/2018-01/older-adults-and-alcohol.pdf.

National Institute on Aging. (2019, April 23). Social isolation, loneliness in older people pose health risks. https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks.

National Institute on Alcohol Abuse and Alcoholism. (2013). Using alcohol to relieve your pain: What are the risks? https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/using-alcohol-to-relieve-your-pain.